Developing a general conceptual framework for avian conservation science

USGS Publications Warehouse

Sauer, J.R.

2003-01-01

Avian conservation science in North America has produced a variety of monitoring programs designed to provide information on population status of birds. Waterfowl surveys provide population estimates for breeding ducks over most of the continent, the North American Breeding Bird Survey (BBS) provides indexes to population change for >400 breeding bird species, and many other surveys exist that index bird populations at a variety of scales and seasons. However, many fundamental questions about bird population change remain unanswered. I suggest that analyses of monitoring data provide limited understanding of causes of population change, and that the declining species paradigm (Caughley 1994) is sometimes an inefficient approach to increasing our understanding of causes of population change. In North America, the North American Bird Conservation Initiative (NABCI) provides an opportunity to implement alternative approaches that use management, modeling of population responses to management, and monitoring in combination to increase our understanding of bird populations. In adaptive resources management, modeling provides predictions about consequences of management, and monitoring data allow us to assess the population consequences of management. In this framework, alternative hypotheses about response of populations to management can be evaluated by formulating a series of models with differing structure, and management and monitoring provide information about which model best predicts population response.

Modeling a Civil Event Case Study for Consequence Management Using the IMPRINT Forces Module

NASA Technical Reports Server (NTRS)

Gacy, Marc; Gosakan, Mala; Eckdahl, Angela; Miller, Jeffrey R.

2012-01-01

A critical challenge in the Consequence Management (CM) domain is the appropriate allocation of necessary and skilled military and civilian personnel and materiel resources in unexpected emergencies. To aid this process we used the Forces module in the Improved Performance Research Integration Tool (IMPRINT). This module enables analysts to enter personnel and equipment capabilities, prioritized schedules and numbers available, along with unexpected emergency requirements in order to assess force response requirements. Using a suspected terrorist threat on a college campus, we developed a test case model which exercised the capabilities of the module, including the scope and scale of operations. The model incorporates data from multiple sources, including daily schedules and frequency of events such as fire calls. Our preliminary results indicate that the model can predict potential decreases in civilian emergency response coverage due to an involved unplanned incident requiring significant portions of police, fire and civil responses teams.

Guidance for Facilities on Risk Management Programs (RMP)

EPA Pesticide Factsheets

Includes supplemental guidance specific to ammonia refrigeration, wastewater treatment, propane storage, warehouses, chemical distributors, offsite consequence analysis, retail agriculture, applicability of program levels, prevention, emergency response.

EVALUATING HYDROLOGICAL RESPONSE TO FORECASTED LAND-USE CHANGE: SCENARIO TESTING WITH THE AUTOMATED GEOSPATIAL WATERSHED ASSESSMENT TOOL

EPA Science Inventory

Studies of future management and policy options based on different assumptions provide a mechanism to examine possible outcomes and especially their likely benefits or consequences. Planning and assessment in land and water resource management are evolving toward complex, spatia...

Plant and soil consequences of shrub management in a big sagebrush-dominated rangeland ecosystem

USDA-ARS?s Scientific Manuscript database

Soil organic carbon (SOC) responses to shrub management in western US rangelands, especially those dominated by Wyoming big sagebrush (Artemisia tridentata Nutt. ssp. wyomingensis Beetle & Young) in low rainfall areas (<300 mm), remains a major knowledge gap. We sampled vegetation and soils in 2009 ...

2013 Consequence Management Advisory Team (CMAT) Annual Report

EPA Pesticide Factsheets

Chemical, Biological, Radiological and Nuclear CMAT reviews use of data tools such as Airborne Spectral Photometric Environmental Collection Technology, new sampling and decontamination techniques, new response technologies, and improvement potential.

Financial management services in consumer-directed programs.

PubMed

Scherzer, Teresa; Wong, Alice; Newcomer, Robert

2007-01-01

Shifting from an agency-based model of personal assistance services to consumer direction has important consequences for both recipients and workers. In consumer direction, recipients assume the responsibilities of employing their attendants--for both self-directing their supportive services and being responsible for numerous fiscal responsibilities. Many states have eased these fiscal responsibilities among recipients in publicly financed personal care programs by using Financial Management Services (also known as fiscal intermediaries). This article introduces the major types of Financial Management Services organizations used by Medicaid consumer-directed personal care programs, and examines the extent to which the varied approaches can and do serve the needs of both recipients and workers. Despite the expansion of consumer-directed programs and the accompanying emergence of Financial Management Services, these organizations have not been extensively studied or evaluated. The paper concludes with a discussion of the challenges, opportunities, and policy implications of the current practice; and suggests directions for future research.

A coupled modeling approach to assess the impact of fuel treatments on post-wildfire runoff and erosion

USDA-ARS?s Scientific Manuscript database

The hydrological consequences of wildfires are some of the most significant and long-lasting effects. Since wildfire severity impacts post-fire hydrological response, fuel treatments can be a useful tool for land managers to moderate this response. However, current models focus on only one aspect of...

Gender and Workplace Bullying: Men's Experiences of Surviving Bullying at Work.

PubMed

O'Donnell, Sue M; MacIntosh, Judith A

2016-02-01

Although men are targets of workplace bullying, there is limited research focused on their experiences. To address this gap, we used a qualitative grounded theory approach and interviewed a community sample of 20 Atlantic Canadian men to explore and explain their experiences of, and responses to, bullying. The main problem identified by men was a lack of workplace support to address and resolve the bullying, a challenge named abandonment. Men addressed this problem by surviving, a process that involved efforts to manage persistent bullying and the associated consequences. Men experienced physical, emotional, and social health consequences and, contrary to prevailing assumptions related to men's help-seeking behaviors, men want support and many sought help to address the problem and its consequences. Responses to abandonment and the associated consequences varied according to a number of factors including gender and highlight the need for research aimed at understanding the gendered nature of bullying. © The Author(s) 2015.

2016 Consequence Management Advisory Division's (CMAD) Annual Report

EPA Pesticide Factsheets

CMAD annual report for 2016 which covers activities such as radiation task force leaders annual training, national criminal enforcement response team annual training, field technology demonstrations, and a new method to detect perfluorinated compounds.

The Tokaimura Nuclear Accident: A Tragedy of Human Errors.

ERIC Educational Resources Information Center

Ryan, Michael E.

2001-01-01

Discusses nuclear power and the consequences of a nuclear accident. Covers issues ranging from chemical process safety to risk management of chemical industries to the ethical responsibilities of the chemical engineer. (Author/ASK)

Can we manage for biological diversity in the absence of science?

USGS Publications Warehouse

Trauger, D.L.; Hall, R.J.

1995-01-01

Conservation of biological diversity is dependent on sound scientific information about underlying ecological processes. Current knowledge of the composition, distribution, abundance and life cycles of most species of plants and animals is incomplete, insufficient, unreliable, or nonexistent. Contemporary managers are also confronted with additional levels of complexity related to varying degrees of knowledge and understanding about interactions of species and ecosystems. Consequently, traditional species-oriented management schemes may have unintended consequences and ecosystem-oriented management initiatives may fail in the face of inadequate or fragmentary information on the structure, function, and dynamics of biotic communities and ecological systems. Nevertheless, resource managers must make decisions and manage based on the best biological information currently available. Adaptive resource management may represent a management paradigm that allows managers to learn something about the species or systems that they are managing while they are managing, but potential pitfalls lurk for such approaches. In addition to lack of control over the primary physical, chemical, and ecological processes, managers also lack control over social, economic, and political parameters affecting resource management options. Moreover, appropriate goals may be difficult to identify and criteria for determining success may be elusive. Some management responsibilities do not lend themselves to adaptive strategies. Finally, the lessons learned from adaptive management are usually obtained from a highly situational context that may limit applicability in a wider range of situations or undermine confidence that problems and solutions were properly diagnosed and addressed. Several scenarios are critically examined where adaptive management approaches may be inappropriate or ineffective and where management for biological diversity may be infeasible or inefficient without a sound scientific basis. Whereas some level of management must exist to meet agency responsibilities, more research is needed to conserve biological diversity.

Evolutionary impact assessment: accounting for evolutionary consequences of fishing in an ecosystem approach to fisheries management.

PubMed

Laugen, Ane T; Engelhard, Georg H; Whitlock, Rebecca; Arlinghaus, Robert; Dankel, Dorothy J; Dunlop, Erin S; Eikeset, Anne M; Enberg, Katja; Jørgensen, Christian; Matsumura, Shuichi; Nusslé, Sébastien; Urbach, Davnah; Baulier, Loїc; Boukal, David S; Ernande, Bruno; Johnston, Fiona D; Mollet, Fabian; Pardoe, Heidi; Therkildsen, Nina O; Uusi-Heikkilä, Silva; Vainikka, Anssi; Heino, Mikko; Rijnsdorp, Adriaan D; Dieckmann, Ulf

2014-03-01

Managing fisheries resources to maintain healthy ecosystems is one of the main goals of the ecosystem approach to fisheries (EAF). While a number of international treaties call for the implementation of EAF, there are still gaps in the underlying methodology. One aspect that has received substantial scientific attention recently is fisheries-induced evolution (FIE). Increasing evidence indicates that intensive fishing has the potential to exert strong directional selection on life-history traits, behaviour, physiology, and morphology of exploited fish. Of particular concern is that reversing evolutionary responses to fishing can be much more difficult than reversing demographic or phenotypically plastic responses. Furthermore, like climate change, multiple agents cause FIE, with effects accumulating over time. Consequently, FIE may alter the utility derived from fish stocks, which in turn can modify the monetary value living aquatic resources provide to society. Quantifying and predicting the evolutionary effects of fishing is therefore important for both ecological and economic reasons. An important reason this is not happening is the lack of an appropriate assessment framework. We therefore describe the evolutionary impact assessment (EvoIA) as a structured approach for assessing the evolutionary consequences of fishing and evaluating the predicted evolutionary outcomes of alternative management options. EvoIA can contribute to EAF by clarifying how evolution may alter stock properties and ecological relations, support the precautionary approach to fisheries management by addressing a previously overlooked source of uncertainty and risk, and thus contribute to sustainable fisheries.

Evolutionary impact assessment: accounting for evolutionary consequences of fishing in an ecosystem approach to fisheries management

PubMed Central

Laugen, Ane T; Engelhard, Georg H; Whitlock, Rebecca; Arlinghaus, Robert; Dankel, Dorothy J; Dunlop, Erin S; Eikeset, Anne M; Enberg, Katja; Jørgensen, Christian; Matsumura, Shuichi; Nusslé, Sébastien; Urbach, Davnah; Baulier, Loїc; Boukal, David S; Ernande, Bruno; Johnston, Fiona D; Mollet, Fabian; Pardoe, Heidi; Therkildsen, Nina O; Uusi-Heikkilä, Silva; Vainikka, Anssi; Heino, Mikko; Rijnsdorp, Adriaan D; Dieckmann, Ulf

2014-01-01

Managing fisheries resources to maintain healthy ecosystems is one of the main goals of the ecosystem approach to fisheries (EAF). While a number of international treaties call for the implementation of EAF, there are still gaps in the underlying methodology. One aspect that has received substantial scientific attention recently is fisheries-induced evolution (FIE). Increasing evidence indicates that intensive fishing has the potential to exert strong directional selection on life-history traits, behaviour, physiology, and morphology of exploited fish. Of particular concern is that reversing evolutionary responses to fishing can be much more difficult than reversing demographic or phenotypically plastic responses. Furthermore, like climate change, multiple agents cause FIE, with effects accumulating over time. Consequently, FIE may alter the utility derived from fish stocks, which in turn can modify the monetary value living aquatic resources provide to society. Quantifying and predicting the evolutionary effects of fishing is therefore important for both ecological and economic reasons. An important reason this is not happening is the lack of an appropriate assessment framework. We therefore describe the evolutionary impact assessment (EvoIA) as a structured approach for assessing the evolutionary consequences of fishing and evaluating the predicted evolutionary outcomes of alternative management options. EvoIA can contribute to EAF by clarifying how evolution may alter stock properties and ecological relations, support the precautionary approach to fisheries management by addressing a previously overlooked source of uncertainty and risk, and thus contribute to sustainable fisheries. PMID:26430388

Beliefs About Dysmenorrhea and Their Relationship to Self-Management.

PubMed

Chen, Chen X; Kwekkeboom, Kristine L; Ward, Sandra E

2016-08-01

Dysmenorrhea is highly prevalent and is the leading cause of work and school absences among women of reproductive age. However, self-management of dysmenorrhea is not well understood in the US, and little evidence is available on factors that influence dysmenorrhea self-management. Guided by the Common Sense Model, we examined women's representations of dysmenorrhea (beliefs about causes, symptoms, consequences, timeline, controllability, coherence, and emotional responses), described their dysmenorrhea self-management behaviors, and investigated the relationship between representations and self-management behaviors. We conducted a cross-sectional, web-based survey of 762 adult women who had dysmenorrhea symptoms in the last six months. Participants had varied beliefs about the causes of their dysmenorrhea symptoms, which were perceived as a normal part of life. Dysmenorrhea symptoms were reported as moderately severe, with consequences that moderately affected daily life. Women believed they understood their symptoms moderately well and perceived them as moderately controllable but them to continue through menopause. Most women did not seek professional care but rather used a variety of pharmacologic and complementary health approaches. Care-seeking and use of self-management strategies were associated with common sense beliefs about dysmenorrhea cause, consequences, timeline, and controllability. The findings may inform development and testing of self-management interventions that address dysmenorrhea representations and facilitate evidence-based management. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

RMP Guidance for Warehouses - Table of Contents

EPA Pesticide Factsheets

This Risk Management Program (40 CFR Part 68) Guidance is organized into chapters, each covering a topic such as applicability of the rule, requirements for the five-year accident history and offsite consequence analysis, and emergency response.

Defending Against Biological and Chemical Attacks

DTIC Science & Technology

2010-08-01

addition, we field integrated installation consequence management response capabilities to select installations both at home and abroad. Just as...decon- tamination, like self-decontaminating or strippable coat- ings for vehicles; we are developing technologies to focus decontamination on the

Forest carbon estimation using the Forest Vegetation Simulator: Seven things you need to know

Treesearch

Coeli M. Hoover; Stephanie A. Rebain

2011-01-01

Interest in options for forest-related greenhouse gas mitigation is growing, and so is the need to assess the carbon implications of forest management actions. Generating estimates of key carbon pools can be time consuming and cumbersome, and exploring the carbon consequences of management alternatives is often a complicated task. In response to this, carbon reporting...

Forest fire management to avoid unintended consequences: a case study of Portugal using system dynamics.

PubMed

Collins, Ross D; de Neufville, Richard; Claro, João; Oliveira, Tiago; Pacheco, Abílio P

2013-11-30

Forest fires are a serious management challenge in many regions, complicating the appropriate allocation to suppression and prevention efforts. Using a System Dynamics (SD) model, this paper explores how interactions between physical and political systems in forest fire management impact the effectiveness of different allocations. A core issue is that apparently sound management can have unintended consequences. An instinctive management response to periods of worsening fire severity is to increase fire suppression capacity, an approach with immediate appeal as it directly treats the symptom of devastating fires and appeases the public. However, the SD analysis indicates that a policy emphasizing suppression can degrade the long-run effectiveness of forest fire management. By crowding out efforts to preventative fuel removal, it exacerbates fuel loads and leads to greater fires, which further balloon suppression budgets. The business management literature refers to this problem as the firefighting trap, wherein focus on fixing problems diverts attention from preventing them, and thus leads to inferior outcomes. The paper illustrates these phenomena through a case study of Portugal, showing that a balanced approach to suppression and prevention efforts can mitigate the self-reinforcing consequences of this trap, and better manage long-term fire damages. These insights can help policymakers and fire managers better appreciate the interconnected systems in which their authorities reside and the dynamics that may undermine seemingly rational management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

General RMP Guidance - Chapter 11: Communication with the Public

EPA Pesticide Factsheets

CAA requires that Risk Management Plans and offsite consequence analysis be made available to the public, so you should be prepared to discuss them with the press, Local Emergency Planning Committees, State Emergency Response Commissions, and others.

An Examination of Cultural Influences on Team Cognition and Information Sharing in Emergency Crisis Management Domains: A Mixed Methodological Approach

ERIC Educational Resources Information Center

Endsley, Tristan Caroline

2016-01-01

The consequence for better understanding and facilitating teamwork during crisis and disaster response in the coming years is significant. It becomes clear that environmental and situational complexity requires a reliance on teams to carry out response efforts. Crises, regardless of the type of event, require complex decision-making and planning…

Fuels planning: science synthesis and integration; environmental consequences fact sheet 10: The Understory Response Model

Treesearch

Steve Sutherland; Melanie Miller

2005-01-01

The Understory Response Model is a species-specific computer model that qualitatively predicts change in total species biomass for grasses, forbs, and shrubs after thinning, prescribed fire, or wildfire. The model examines the effect of fuels management on plant survivorship and reproduction. This fact sheet identifies the intended users and uses, required inputs, what...

Strategy for Homeland Defense and Defense Support of Civil Authorities

DTIC Science & Technology

2013-02-01

1 As defined by “Sustaining U.S. Global Leadership : Priorities for the 21st Century Defense,” January...and nuclear (CBRN) consequence management response forces in recognition of the proliferation of destructive technologies and the potent ideologies...the wake of Hurricane Katrina. Although DoD is always in a support role to civilian authorities (primarily the Federal Emergency Management Agency, or

Should pediatric neurosurgeons still manage neurotrauma today?

PubMed

Peter, Jonathan C

2010-02-01

Neurotrauma remains a major global burden of injury, especially for young patients, and will consequently always be a condition that pediatric neurosurgeons are called upon to treat. However, the face of modern neurotrauma management is changing, presenting important challenges to today's pediatric neurosurgeons. This article summarizes some of the issues in neurotrauma facing clinicians whose responsibility it is to treat these children. It is up to the individual neurosurgeon to familiarize him- or herself with the emerging literature on the modern management of pediatric neurotrauma.

The social media manifesto: a comprehensive review of the impact of social media on emergency management.

PubMed

Crowe, Adam

2011-02-01

Over the past five years, social media have impacted emergency management and disaster response in numerous ways. The emergency management professional must begin to accept this impact not as an arbitrary consequence of an uncontrolled disaster, but rather as a tool to help coordinate, manage and facilitate a safe and expected response during emergencies and disasters. This paper will explain the power and purpose of social media as well as how social media systems have equalised capabilities for all levels and sizes of government. Moreover, this paper will also highlight the social media systems that are being used as operational tools as well as what the future holds. Lastly, common implementation challenges will be discussed through a look at systematic approaches to applying social media in emergency management as a positive and valuable tool.

Characterizing driver-response relationships in marine pelagic ecosystems for improved ocean management.

PubMed

Hunsicker, Mary E; Kappel, Carrie V; Selkoe, Kimberly A; Halpern, Benjamin S; Scarborough, Courtney; Mease, Lindley; Amrhein, Alisan

2016-04-01

Scientists and resource managers often use methods and tools that assume ecosystem components respond linearly to environmental drivers and human stressors. However, a growing body of literature demonstrates that many relationships are-non-linear, where small changes in a driver prompt a disproportionately large ecological response. We aim to provide a comprehensive assessment of the relationships between drivers and ecosystem components to identify where and when non-linearities are likely to occur. We focused our analyses on one of the best-studied marine systems, pelagic ecosystems, which allowed us to apply robust statistical techniques on a large pool of previously published studies. In this synthesis, we (1) conduct a wide literature review on single driver-response relationships in pelagic systems, (2) use statistical models to identify the degree of non-linearity in these relationships, and (3) assess whether general patterns exist in the strengths and shapes of non-linear relationships across drivers. Overall we found that non-linearities are common in pelagic ecosystems, comprising at least 52% of all driver-response relation- ships. This is likely an underestimate, as papers with higher quality data and analytical approaches reported non-linear relationships at a higher frequency (on average 11% more). Consequently, in the absence of evidence for a linear relationship, it is safer to assume a relationship is non-linear. Strong non-linearities can lead to greater ecological and socioeconomic consequences if they are unknown (and/or unanticipated), but if known they may provide clear thresholds to inform management targets. In pelagic systems, strongly non-linear relationships are often driven by climate and trophodynamic variables but are also associated with local stressors, such as overfishing and pollution, that can be more easily controlled by managers. Even when marine resource managers cannot influence ecosystem change, they can use information about threshold responses to guide how other stressors are managed and to adapt to new ocean conditions. As methods to detect and reduce uncertainty around threshold values improve, managers will be able to better understand and account for ubiquitous non-linear relationships.

Combating terrorism : federal response teams provide varied capabilities; opportunities remain to improve coordination

DOT National Transportation Integrated Search

2000-01-01

The General Accounting Office (GAO) was asked to review federal agency teams that can respond to and help manage the consequences of a domestic terrorist incident involving chemical, biological, radiological, or nuclear agents or weapons. This report...

Creating a Healthy Organizational Climate.

ERIC Educational Resources Information Center

Bolding, James T.; Van Patten, James J.

1982-01-01

Four areas of college management responsibility are reviewed: the mission of the organization; administrator/faculty relationship; individual stress; and measuring organizational health. According to Argyris (1980) an organization updates its goals (1) as a consequence of detecting and solving routine problems, and (2) through periodical…

The clinical management of diabetic foot in the elderly and medico-legal implications.

PubMed

Terranova, Claudio; Bruttocao, Andrea

2013-10-01

Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.

Potential Standards and Methods for the National Guard’s Homeland Response Force

DTIC Science & Technology

2011-09-01

rapidly determine a missile launch and probable impact area ( Opall -Rome, 2009). Since 2006, Color Red coverage has expanded throughout the country...Manportable Air Defense (MANPAD) systems, land mines , advanced communication systems, mortars, unmanned air systems (UAS), frequency-hopping...Consequence Management Response Force (CCMRF). Internal document. Opall -Rome, B. (2009, January19). In Israel: Anti-sniper gear spots rockets

Managing Records for the Long Term - 12363

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

Montgomery, John V.; Gueretta, Jeanie

The U.S. Department of Energy (DOE) is responsible for managing vast amounts of information documenting historical and current operations. This information is critical to the operations of the DOE Office of Legacy Management. Managing legacy records and information is challenging in terms of accessibility and changing technology. The Office of Legacy Management is meeting these challenges by making records and information management an organizational priority. The Office of Legacy Management mission is to manage DOE post-closure responsibilities at former Cold War weapons sites to ensure the future protection of human health and the environment. These responsibilities include environmental stewardship andmore » long-term preservation and management of operational and environmental cleanup records associated with each site. A primary organizational goal for the Office of Legacy Management is to 'Preserve, Protect, and Share Records and Information'. Managing records for long-term preservation is an important responsibility. Adequate and dedicated resources and management support are required to perform this responsibility successfully. Records tell the story of an organization and may be required to defend an organization in court, provide historical information, identify lessons learned, or provide valuable information for researchers. Loss of records or the inability to retrieve records because of poor records management processes can have serious consequences and even lead to an organisation's downfall. Organizations must invest time and resources to establish a good records management program because of its significance to the organization as a whole. The Office of Legacy Management will continue to research and apply innovative ways of doing business to ensure that the organization stays at the forefront of effective records and information management. DOE is committed to preserving records that document our nation's Cold War legacy, and the Office of Legacy Management will keep records management as a high priority. (authors)« less

Effects of performance measure implementation on clinical manager and provider motivation.

PubMed

Damschroder, Laura J; Robinson, Claire H; Francis, Joseph; Bentley, Douglas R; Krein, Sarah L; Rosland, Ann-Marie; Hofer, Timothy P; Kerr, Eve A

2014-12-01

Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. Next steps include working with VHA leaders to develop and test implementation approaches to help ensure that the next generation of PMs motivate truly patient-centered care and are clinically meaningful.

Meeting the challenge of interacting threats in freshwater ecosystems: A call to scientists and managers

USGS Publications Warehouse

Craig, Laura S.; Olden, Julian D.; Arthington, Angela; Entrekin, Sally; Hawkins, Charles P.; Kelly, John J.; Kennedy, Theodore A.; Maitland, Bryan M.; Rosi, Emma J.; Roy, Allison; Strayer, David L.; Tank, Jennifer L.; West, Amie O.; Wooten, Matthew S.

2017-01-01

Human activities create threats that have consequences for freshwater ecosystems and, in most watersheds, observed ecological responses are the result of complex interactions among multiple threats and their associated ecological alterations. Here we discuss the value of considering multiple threats in research and management, offer suggestions for filling knowledge gaps, and provide guidance for addressing the urgent management challenges posed by multiple threats in freshwater ecosystems. There is a growing literature assessing responses to multiple alterations, and we build off this background to identify three areas that require greater attention: linking observed alterations to threats, understanding when and where threats overlap, and choosing metrics that best quantify the effects of multiple threats. Advancing science in these areas will help us understand existing ecosystem conditions and predict future risk from multiple threats. Because addressing the complex issues and novel ecosystems that arise from the interaction of multiple threats in freshwater ecosystems represents a significant management challenge, and the risks of management failure include loss of biodiversity, ecological goods, and ecosystem services, we also identify actions that could improve decision-making and management outcomes. These actions include drawing insights from management of individual threats, using threat attributes (e.g., causes and spatio-temporal dynamics) to identify suitable management approaches, testing management strategies that are likely to be successful despite uncertainties about the nature of interactions among threats, avoiding unintended consequences, and maximizing conservation benefits. We also acknowledge the broadly applicable challenges of decision-making within a socio-political and economic framework, and suggest that multidisciplinary teams will be needed to innovate solutions to meet the current and future challenge of interacting threats in freshwater ecosystems. 

Development of a Model of Soldier Effectiveness: Retranslation Materials and Results

DTIC Science & Technology

1987-05-01

covering financial responsibility, particularly the family checking account . Consequent- ly, the bad check rate for the unit drop- ped from 70 a month...Alcohol, and Aggressive Acts " Showing prudence in financial management and responsibility in personal/family matters; avoiding alcohol and other drugs or...threatening others, etc. versus " Acting irresponsibly in financial or personal/family affairs such that command time is required to counsel or otherwise

The toxicology and immunology of detergent enzymes.

PubMed

Basketter, David; Berg, Ninna; Kruszewski, Francis H; Sarlo, Katherine; Concoby, Beth

2012-01-01

Detergent enzymes have a very good safety profile, with almost no capacity to generate adverse acute or chronic responses in humans. The exceptions are the limited ability of some proteases to produce irritating effects at high concentrations, and the intrinsic potential of these bacterial and fungal proteins to act as respiratory sensitizers, demonstrated in humans during the early phase of the industrial use of enzymes during the 1960s and 1970s. How enzymes generate these responses are beginning to become a little clearer, with a developing appreciation of the cell surface mechanism(s) by which the enzymatic activity promotes the T-helper (T(H))-2 cell responses, leading to the generation of IgE. It is a reasonable assumption that the majority of enzyme proteins possess this intrinsic hazard. However, toxicological methods for characterizing further the respiratory sensitization hazard of individual enzymes remains a problematic area, with the consequence that the information feeding into risk assessment/management, although sufficient, is limited. Most of this information was in the past generated in animal models and in vitro immunoassays that assess immunological cross-reactivity. Ultimately, by understanding more fully the mechanisms which drive the IgE response to enzymes, it will be possible to develop better methods for hazard characterization and consequently for risk assessment and management.

LINKING INDIVIDUAL-LEVEL RESPONSES AND POPULATION-LEVEL CONSEQUENCES

EPA Science Inventory

The protection of populations is at the heart of ecological risk assessment, yet most studies measure effects on individuals. In this chapter, we outline the need to enhance our ability to project and interpret the effect of stressors on natural populations and to manage risk mor...

Robustness mechanisms in primate societies: a perturbation study

PubMed Central

Flack, Jessica C; Krakauer, David C; de Waal, Frans B. M

2005-01-01

Conflict management mechanisms have a direct, critical effect on system robustness because they mitigate conflict intensity and help repair damaged relationships. However, robustness mechanisms can also have indirect effects on system integrity by facilitating interactions among components. We explore the indirect role that conflict management mechanisms play in the maintenance of social system robustness, using a perturbation technique to ‘knockout’ components responsible for effective conflict management. We explore the effects of knockout on pigtailed macaque (Macaca nemestrina) social organization, using a captive group of 84 individuals. This system is ideal in addressing this question because there is heterogeneity in performance of conflict management. Consequently, conflict managers can be easily removed without disrupting other control structures. We find that powerful conflict managers are essential in maintaining social order for the benefit of all members of society. We show that knockout of components responsible for conflict management results in system destabilization by significantly increasing mean levels of conflict and aggression, decreasing socio-positive interaction and decreasing the operation of repair mechanisms. PMID:16024369

The Allocation of Runway Slots by Auction. Volume II. The Airline Management Game and Slot Auction Testing.

DTIC Science & Technology

1980-04-15

schedule their air transportation networks, and learn the performance and financial results through simulation of the resulting traffic flows, costs...players in the role of airline management responsible for airline scheduling and market, fleet and financial planning. The Game Administrator created a...revenues and consequently the financial results for each airline. During this exercise the objective of each airline team was to schedule its flights so

Clinical Manifestations of an Anti-Drug Antibody Response: Autoimmune Reactions.

PubMed

Swanson, Steven J

2014-12-01

Antibodies can be generated against a therapeutic protein upon administration to human subjects. When the therapeutic protein closely mimics one of the subject's endogenous proteins, those antibodies might bind to the endogenous protein in addition to the therapeutic protein. This scenario results when tolerance to the endogenous protein is broken. The consequences of breaking tolerance include an autoimmune response where antibodies are generated against the endogenous protein. These autoantibodies could have significant clinical relevance depending on several factors, including the redundancy of action of the endogenous protein as well as the concentration, binding affinity, and neutralizing potential of the antibodies. The consequences of a therapeutic-protein-induced autoimmune reaction can be challenging to manage as the stimulus for further perpetuation of the immune response can shift from the therapeutic protein to the endogenous protein. The potential for inducing an autoimmune response is one of the reasons that the immune response to a therapeutic protein should be monitored if it persists through the end of the study.

Chemical, Biological, Radiological, and Nuclear Consequence Management: Ways to Improve Fixed-Site Decontamination Capability

DTIC Science & Technology

2007-05-10

objective is achieved through consequence management and fixed-site decontamination operations. The effectiveness of CBRN consequence management...decontamination operations. The effectiveness of CBRN consequence management and fixed-site decontamination executed in the Joint Security Area can be...when faced with Chemical, Biological, Radiological, or Nuclear (CBRN) contaminated ports of debarkation. The effectiveness of CBRN consequence

Understanding chronic heart failure

PubMed Central

Fenton, Matthew; Burch, Michael

2007-01-01

The key principles of chronic heart failure and the development of clinical management strategies are described. The physiological changes in chronic heart failure and the clinical management of children with heart failure are considered, but the treatment of heart failure related to congenital heart disease or the intensive care management of heart failure are not mentioned as both topics require consideration in their own right. A greater understanding of the maladaptive responses to chronic heart failure has enabled targeted therapy to be introduced with consequent improvement in symptoms, reduction in hospitalisation and lower mortality. PMID:17715446

Toward a Responsibility-Catering Prioritarian Ethical Theory of Risk.

PubMed

Wikman-Svahn, Per; Lindblom, Lars

2018-03-05

Standard tools used in societal risk management such as probabilistic risk analysis or cost-benefit analysis typically define risks in terms of only probabilities and consequences and assume a utilitarian approach to ethics that aims to maximize expected utility. The philosopher Carl F. Cranor has argued against this view by devising a list of plausible aspects of the acceptability of risks that points towards a non-consequentialist ethical theory of societal risk management. This paper revisits Cranor's list to argue that the alternative ethical theory responsibility-catering prioritarianism can accommodate the aspects identified by Cranor and that the elements in the list can be used to inform the details of how to view risks within this theory. An approach towards operationalizing the theory is proposed based on a prioritarian social welfare function that operates on responsibility-adjusted utilities. A responsibility-catering prioritarian ethical approach towards managing risks is a promising alternative to standard tools such as cost-benefit analysis.

Universities, Reflexivity and Critique: Uneasy Parallels in Practice

ERIC Educational Resources Information Center

May, Tim; Perry, Beth

2013-01-01

There are profound changes affecting universities. Under pressure from the forward march of neo-liberalism, there is a process of forgetting about the origins of the university and its distinctive place in society. Whilst responses by university management often amplify these consequences, there are similar tendencies within academic professional…

Foundations for a Team Oriented Curriculum

ERIC Educational Resources Information Center

Neal, Brandi; Martz, Ben

2016-01-01

The business world today values collaboration and team work skills such as those found in the area of project management, business process reengineering, quality circles, etc. In response, the use of group projects permeates many curricula today with varying consequences and levels of success. Technology claims to enhance collaboration in…

Job Aids for Using Preventive Radiological/Nuclear Detection Equipment for Consequence Management

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

Buddemeier, Brooke R.; Haynes, Daniel; Wood-Zika, Annmarie R.

The overall objective of this project is to research, evaluate, and test first responder preventive radiological/nuclear detection equipment (PRND) to provide state and local agencies with guidance on how to best use this equipment for response after a radiological/nuclear release or detonation.

Mortality Salience and Morality: Thinking about Death Makes People Less Utilitarian

ERIC Educational Resources Information Center

Tremoliere, Bastien; De Neys, Wim; Bonnefon, Jean-Francois

2012-01-01

According to the dual-process model of moral judgment, utilitarian responses to moral conflict draw on limited cognitive resources. Terror Management Theory, in parallel, postulates that mortality salience mobilizes these resources to suppress thoughts of death out of focal attention. Consequently, we predicted that individuals under mortality…

Adaptive social impact management for conservation and environmental management.

PubMed

Kaplan-Hallam, Maery; Bennett, Nathan J

2018-04-01

Concerns about the social consequences of conservation have spurred increased attention the monitoring and evaluation of the social impacts of conservation projects. This has resulted in a growing body of research that demonstrates how conservation can produce both positive and negative social, economic, cultural, health, and governance consequences for local communities. Yet, the results of social monitoring efforts are seldom applied to adaptively manage conservation projects. Greater attention is needed to incorporating the results of social impact assessments in long-term conservation management to minimize negative social consequences and maximize social benefits. We bring together insights from social impact assessment, adaptive management, social learning, knowledge coproduction, cross-scale governance, and environmental planning to propose a definition and framework for adaptive social impact management (ASIM). We define ASIM as the cyclical process of monitoring and adaptively managing social impacts over the life-span of an initiative through the 4 stages of profiling, learning, planning, and implementing. We outline 14 steps associated with the 4 stages of the ASIM cycle and provide guidance and potential methods for social-indicator development, predictive assessments of social impacts, monitoring and evaluation, communication of results, and identification and prioritization of management responses. Successful ASIM will be aided by engaging with best practices - including local engagement and collaboration in the process, transparent communication of results to stakeholders, collective deliberation on and choice of interventions, documentation of shared learning at the site level, and the scaling up of insights to inform higher-level conservation policies-to increase accountability, trust, and perceived legitimacy among stakeholders. The ASIM process is broadly applicable to conservation, environmental management, and development initiatives at various scales and in different contexts. © 2017 Society for Conservation Biology.

Lessons from the domestic Ebola response: Improving health care system resilience to high consequence infectious diseases.

PubMed

Meyer, Diane; Kirk Sell, Tara; Schoch-Spana, Monica; Shearer, Matthew P; Chandler, Hannah; Thomas, Erin; Rose, Dale A; Carbone, Eric G; Toner, Eric

2018-05-01

The domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events. Interviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group. Salient themes identified included health care facility issues-specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations-and health care workforce issues-specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment. The experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Responses of Israeli HMOs to environmental change following the National Health Insurance Law: Opening the black box.

PubMed

Gross, Revital; Harrison, Michael I

2006-04-01

Managed competition was introduced into the Israeli health care system with the enactment of the National Health Insurance (NHI) Law of 1995, which radically transformed health management organizations' (HMO) regulatory and competitive environments. We conducted an in-depth, qualitative analysis of the strategies developed by two Israeli HMOs in response to this change, and developed the concept of a "strategic repertoire" to integrate diverse theories of organizational adaptation to environmental change. Although the responses of these organizations to managed competition were broadly comparable, they diverged from one another in important ways. Our analysis highlights how the interaction among organizational history, managerial choice, and environmental constraints creates divergence in organizational responses to national policy initiatives. Policy implications arising from the findings include ways of anticipating unintended consequences of policy initiatives, such as involving provider organizations in the structuring of reform, or simulating their response in advance, based on expert knowledge of their strategic repertoires; and the need to include mechanisms for obtaining feedback on organizational responses in the implementation of reform. This will facilitate the adjustment of program regulations and incentives in response to emerging practices.

Towards responsible system development in health services: a discourse analysis study of design conflict resolution tactics.

PubMed

Irestig, Magnus; Timpka, Toomas

2010-02-01

We set out to examine design conflict resolution tactics used in development of large information systems for health services and to outline the design consequences for these tactics. Discourse analysis methods were applied to data collected from meetings conducted during the development of a web-based system in a public health context. We found that low risk tactics were characterized by design issues being managed within the formal mandate and competences of the design group. In comparison, high risk tactics were associated with irresponsible compromises, i.e. decisions being passed on to others or to later phases of the design process. The consequence of this collective disregard of issues such as responsibility and legitimacy is that the system design will be impossible to implement in factual health service contexts. The results imply that downstream responsibility issues have to be continuously dealt with in system development in health services.

Government of Canada Initiatives in Support of the Joint Convention

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

Brown, P.A.; Metcalfe, D.E.; Lojk, R.

The Government of Canada strongly supported international efforts to bring into force the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management (the Joint Convention), and was the second country to ratify it. The Joint Convention places a number of obligations on Contracting Parties aimed at achieving and maintaining a high level of safety worldwide in spent fuel and radioactive waste management, ensuring that effective defenses against potential hazards are in place during all management stages, preventing accidents with radiological consequences and mitigating their consequences should they occur. In addition to establishingmore » and maintaining a modem regulatory framework and an independent regulatory body through the 2000 Nuclear Safety and Control Act, the Government of Canada has implemented a number of initiatives that address its responsibilities and serve to further enhance Canada's compliance with the Joint Convention. For nuclear fuel waste, the Government of Canada brought into force the Nuclear Fuel Waste Act in 2002 to require waste owners to develop, fund, organize and implement a long-term solution for Canada's nuclear fuel waste. The Act clearly reserves for Government the decision on the solution to be implemented in the best interests of Canadians, as well as oversight to ensure that waste owners are fulfilling their responsibilities. In the case of low-level radioactive waste, long-term solutions are being developed to ensure the protection of health, safety, and the environment, both now and in the future. Regarding uranium mine and mill tailings, current operators have state-of-the-art waste management facilities in place. The Government of Canada works with provincial governments to ensure that any potential abandoned or legacy mines sites where no owner can be held responsible are safely decommissioned and managed over the long term. (authors)« less

A Quantitative Investigation of Cloud Computing Adoption in Nigeria: Testing an Enhanced Technology Acceptance Model

ERIC Educational Resources Information Center

Ishola, Bashiru Abayomi

2017-01-01

Cloud computing has recently emerged as a potential alternative to the traditional on-premise computing that businesses can leverage to achieve operational efficiencies. Consequently, technology managers are often tasked with the responsibilities to analyze the barriers and variables critical to organizational cloud adoption decisions. This…

Ecosystem services: foundations, opportunities, and challenges for the forest products sector

Treesearch

Trista M. Patterson; Dana L. Coelho

2009-01-01

The ecosystem service concept has been proposed as a meaningful framework for natural resource management. In theory, it holds concomitant benefit and consequence for the forest product sector. However, numerous barriers impede practitioners from developing concrete and enduring responses to emerging ecosystem service markets, policies, and initiatives. Principal among...

The Tyranny of Bureaucracy: Continuing Challenges of Leading and Managing from the Middle

ERIC Educational Resources Information Center

Fitzgerald, Tanya

2009-01-01

Fiscal efficiency and organizational effectiveness were the primary objectives that underpinned the reform of educational administration in New Zealand in the late 1980s. The consequent re-organization of schools and schooling located responsibility and accountability for school performance, teachers' work and student outcomes firmly at the door…

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

49 CFR 195.452 - Pipeline integrity management in high consequence areas.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 3 2014-10-01 2014-10-01 false Pipeline integrity management in high consequence... Management § 195.452 Pipeline integrity management in high consequence areas. (a) Which pipelines are covered... by this section must: (1) Develop a written integrity management program that addresses the risks on...

Initiatives and Challenges in Consequence Management after a WMD Attack

DTIC Science & Technology

2004-08-01

Challenges in Consequence Management people to seek shelter or other protection when possible, to avoid exposure to weapons of mass destruction effects . The...Potential Effects .........................................9 V. Methods for Managing the Consequences of WMD Use.................14 VI. Toward a...mass destruction (WMD). Consequence management1 is a process to mitigate the effects of the use of weapons of mass destruction, including

Homeland Biological Warfare Consequence Management: Capabilities and Needs Assessment

DTIC Science & Technology

2001-04-01

AU/ACSC/105/2001-04 AIR COMMAND AND STAFF COLLEGE AIR UNIVERSITY HOMELAND BIOLOGICAL WARFARE CONSEQUENCE MANAGEMENT: CAPABILITIES AND NEEDS...Dates Covered (from... to) - Title and Subtitle Homeland biological Warfare Consequence Management: Capabilities and Needs Assessment Contract...FEMA, DoJ, DoD, HHS, etc.) make a comprehensive, organized solution to the problem difficult. Focusing on the consequence management functions

Managing neurobehavioral capability when social expediency trumps biological imperatives

PubMed Central

Spaeth, Andrea M.; Goel, Namni; Dinges, David F.

2013-01-01

Sleep, which is evolutionarily conserved across species, is a biological imperative that cannot be ignored or replaced. However, the percentage of habitually sleep-restricted adults has increased in recent decades. Extended work hours and commutes, shift work schedules, and television viewing are particularly potent social factors that influence sleep duration. Chronic partial sleep restriction, a product of these social expediencies, leads to the accumulation of sleep debt over time and consequently increases sleep propensity, decreases alertness, and impairs critical aspects of cognitive functioning. Significant interindividual variability in the neurobehavioral responses to sleep restriction exists—this variability is stable and phenotypic—suggesting a genetic basis. Identifying vulnerability to sleep loss is essential as many adults cannot accurately judge their level of impairment in response to sleep restriction. Indeed, the consequences of impaired performance and the lack of insight due to sleep loss can be catastrophic. In order to cope with the effects of social expediencies on biological imperatives, identification of biological (including genetic) and behavioral markers of sleep loss vulnerability as well as development of technological approaches for fatigue management are critical. PMID:22877676

A Multilevel Analysis of Professional Conflicts in Health Care Teams: Insight for Future Training.

PubMed

Bochatay, Naike; Bajwa, Nadia M; Cullati, Stéphane; Muller-Juge, Virginie; Blondon, Katherine S; Junod Perron, Noëlle; Maître, Fabienne; Chopard, Pierre; Vu, Nu Viet; Kim, Sara; Savoldelli, Georges L; Hudelson, Patricia; Nendaz, Mathieu R

2017-11-01

Without a proper understanding of conflict between health care professionals, designing effective conflict management training programs for trainees that reflect the complexity of the clinical working environment is difficult. To better inform the development of conflict management training, this study sought to explore health care professionals' experiences of conflicts and their characteristics. Between 2014 and early 2016, 82 semistructured interviews were conducted with health care professionals directly involved in first-line patient care in four departments of the University Hospitals of Geneva. These professionals included residents, fellows, certified nursing assistants, nurses, and nurse supervisors. All interviews were transcribed verbatim, and conventional content analysis was used to derive conflict characteristics. Six conflict sources were identified. Among these sources, disagreements on patient care tended to be the primary trigger of conflict, whereas sources related to communication contributed to conflict escalation without directly triggering conflict. A framework of workplace conflict that integrates its multidimensional and cyclical nature was subsequently developed. This framework suggests that conflict consequences and responses are interrelated, and might generate further tensions that could affect health care professionals, teams, and organizations, as well as patient care. Findings also indicated that supervisors' responses to contentious situations often failed to meet health care professionals' expectations. Understanding conflicts between health care professionals involves several interrelated dimensions, such as sources, consequences, and responses to conflict. There is a need to strengthen health care professionals' ability to identify and respond to conflict and to further develop conflict management programs for clinical supervisors.

Quantitative analysis of factors that affect oil pipeline network accident based on Bayesian networks: A case study in China

NASA Astrophysics Data System (ADS)

Zhang, Chao; Qin, Ting Xin; Huang, Shuai; Wu, Jian Song; Meng, Xin Yan

2018-06-01

Some factors can affect the consequences of oil pipeline accident and their effects should be analyzed to improve emergency preparation and emergency response. Although there are some qualitative analysis models of risk factors' effects, the quantitative analysis model still should be researched. In this study, we introduce a Bayesian network (BN) model of risk factors' effects analysis in an oil pipeline accident case that happened in China. The incident evolution diagram is built to identify the risk factors. And the BN model is built based on the deployment rule for factor nodes in BN and the expert knowledge by Dempster-Shafer evidence theory. Then the probabilities of incident consequences and risk factors' effects can be calculated. The most likely consequences given by this model are consilient with the case. Meanwhile, the quantitative estimations of risk factors' effects may provide a theoretical basis to take optimal risk treatment measures for oil pipeline management, which can be used in emergency preparation and emergency response.

A Middle-Range Theory for Diabetes Self-management Mastery.

PubMed

Fearon-Lynch, Jennifer A; Stover, Caitlin M

2015-01-01

Diabetes mellitus is the seventh leading cause of death in America and affects 382 million people worldwide. Individuals with diabetes must manage the complexity of the disease, its treatment, and complications to avert deleterious consequences associated with the illness. However, not all patients with diabetes successfully gain mastery to positively impact self-management. A new middle-range theory is proposed that merges 2 extant theories, theory of mastery and organismic integration theory, to better understand this human response. The theories' philosophical, theoretical, and conceptual perspectives were examined and relational properties synthesized to provide a conceptual representation of the phenomenon of interest.

Modelling marine community responses to climate-driven species redistribution to guide monitoring and adaptive ecosystem-based management.

PubMed

Marzloff, Martin Pierre; Melbourne-Thomas, Jessica; Hamon, Katell G; Hoshino, Eriko; Jennings, Sarah; van Putten, Ingrid E; Pecl, Gretta T

2016-07-01

As a consequence of global climate-driven changes, marine ecosystems are experiencing polewards redistributions of species - or range shifts - across taxa and throughout latitudes worldwide. Research on these range shifts largely focuses on understanding and predicting changes in the distribution of individual species. The ecological effects of marine range shifts on ecosystem structure and functioning, as well as human coastal communities, can be large, yet remain difficult to anticipate and manage. Here, we use qualitative modelling of system feedback to understand the cumulative impacts of multiple species shifts in south-eastern Australia, a global hotspot for ocean warming. We identify range-shifting species that can induce trophic cascades and affect ecosystem dynamics and productivity, and evaluate the potential effectiveness of alternative management interventions to mitigate these impacts. Our results suggest that the negative ecological impacts of multiple simultaneous range shifts generally add up. Thus, implementing whole-of-ecosystem management strategies and regular monitoring of range-shifting species of ecological concern are necessary to effectively intervene against undesirable consequences of marine range shifts at the regional scale. Our study illustrates how modelling system feedback with only limited qualitative information about ecosystem structure and range-shifting species can predict ecological consequences of multiple co-occurring range shifts, guide ecosystem-based adaptation to climate change and help prioritise future research and monitoring. © 2016 John Wiley & Sons Ltd.

A conceptual model for site-level ecology of the giant gartersnake (Thamnophis gigas) in the Sacramento Valley, California

USGS Publications Warehouse

Halstead, Brian J.; Wylie, Glenn D.; Casazza, Michael L.; Hansen, Eric C.; Scherer, Rick D.; Patterson, Laura C.

2015-08-14

Bayesian networks further provide a clear visual display of the model that facilitates understanding among various stakeholders (Marcot and others, 2001; Uusitalo , 2007). Empirical data and expert judgment can be combined, as continuous or categorical variables, to update knowledge about the system (Marcot and others, 2001; Uusitalo , 2007). Importantly, Bayesian network models allow inference from causes to consequences, but also from consequences to causes, so that data can inform the states of nodes (values of different random variables) in either direction (Marcot and others, 2001; Uusitalo , 2007). Because they can incorporate both decision nodes that represent management actions and utility nodes that quantify the costs and benefits of outcomes, Bayesian networks are ideally suited to risk analysis and adaptive management (Nyberg and others, 2006; Howes and others, 2010). Thus, Bayesian network models are useful in situations where empirical data are not available, such as questions concerning the responses of giant gartersnakes to management.

Food for contagion: Synthesis and future directions for studying host–parasite responses to resource shifts in anthropogenic environments

PubMed Central

Altizer, Sonia. M.; Becker, Daniel J.; Epstein, Jonathan H.; Forbes, Kristian M.; Gillespie, Thomas R.; Hall, Richard J.; Hawley, Dana; Hernandez, Sonia M.; Martin, Lynn B.; Plowright, Raina K.; Satterfield, Dara A.; Streicker, Daniel G.

2018-01-01

Human-provided resource subsidies for wildlife are diverse, common, and have profound consequences for wildlife–pathogen interactions, as demonstrated by papers in this themed issue spanning empirical, theoretical, and management perspectives from a range of study systems. Contributions cut across scales of organization, from the within-host dynamics of immune function, to population-level impacts on parasite transmission, to landscape- and regional-scale patterns of infection. In this concluding paper, we identify common threads and key findings from author contributions, including the consequences of resource subsidies for (i) host immunity; (ii) animal aggregation and contact rates; (iii) host movement and landscape-level infection patterns; and (iv) inter-specific contacts and cross-species transmission. Exciting avenues for future work include studies that integrate mechanistic modeling and empirical approaches to better explore cross-scale processes, and experimental manipulations of food resources to quantify host and pathogen responses. Work is also needed to examine evolutionary responses to provisioning, and ask how diet-altered changes to the host microbiome influence infection processes. Given the massive public health and conservation implications of anthropogenic resource shifts, we end by underscoring the need for practical recommendations to manage supplemental feeding practices, limit human–wildlife conflicts over shared food resources, and reduce cross-species transmission risks, including to humans. PMID:29531154

The ecosystem approach to fisheries: management at the dynamic interface between biodiversity conservation and sustainable use.

PubMed

Jennings, Simon; Smith, Anthony D M; Fulton, Elizabeth A; Smith, David C

2014-08-01

The emergence of an ecosystem approach to fisheries (EAF) was characterized by the adoption of objectives for maintaining ecosystem health alongside those for fisheries. The EAF was expected to meet some aspirations for biodiversity conservation, but health was principally linked to sustainable use rather than lower levels of human impact. Consequently, while policies including EAF concepts identified objectives for fisheries management and biodiversity conservation, the wording often reflected unresolved societal and political debates about objectives and gave imprecise guidance on addressing inevitable trade-offs. Despite scientific progress in making trade-offs and consequences explicit, there remain substantial differences in interpretations of acceptable impact, responses to uncertainty and risk, and the use of management measures by groups accountable for fisheries management and biodiversity conservation. Within and among nations and regions, these differences are influenced by the contribution of fisheries, aquaculture, farming, and trade to food security, consumers' options, and other social, economic, and environmental factors. Notwithstanding, mutual understanding of the motivations and norms of fisheries management and biodiversity conservation groups is increasing, and interactions between these groups have likely supported more progress toward meeting their stated objectives than would have otherwise been achievable. © 2014 New York Academy of Sciences.

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

Brouillette, Greg A.

These are slides for various presentations on C41SR and urban disasters disasters response and recovery tools. These are all mainly charts and images of disaster response and recovery tools. Slides included have headings such as the following: vignette of a disaster response, situational awareness and common operating picture available to EOC, plume modeling capability, Program ASPECT Chemical Response Products, EPA ASPECT - Hurricane RITA Response 9/25/2005, Angel Fire Imagery, incident commander's view/police chief's view/ EMS' view, common situational awareness and collaborative planning, exercise, training capability, systems diagram, Austere Challenge 06 Sim/C4 Requirements, common situational awareness and collaborative planning, exercise, trainingmore » environment, common situational awareness, real world, crisis response, and consequence management.« less

Risky business: Addressing the consequences of predicting violence.

PubMed

Miller, Sarah L; Brodsky, Stanley L

2011-01-01

Despite major advances in the prediction of violence and risk management, risk evaluations are necessarily imperfect. This article focuses on the role of the evaluator in such assessments and addresses the consequences incurred by clinicians involved in conducting risk assessments. We discuss the risks of overpredicting and underpredicting violence with respect to how these risks can influence an evaluator's opinion. Then, we review how law and psychology inform the clinician's work. Finally, in response to the compelling tendency toward overprediction of violence, we propose a preliminary self-assessment guide as a method of examining influences on the evaluator in assessing violence risk.

Blood management issues using blood management strategies.

PubMed

Stulberg, Bernard N; Zadzilka, Jayson D

2007-06-01

Blood management strategies is a term used to address a coordinated approach to the management of blood loss in the perioperative period for total joint arthroplasty. The premise of any blood management strategy is that each patient, surgeon, and operative intervention experiences different risks of requiring transfusion, that those risks can be identified, and that a plan can be implemented to address them. A surgeon's decision to transfuse should be based on physiologic assessment of the patient's response to anemia and not on an arbitrary number ("transfusion trigger"). Intervention strategies can be applied preoperatively, intraoperatively, and postoperatively. Patient-specific planning allows for the appropriate use of patient, hospital, and system resources, ensuring that the consequences of anemia are minimized and that the patient's recovery process is optimized.

Radioactive Waste Management in Non-Nuclear Countries - 13070

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

Kubelka, Dragan; Trifunovic, Dejan

2013-07-01

This paper challenges internationally accepted concepts of dissemination of responsibilities between all stakeholders involved in national radioactive waste management infrastructure in the countries without nuclear power program. Mainly it concerns countries classified as class A and potentially B countries according to International Atomic Energy Agency. It will be shown that in such countries long term sustainability of national radioactive waste management infrastructure is very sensitive issue that can be addressed by involving regulatory body in more active way in the infrastructure. In that way countries can mitigate possible consequences on the very sensitive open market of radioactive waste management services,more » comprised mainly of radioactive waste generators, operators of end-life management facilities and regulatory body. (authors)« less

Measuring soil sustainability via soil resilience.

PubMed

Ludwig, Marie; Wilmes, Paul; Schrader, Stefan

2018-06-01

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

Underestimating risks to the northern spotted owl in fire-prone forests: response to Hanson et al

Treesearch

Thomas A. Spies; Jay D. Miller; Joseph B. Buchanan; John F. Lehmkuhl; Jerry F. Franklin; Sean P. Healey; Paul F. Hessburg; Hugh D. Safford; Warren B. Cohen; Rebecca S.H. Kennedy; Eric E. Knapp; James K. Agee; Melinda Moeur

2010-01-01

The development of conservation plans for Northern Spotted Owls (NSO) (Strix occidentalis caurina) in disturbance-prone landscapes requires evaluation of multiple threats and careful consideration of the consequences of management actions intended to reduce risk. Hanson et al. (2009) used downwardly revised estimates of recent old-forest losses to...

Whiskey springs long-term coast redwood density management; final growth, sprout, and yield results

Treesearch

Lynn A. Webb; James L. Lindquist; Erik Wahl; Andrew Hubb

2012-01-01

Multi-decadal studies of commercial and precommercial thinning in redwood stands are rare and consequently of value. The Whiskey Springs study at Jackson Demonstration State Forest has a data set spanning 35 years. In addition to growth and yield response to commercial thinning, the results provide important information for evaluating regeneration and...

Reputation management on facebook: awareness is key to protecting yourself, your practice, and the veterinary profession.

PubMed

Weijs, Cynthia A; Coe, Jason B; Muise, Amy; Christofides, Emily; Desmarais, Serge

2014-01-01

From the Social media use by health professionals occurs in a digital environment where etiquette has yet to be solidly defined. The objectives of this study were to explore veterinarians' personal use of Facebook, knowledge of privacy settings, and factors related to sharing personal information online. All American Animal Hospital Association member veterinarians with a valid e-mail address (9469) were invited to complete an online survey about Facebook (e.g., time spent on Facebook, awareness of consequences, types of information posted). Questions assessing personality dimensions including trust, popularity, self-esteem and professional identity were included. The response rate was 17% (1594 of 9469); 72% of respondents (1148 of 1594) had a personal Facebook profile. Veterinarians were more likely to share information on Facebook than they would in general. Trust, need for popularity, and more time spent on Facebook predicted more disclosure of personal information on Facebook. Awareness of consequences and increased veterinary experience predicted lesser disclosure. As veterinary practices use Facebook to improve client services, they need also to manage risks associated with online disclosure by staff. Raising awareness of reputation management and consequences of posting certain types of information to Facebook is integral to protecting the individual, the practice, and the veterinary profession.

Game theory as a conceptual framework for managing insect pests.

PubMed

Brown, Joel S; Staňková, Kateřina

2017-06-01

For over 100 years it has been recognized that insect pests evolve resistance to chemical pesticides. More recently, managers have advocated restrained use of pesticides, crop rotation, the use of multiple pesticides, and pesticide-free sanctuaries as resistance management practices. Game theory provides a conceptual framework for combining the resistance strategies of the insects and the control strategies of the pest manager into a unified conceptual and modelling framework. Game theory can contrast an ecologically enlightened application of pesticides with an evolutionarily enlightened one. In the former case the manager only considers ecological consequences whereas the latter anticipates the evolutionary response of the pests. Broader applications of this game theory approach include anti-biotic resistance, fisheries management and therapy resistance in cancer. Copyright © 2017 Elsevier Inc. All rights reserved.

Emerging Technologies: Biosecurity and Consequence Management Implications

NASA Astrophysics Data System (ADS)

Perkins, Dana; Nordmann, Brian

The natural outbreaks of disease and pandemics are transnational threats that create international challenges when detection and containment are not timely due to scarce human and material resources. Whether the cause of those outbreaks is natural or intentional in origin, the main goal of consequence management operations is to save lives. The consequence management process is a continuum of inter-connected phases such as planning, preparation, response, and recovery. The rapid advances of life sciences and the emergence of dual-use technologies such as synthetic biology and nanotechnology pose additional challenges in terms of planning for the unknown potential threats whether they may be synthetic microorganisms with unpredictable dissemination patterns or nanoscale-manipulated biological agents evading current detection capabilities. The US National Strategy for Countering Biological Threats is emphasizing prevention while continuing to support the national preparedness goals and response/recovery capabilities. The recent policies, guidelines, and recommendations on overhauling the biological risk management in the United States are a proactive stance to a rapidly changing global environment. They include optimization of the current oversight frameworks and active engagement of the industry and academia in order to reduce the risk that individuals with ill intent may exploit the commercial application of nucleic acid synthesis technology to access genetic material derived from or by encoding Biological Select Agents or Toxins. We are also actively seeking to increase our knowledge of health effects of various types of nanomaterials, and how to assess, control, and prevent harmful exposure, taking into consideration the numerous gaps that currently exist with regard to the distinct behavior of nanoparticles compared to the same chemical or material at "macro-scale". Fundamentally, a biological incident, whether it is of natural, accidental, or deliberate origin, constitutes a public health problem and the United States is engaged with the international community to enhance our collective capability to address emerging health security threats.

Responses of the pulp, periradicular and soft tissues following trauma to the permanent teeth.

PubMed

Yu, C Y; Abbott, P V

2016-03-01

Trauma to the permanent teeth involves not only the teeth but also the pulp, the periodontal ligament, alveolar bone, gingiva and other associated structures. There are many variations in the types of injuries with varying severity and often a tooth may sustain more than one injury at the same time. In more severe trauma cases, there are many different cellular systems of mineralized hard and unmineralized soft tissues involved, each with varying potential for healing. Furthermore, the responses of the different tissues may be interrelated and dependent on each other. Hence, healing subsequent to dental trauma has long been known to be very complex. Because of this complexity, tissue responses and the consequences following dental trauma have been confusing and puzzling for many clinicians. In this review, the tissue responses are described under the tissue compartments typically involved following dental trauma: the pulp, periradicular and associated soft tissues. The factors involved in the mechanisms of trauma are analysed for their effects on the tissue responses. A thorough understanding of the possible tissue responses is imperative for clinicians to overcome the confusion and manage dental trauma adequately and conservatively in order to minimize the consequences following trauma. © 2016 Australian Dental Association.

Taking Risk Assessment and Management to the Next Level: Program-Level Risk Analysis to Enable Solid Decision-Making on Priorities and Funding

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

Nelson, J. G.; Morton, R. L.; Castillo, C.

2011-02-01

A multi-level (facility and programmatic) risk assessment was conducted for the facilities in the Nevada National Security Site (NNSS) Readiness in Technical Base and Facilities (RTBF) Program and results were included in a new Risk Management Plan (RMP), which was incorporated into the fiscal year (FY) 2010 Integrated Plans. Risks, risk events, probability, consequence(s), and mitigation strategies were identified and captured, for most scope areas (i.e., risk categories) during the facilitated risk workshops. Risk mitigations (i.e., efforts in addition to existing controls) were identified during the facilitated risk workshops when the risk event was identified. Risk mitigation strategies fell intomore » two broad categories: threats or opportunities. Improvement projects were identified and linked to specific risks they mitigate, making the connection of risk reduction through investments for the annual Site Execution Plan. Due to the amount of that was collected, analysis to be performed, and reports to be generated, a Risk Assessment/ Management Tool (RAMtool) database was developed to analyze the risks in real-time, at multiple levels, which reinforced the site-level risk management process and procedures. The RAMtool database was developed and designed to assist in the capturing and analysis of the key elements of risk: probability, consequence, and impact. The RAMtool calculates the facility-level and programmatic-level risk factors to enable a side-by-side comparison to see where the facility manager and program manager should focus their risk reduction efforts and funding. This enables them to make solid decisions on priorities and funding to maximize the risk reduction. A more active risk management process was developed where risks and opportunities are actively managed, monitored, and controlled by each facility more aggressively and frequently. risk owners have the responsibility and accountability to manage their assigned risk in real-time, using the RAMtool database.« less

Warning systems in risk management.

PubMed

Paté-Cornell, M E

1986-06-01

A method is presented here that allows probabilistic evaluation and optimization of warning systems, and comparison of their performance and cost-effectiveness with those of other means of risk management. The model includes an assessment of the signals, and of human response, given the memory that people have kept of the quality of previous alerts. The trade-off between the rate of false alerts and the length of the lead time is studied to account for the long-term effects of "crying wolf" and the effectiveness of emergency actions. An explicit formulation of the system's benefits, including inputs from a signal model, a response model, and a consequence model, is given to allow optimization of the warning threshold and of the system's sensitivity.

Causes, consequences, and policy responses to the migration of health workers: key findings from India.

PubMed

Walton-Roberts, Margaret; Runnels, Vivien; Rajan, S Irudaya; Sood, Atul; Nair, Sreelekha; Thomas, Philomina; Packer, Corinne; MacKenzie, Adrian; Tomblin Murphy, Gail; Labonté, Ronald; Bourgeault, Ivy Lynn

2017-04-05

This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been "sources" of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

The 2011 flood event in the Mekong Delta: preparedness, response, damage and recovery of private households and small businesses.

PubMed

Chinh, Do Thi; Bubeck, Philip; Dung, Nguyen Viet; Kreibich, Heidi

2016-10-01

Floods frequently cause substantial economic and human losses, particularly in developing countries. For the development of sound flood risk management schemes that reduce flood consequences, detailed insights into the different components of the flood risk management cycle, such as preparedness, response, flood impact analyses and recovery, are needed. However, such detailed insights are often lacking: commonly, only (aggregated) data on direct flood damage are available. Other damage categories such as losses owing to the disruption of production processes are usually not considered, resulting in incomplete risk assessments and possibly inappropriate recommendations for risk management. In this paper, data from 858 face-to-face interviews among flood-prone households and small businesses in Can Tho city in the Vietnamese Mekong Delta are presented to gain better insights into the damage caused by the 2011 flood event and its management by households and businesses. © 2016 The Author(s). Disasters © Overseas Development Institute, 2016.

Hanford science and technology needs statements, 2000

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

BERLIN, G.T.

In the aftermath of the Cold War, the United States has begun addressing the environmental consequences of five decades of nuclear weapons production. In November 1989, DOE established the Office of Environmental Restoration and Waste Management (EM) as the central authority for cleaning up the DOE weapons complex legacy of pollution, for preventing further environmental contamination, and for instituting responsible environmental management. While performing its tasks, EM found that many aspects of its large and complex mission could not be achieved using existing science and technology or without incurring unreasonable costs, risks, or schedule impacts. Consequently, a process was developedmore » to solicit needs from around the DOE complex and focus the science and technology resources of EM-50, the National Laboratories, private industry, and colleges and universities on those needs. This document describes those needs that the Hanford Site has identified as requiring additional science or technology to complete.« less

Hanford science and technology needs statements, 1999

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

Berlin, G.T.

In the aftermath of the Cold War, the US has begun addressing the environmental consequences of five decades of nuclear weapons production. In November 1989, DOE established the Office of Environmental Restoration and Waste Management (EM) as the central authority for cleaning up the DOE weapons complex legacy of pollution, for preventing further environmental contamination, and for instituting responsible environmental management. While performing its tasks, EM found that many aspects of its large and complex decisions could not be achieved using existing science and technology or without incurring unreasonable costs, risks, or schedule impacts. Consequently, a process was developed tomore » solicit needs from around the DOE complex and focus the science and technology resources of EM-50, the National Laboratories, private industry, and collages and universities on those needs. This document describes those needs which the Hanford Site has identified as requiring additional science or technology to complete.« less

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

Treesearch

C.J. Peterson

2008-01-01

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

Views, Knowledge, and Beliefs about Genetics and Genetic Counseling among Deaf People

ERIC Educational Resources Information Center

Middleton, Anna; Emery, Steven D.; Turner, Graham H.

2010-01-01

Genetic counseling is part of the social response to the science of genetics. It is intended to help twenty-first-century societies manage the consequences of our ability to observe and intervene in our genetic makeup. This article explores the views, knowledge, and beliefs of some Deaf and hard of hearing people about genetics and genetic…

A View from the Principal's Office: A Grounded-Theory Exploration of Principals' Perceptions of Non-Academic Barriers to Learning--Implications for School Social Work

ERIC Educational Resources Information Center

Prather, JoNataye Arnitra

2010-01-01

The importance of the principal has been found to be a critical factor in student and school success. School principal responsibilities traditionally encompass operations and management. However, many principals are unable to fulfill these expectations because of students' social and behavioral issues. Consequently, this qualitative study explored…

Current management of acute diverticulitis: a survey of Australasian surgeons.

PubMed

Jaung, Rebekah; Robertson, Jason; Rowbotham, David; Bissett, Ian

2016-03-11

To evaluate the current practice and degree of consensus amongst Australasian surgeons regarding non-surgical management of acute diverticulitis (AD) and to determine whether newer approaches to management are being translated into practice. An online survey was distributed to all Australasian colorectal surgeons and all general surgeons in the Auckland region. Responses were collected over two months and analysed to identify points of consensus and areas of significant difference in opinion between these groups. Responses were received from a total of 99 of 200 (49.5%) colorectal surgeons, and 19 of 36 (52.7%) general surgeons. The Hinchey Classification was the most commonly used measure of disease severity, used by 67 (95.7%) colorectal surgeons and 12 (92.3%) general surgeons. There was lack of consensus around important aspects of AD management, including antibiotic therapy, and use and modality of follow-up imaging. Selective antibiotic therapy and use of anti-inflammatory medication as adjuncts to treatment were practised by a minority of those surveyed. Newer approaches to management were being utilised by some respondents. The lack of consensus regarding management of AD may be a consequence of a paucity of high-level evidence to support specific management approaches, particularly in patients with uncomplicated AD.

Developing a Decision Support System for Flood Response: NIMS/ICS Fundamentals

NASA Astrophysics Data System (ADS)

Gutenson, J. L.; Zhang, X.; Ernest, A. N. S.; Oubeidillah, A.; Zhu, L.

2015-12-01

Effective response to regional disasters such as floods requires a multipronged, non-linear approach to reduce loss of life, property and harm to the environment. These coordinated response actions are typically undertaken by multiple jurisdictions, levels of government, functional agencies and other responsible entities. A successful response is highly dependent on the effectiveness and efficiency of each coordinated response action undertaken across a broad spectrum of organizations and activities. In order to provide a unified framework for those responding to incidents or planned events, FEMA provides a common and flexible approach for managing incidents, regardless of cause, size, location or complexity, referred to as the National Incident Management System (NIMS). Integral to NIMS is the Incident Command System (ICS), which establishes a common, pre-defined organizational structure to ensure coordination and management of procedures, resources and communications, for efficient incident management. While being both efficient and rigorous, NIMS, and ICS to a lesser extent, is an inherently complex framework that requires significant amount of training for planners, responders and managers to master, especially considering the wide array of incident types that Local Emergency Planning Committees (LEPCs) must be prepared to respond to. The existing Water-Wizard Decision Support System (DSS), developed to support water distribution system recovery operations for Decontamination (Decon), Operational Optimization (WDS), and Economic Consequence Assessment (Econ), is being evolved to integrate incident response functions. Water-Wizard runs on both mobile and desktop devices, and is being extended to utilize smartphone and mobile device specific data streams (e.g GPS location) to augment its fact-base in real-time for situational-aware DSS recommendations. In addition, the structured NIMS and ICS frameworks for incident management and response are being incorporated into the Water-Wizard knowledgebase, with a mid-term goal of integrating flood-specific emergency response domain knowledge to provide a real-time flood responder decision support.

A plea for rational mitigation of poor outcomes in the 'off-label use' of medications for the management of pain.

PubMed

Khursheed, Faraz; Ioffe, Julia; Gould, Harry J

2015-02-15

Neuropathic pain is a common and difficult to manage public health problem characterized by frequent treatment failure and high management costs. The variable presentation and response to treatment among patients make it difficult for physicians to apply a single, standardized approach for management. The physician's role in treating neuropathic pain is complex. Clinical decisions must be drawn from personal and shared experience, case reports, and evidence-based, controlled trials performed on selected populations of patients with common, narrowly-defined conditions. Recent advances in our understanding of the mechanisms that underlie the processing of nociceptive stimuli and the perception of pain have led to the increased 'off-label use' of adjuvant medications in an attempt to provide relief for many patients who heretofore have suffered unnecessarily with intractable neuropathic pain. Unfortunately, as with any treatment, sound clinical decisions can occasionally result in an untoward adverse response. It is therefore imperative that potential adverse effects inherent to all medications be considered and weighed against the untoward consequences of withholding treatment prior to incorporating their use in any course of management. This commentary presents a case report that illustrates a particularly devastating consequence that was encountered when a medication was selected for 'off-label use' in the treatment of intractable pain and presents an opinion for consideration in developing guidelines for determining acceptable risk and standard of care based upon rational adherence or deviation from the approved indications offered for the use of a medication at the time of its introduction into practice is granted. Copyright © 2014 Elsevier B.V. All rights reserved.

Role of strategic planning in engineering management

NASA Technical Reports Server (NTRS)

Krishen, Kumar

1993-01-01

Today, more than ever before, engineers are faced with uncertain and sometimes chaotic environments in which to function. The traditional roles of an engineer to design, develop, and streamline a manufacturing process for a product are still valued and relevant. However, the need for an engineer to participate in the process of identifying the product to be developed, the schedule and resources required, and the goal of satisfying the customer, has become paramount to achieving the success of the enterprise. When we include these endeavors in the functions of an engineer, management of 'engineering' takes on a new dimension. In this paper, the ramifications of the changing and increased functions of an engineer and consequent impacts on engineering management are explored. The basic principles which should be invoked in order to embrace the new environment for engineering management are outlined. The ultimate finding of this study is that the enterprise strategic plan should be developed in such a way as to allow engineering management to encompass the full spectrum of the responsibilities of engineers. A consequence of this is that the fundamental elements of the strategic process can best be implemented through a project team or group approach. The paper thus concentrates on three areas: evolving environment, strategic plan, and ways to achieve enterprise success.

Parents' Experiences of Caring Responsibility for Their Adult Child with Schizophrenia.

PubMed

Blomgren Mannerheim, Ann; Hellström Muhli, Ulla; Siouta, Eleni

2016-01-01

As a consequence of the latest psychiatry-related reform in Sweden and its implementation, relatives and family members have taken over from the formal healthcare system significant responsibility for the care of persons with a mental disability and illness. The aim of this study was to systematically describe and analyze the experiences of parents' informal care responsibility. The questions were, what are the experiences around parents' informal care activities and responsibilities and how do parents construct and manage their caring responsibility and with what consequences? Semistructured in-depth interviews were conducted (16 hours of recorded material) with eight parents who were all members of the Interest Association for Schizophrenia (Intresseföreningen för Schizofreni (IFS)) in Sweden. A mixed hermeneutic deductive and inductive method was used for the interpretation of the material. The parents endow their informal caring responsibility with meaning of being a good, responsible, and accountable parent with respect to their social context and social relationships as well as with respect to the psychiatric care representatives. In this tense situation, parents compromise between elements of struggle, cooperation, avoidance, and adaption in their interaction with the world outside, meaning the world beyond the care provision for their child, as well as with the world inside themselves.

Parents' Experiences of Caring Responsibility for Their Adult Child with Schizophrenia

PubMed Central

Blomgren Mannerheim, Ann; Siouta, Eleni

2016-01-01

As a consequence of the latest psychiatry-related reform in Sweden and its implementation, relatives and family members have taken over from the formal healthcare system significant responsibility for the care of persons with a mental disability and illness. The aim of this study was to systematically describe and analyze the experiences of parents' informal care responsibility. The questions were, what are the experiences around parents' informal care activities and responsibilities and how do parents construct and manage their caring responsibility and with what consequences? Semistructured in-depth interviews were conducted (16 hours of recorded material) with eight parents who were all members of the Interest Association for Schizophrenia (Intresseföreningen för Schizofreni (IFS)) in Sweden. A mixed hermeneutic deductive and inductive method was used for the interpretation of the material. The parents endow their informal caring responsibility with meaning of being a good, responsible, and accountable parent with respect to their social context and social relationships as well as with respect to the psychiatric care representatives. In this tense situation, parents compromise between elements of struggle, cooperation, avoidance, and adaption in their interaction with the world outside, meaning the world beyond the care provision for their child, as well as with the world inside themselves. PMID:26966575

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

PubMed

Barthe, B; Messing, K; Abbas, L

2011-01-01

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

Unintended consequences of management actions in salt pond restoration: cascading effects in trophic interactions

USGS Publications Warehouse

Takekawa, John Y.; Ackerman, Joshua T.; Brand, Arriana; Graham, Tanya R.; Eagles-Smith, Collin A.; Herzog, Mark; Topping, Brent R.; Shellenbarger, Gregory; Kuwabara, James S.; Mruz, Eric; Piotter, Sara L.; Athearn, Nicole D.

2015-01-01

Salt evaporation ponds have played an important role as habitat for migratory waterbirds across the world, however, efforts to restore and manage these habitats to maximize their conservation value has proven to be challenging. For example, salinity reduction has been a goal for restoring and managing former salt evaporation ponds to support waterbirds in the South Bay Salt Pond Restoration Project in San Francisco Bay, California, USA. Here, we describe a case study of unexpected consequences of a low-dissolved oxygen (DO) event on trophic interactions in a salt pond system following management actions to reduce salinity concentrations. We document the ramifications of an anoxic event in water quality including salinity, DO, and temperature, and in the response of the biota including prey fish biomass, numerical response by California Gulls (Larus californicus), and chick survival of Forster's Tern (Sterna forsteri). Management actions intended to protect receiving waters resulted in decreased DO concentrations that collapsed to zero for ≥ 4 consecutive days, resulting in an extensive fish kill. DO depletion likely resulted from an algal bloom that arose following transition of the pond system from high to low salinity as respiration and decomposition outpaced photosynthetic production. We measured a ≥ 6-fold increase in biomass of fish dropped on the levee by foraging avian predators compared with weeks prior to and following the low-DO event. California Gulls rapidly responded to the availability of aerobically-stressed and vulnerable fish and increased in abundance by two orders of magnitude. Mark-recapture analysis of 254 Forster's Tern chicks indicated that their survival declined substantially following the increase in gull abundance. Thus, management actions to reduce salinity concentrations resulted in cascading effects in trophic interactions that serves as a cautionary tale illustrating the importance of understanding the interaction of water quality and trophic structure when managing restoration of salt ponds.

Unintended Consequences of Management Actions in Salt Pond Restoration: Cascading Effects in Trophic Interactions

PubMed Central

Takekawa, John Y.; Ackerman, Joshua T.; Brand, L. Arriana; Graham, Tanya R.; Eagles-Smith, Collin A.; Herzog, Mark P.; Topping, Brent R.; Shellenbarger, Gregory G.; Kuwabara, James S.; Mruz, Eric; Piotter, Sara L.; Athearn, Nicole D.

2015-01-01

Salt evaporation ponds have played an important role as habitat for migratory waterbirds across the world, however, efforts to restore and manage these habitats to maximize their conservation value has proven to be challenging. For example, salinity reduction has been a goal for restoring and managing former salt evaporation ponds to support waterbirds in the South Bay Salt Pond Restoration Project in San Francisco Bay, California, USA. Here, we describe a case study of unexpected consequences of a low-dissolved oxygen (DO) event on trophic interactions in a salt pond system following management actions to reduce salinity concentrations. We document the ramifications of an anoxic event in water quality including salinity, DO, and temperature, and in the response of the biota including prey fish biomass, numerical response by California Gulls (Larus californicus), and chick survival of Forster's Tern (Sterna forsteri). Management actions intended to protect receiving waters resulted in decreased DO concentrations that collapsed to zero for ≥ 4 consecutive days, resulting in an extensive fish kill. DO depletion likely resulted from an algal bloom that arose following transition of the pond system from high to low salinity as respiration and decomposition outpaced photosynthetic production. We measured a ≥ 6-fold increase in biomass of fish dropped on the levee by foraging avian predators compared with weeks prior to and following the low-DO event. California Gulls rapidly responded to the availability of aerobically-stressed and vulnerable fish and increased in abundance by two orders of magnitude. Mark-recapture analysis of 254 Forster's Tern chicks indicated that their survival declined substantially following the increase in gull abundance. Thus, management actions to reduce salinity concentrations resulted in cascading effects in trophic interactions that serves as a cautionary tale illustrating the importance of understanding the interaction of water quality and trophic structure when managing restoration of salt ponds. PMID:26030415

What do we mean by "older adults' persistent pain self-management"? A concept analysis.

PubMed

Stewart, Carrie; Schofield, Pat; Elliott, Alison M; Torrance, Nicola; Leveille, Suzanne

2014-02-01

No standard definition exists for the concept "persistent pain self-management" or how it should be defined in relation to older adults. Poorly defined concepts can result in misunderstandings in the clinical setting and can hinder research through difficulties identifying or measuring the concept. To ascertain attributes, referents, antecedents, and consequences of the concept older adults' persistent pain self-management and develop a theoretical definition. Rodgers evolutionary model of concept analysis was used to systematically analyze articles from the academic and grey literature (N = 45). Data were extracted using standardized extraction forms and analyzed using thematic analysis. This concept was discussed in three ways: as an intervention, in reference to everyday behaviors, and as an outcome. Five defining attributes were identified: multidimensional process, personal development, active individuals, symptom response, and symptom control. Patients' perceived need and ability to manage pain with support from others is necessary for pain self-management to occur. Numerous physical, psychological, and social health consequences were identified. A theoretical definition is discussed. Our findings have clarified existing use and understanding regarding the concept of older adults' persistent pain self-management. We have identified three areas for future development: refinement of the attributes of this concept within the context of older adults, an exploration of how providers can overcome difficulties supporting older adults' persistent pain self-management, and a clarification of the overall theoretical framework of older adults' persistent pain self-management. Wiley Periodicals, Inc.

41 CFR 302-15.13 - What are the income tax consequences when my agency pays for my property management services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What are the income tax consequences when my agency pays for my property management services? 302-15.13 Section 302-15.13 Public....13 What are the income tax consequences when my agency pays for my property management services? When...

41 CFR 302-3.421 - What are the income tax consequences when my agency pays for property management services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What are the income tax consequences when my agency pays for property management services? 302-3.421 Section 302-3.421 Public Contracts... § 302-3.421 What are the income tax consequences when my agency pays for property management services...

Role of academic institutions in community disaster response since september 11, 2001.

PubMed

Dunlop, Anne L; Logue, Kristi M; Beltran, Gerald; Isakov, Alexander P

2011-10-01

To describe the role of academic institutions in the community response to Federal Emergency Management Agency-declared disasters from September 11, 2001, to February 1, 2009. We conducted a review of the published literature and Internet reports to identify academic institutions that participated in the community response to disaster events between September 11, 2001, to February 1, 2009, inclusive. From retrieved reports, we abstracted the identity of the academic institutions and the resources and services each provided. We characterized the resources and services in terms of their contribution to established constructs of community disaster resilience and disaster preparedness and response. Between September 11, 2001, and February 1, 2009, there were 98 published or Internet-accessible reports describing 106 instances in which academic institutions participated in the community response to 11 Federal Emergency Management Agency-declared disaster events that occurred between September 11, 2001, and February 1, 2009. Academic institutions included academic health centers and community teaching hospitals; schools of medicine, nursing, and public health; schools with graduate programs such as engineering and psychology; and 4-year programs. The services and resources provided by the academic institutions as part of the community disaster response could be categorized as contributing to community disaster resilience by reducing the consequences or likelihood of an event or to specific dimensions of public health preparedness and response, or both. The most common dimensions addressed by academic institutions (in order of occurrence) were resource management, enabling and sustaining a public health response, information capacity management, and performance evaluation. Since September 11, 2001, the participation of academic institutions in community disaster response has contributed to community resilience and the achievement of specific dimensions of disaster preparedness and response.

The Weakest Pillar: U.S. Northern Command’s Role in Solving the Federal Government’s Domestic Consequence Management Problem

DTIC Science & Technology

2008-10-31

frame a set of confusing guidance on the federal response posture to the threat of WMD in the homeland. Figure 2, although a little dated, depicts the...20 “Coast Guard History Corner,” 3. 21 Susie Moncla, “The Texas City Disaster – April 16 & 17, 1947”, Texas City Library, 1 April 2008...through a unified command. A close review of the two figures and the National Response Framework shows there is little or no coordination between the

[Inappropriate use of health resources and the trivialisation of medicine].

PubMed

Segura Benedicto, Andreu; Giner Ruiz, Vicente

2013-05-01

One of the main problems of our health care system is its excessive use. The most evident results of this misuse are the waste of resources and the iatrogenic consequences that are not justified by any expectations in health improvement. Among the possible causes of this inappropriate use, the trivialization of medical practice should be emphasized. This entails not only a loss of respect and consideration, but facilitates and even stimulates reckless use. Although patients and health care workers are both responsible for this recklessness, politicians and health care managers should be held responsible more so. Without a real emancipation allowing health care users and the population to control the factors that determine their health, it is unlikely that the inappropriate use of health resources and its associated iatrogenic consequences will be reduced. Copyright © 2012 Elsevier España, S.L. All rights reserved.

After Fukushima: managing the consequences of a radiological release.

PubMed

Fitzgerald, Joe; Wollner, Samuel B; Adalja, Amesh A; Morhard, Ryan; Cicero, Anita; Inglesby, Thomas V

2012-06-01

Even amidst the devastation following the earthquake and tsunami in Japan that killed more than 20,000 people, it was the accident at the Fukushima Daiichi nuclear power plant that led the country's prime minister, Naoto Kan, to fear for "the very existence of the Japanese nation." While accidents that result in mass radiological releases have been rare throughout the operating histories of existing nuclear power plants, the growing number of plants worldwide increases the likelihood that such releases will occur again in the future. Nuclear power is an important source of energy in the U.S. and will be for the foreseeable future. Accidents far smaller in scale than the one in Fukushima could have major societal consequences. Given the extensive, ongoing Nuclear Regulatory Commission (NRC) and industry assessment of nuclear power plant safety and preparedness issues, the Center for Biosecurity of UPMC focused on offsite policies and plans intended to reduce radiation exposure to the public in the aftermath of an accident. This report provides an assessment of Japan's efforts at nuclear consequence management; identifies concerns with current U.S. policies and practices for "outside the fence" management of such an event in the U.S.; and makes recommendations for steps that can be taken to strengthen U.S. government, industry, and community response to large-scale accidents at nuclear power plants.

Recovery and resilience after a nuclear power plant disaster: a medical decision model for managing an effective, timely, and balanced response.

PubMed

Coleman, C Norman; Blumenthal, Daniel J; Casto, Charles A; Alfant, Michael; Simon, Steven L; Remick, Alan L; Gepford, Heather J; Bowman, Thomas; Telfer, Jana L; Blumenthal, Pamela M; Noska, Michael A

2013-04-01

Resilience after a nuclear power plant or other radiation emergency requires response and recovery activities that are appropriately safe, timely, effective, and well organized. Timely informed decisions must be made, and the logic behind them communicated during the evolution of the incident before the final outcome is known. Based on our experiences in Tokyo responding to the Fukushima Daiichi nuclear power plant crisis, we propose a real-time, medical decision model by which to make key health-related decisions that are central drivers to the overall incident management. Using this approach, on-site decision makers empowered to make interim decisions can act without undue delay using readily available and high-level scientific, medical, communication, and policy expertise. Ongoing assessment, consultation, and adaption to the changing conditions and additional information are additional key features. Given the central role of health and medical issues in all disasters, we propose that this medical decision model, which is compatible with the existing US National Response Framework structure, be considered for effective management of complex, large-scale, and large-consequence incidents.

An international waste convention: measures for achieving sustainable development.

PubMed

Meyers, Gary D; McLeod, Glen; Anbarci, Melanie A

2006-12-01

Waste is a by-product of economic growth. Consequently, economic growth presents challenges for sustainable resource management and development because continued economic growth implies continued growth in waste outputs. Poor management of waste results in the inappropriate depletion of natural resources and potentially adverse effects on the environment, health and the economy. It is unsustainable. This paper begins by outlining the magnitude of and the current response to the growth in the quantity of waste outputs. This is followed by a consideration of why the international response to date, including the Rio Declaration and Agenda 21, fails to address the issue adequately. The paper concludes with a discussion on why and how an international treaty or other measure could advance sustainable development by providing an appropriate framework within which to address the problem.

Responsibility-centered management: a 10-year nursing assessment.

PubMed

McBride, A B; Neiman, S; Johnson, J

2000-01-01

In 1988-89, Indiana University became the first public university to implement responsibility-centered management (RCM) comprehensively. This article describes and assesses the implementation of RCM on the core campus of Indiana University School of Nursing in Indianapolis. It describes how RCM encouraged an information-rich environment, particularly with the advent of economic modeling; decision making linked to strategic goals/objectives; and a performance-based reward structure (e.g., merit pay increases and incentive plans). It ends with a discussion about the worth of RCM and the changes that frame-work produced, particularly in reconceptualizing the roles of the business officer and dean. The most profound consequence of RCM may be the effect it has in encouraging rethinking of what it means to be a school of nursing at this point in time.

Transformational leadership can improve workforce competencies.

PubMed

Thompson, Juliana

2012-03-01

Staffing problems can arise because of poor delegation skills or a failure by leaders to respond appropriately to economic factors and patient demographics. Training dilemmas, meanwhile, can arise because of managers' confusion about what constitutes 'training' and what constitutes 'education', and where responsibility of provision lies, with the consequence that they neglect these activities. This article uses Kouzes and Posner's (2009) transformational leadership model to show how managers can respond. Leaders who challenge budgets, consider new ways of working and engage effectively with the workforce can improve productivity and care, while those who invest in appropriate learning will have a highly trained workforce. The author explains how integration of leadership roles and management functions can lead to innovative problem solving.

Eastern hemlock response to even- and uneven-age management in the Acadian forest: results from the Penobscot Experimental Forest long-term silviculture study

Treesearch

John C. Brissette; Laura S. Kenefic

2000-01-01

Eastern hemlock (Tsuga canadensis (L.) Carr.) is an important tree species in the mixed-species conifer forests of northern New England and adjacent Canada. Hemlock is very tolerant of understory conditions; consequently, it responds differently to various silvicultural treatments. In a long-term study at the Penobscot Experimental Forest in east-...

Decay fungi associated with oaks and other hardwoods in the western United States

Treesearch

Jessie A. Glaeser; Kevin T. Smith

2010-01-01

An assessment of the presence and extent of the wood decay process should be part of any hazard tree analysis. Identification of the fungi responsible for decay improves both the prediction of the consequences of wood decay and the prescription of management options including tree pruning or removal. Until the outbreak of Sudden Oak Death (SOD), foresters in the...

Historical framework to explain long-term coupled human and natural system feedbacks: application to a multiple-ownership forest landscape in the northern Great Lakes region, USA

Treesearch

Michelle M. Steen-Adams; Nancy Langston; Mark D. O. Adams; David J. Mladenoff

2015-01-01

Current and future human and forest landscape conditions are influenced by the cumulative, unfolding history of socialecological interactions. Examining past system responses, especially unintended consequences, can reveal valuable insights that promote learning and adaptation in forest policy and management. Temporal couplings are complex, however; they can be...

Fuels planning: science synthesis and integration; environmental consequences fact sheet 04: wildlife responses to fuels treatments: key considerations

Treesearch

David Pilliod

2004-01-01

Managers face a difficult task in predicting the effects of fuels treatments on wildlife populations, mostly because information on how animals respond to fuels treatments is scarce or does not exist. This paper discusses key considerations-aspects of an animal's ecology and available information-that, despite the scarcity of information, may make predictions of...

Short-term understory plant community responses to salvage logging in beetle-affected lodgepole pine forests

Treesearch

Paula J. Fornwalt; Charles C. Rhoades; Robert M. Hubbard; Rebecca L. Harris; Akasha M. Faist; William D. Bowman

2018-01-01

Recent bark beetle outbreaks in western North American subalpine forests have prompted managers to salvage log some beetle-affected stands. We examined the short-term (i.e., two to three years post-treatment) consequences of such salvage logging on vascular understory plant (i.e., graminoid, forb, and shrub) communities. At 24 lodgepole pine (Pinus contorta) sites in...

Monitoring post-wildfire vegetation response with remotely sensed time-series data in Spain, USA and Israel

Treesearch

Willem J.D. van Leeuwen; Grant M. Casady; Daniel G. Neary; Susana Bautista; Jose Antonio Alloza; Yohay Carmel; Lea Wittenberg; Dan Malkinson; Barron J. Orr

2010-01-01

Due to the challenges faced by resource managers in maintaining post-fire ecosystem health, there is a need for methods to assess the ecological consequences of disturbances. This research examines an approach for assessing changes in post-fire vegetation dynamics for sites in Spain, Israel and the USA that burned in 1998, 1999 and 2002 respectively. Moderate...

A history of One Health.

PubMed

Evans, B R; Leighton, F A

2014-08-01

One Health is not a new concept. It can be demonstrated that its origins and development literally run the gamut from A to Z, that is to say, from Aristotle to Zoobiquity. Indeed, the consequences of the interaction that occurs between ecosystems, animals and people have shaped, and continue to shape, the course of human events and history. A reasoned and evidence-based assessment of the history of One Health must first be founded on an agreed definition of the term, but, given the many disciplines and sciences involved, finding such a definition is no easy task. Furthermore, there is an extensive and growing list of visionary individuals who have, over the centuries, attempted to promote awareness and advance the conceptto improve the management of the risks and consequences that arise at the interface between animal, human and ecosystem health. The One Health ideas of the 21st Century constitute a re-conceptualisation of health management in response to the accelerating environmental changes of the past 100 years, changes that are associated with the parallel exponential growth and concentration of the global human population. Consequently, the concept of One Health must recognise the constantly evolving relationship between animals and humans and the planet they share.

Exploring local risk managers' use of flood hazard maps for risk communication purposes in Baden-Württemberg

NASA Astrophysics Data System (ADS)

Kjellgren, S.

2013-07-01

In response to the EU Floods Directive (2007/60/EC), flood hazard maps are currently produced all over Europe, reflecting a wider shift in focus from "flood protection" to "risk management", for which not only public authorities but also populations at risk are seen as responsible. By providing a visual image of the foreseen consequences of flooding, flood hazard maps can enhance people's knowledge about flood risk, making them more capable of an adequate response. Current literature, however, questions the maps' awareness raising capacity, arguing that their content and design are rarely adjusted to laypeople's needs. This paper wants to complement this perspective with a focus on risk communication by studying how these tools are disseminated and marketed to the public in the first place. Judging from communication theory, simply making hazard maps publicly available is unlikely to lead to attitudinal or behavioral effects, since this typically requires two-way communication and material or symbolic incentives. Consequently, it is relevant to investigate whether and how local risk managers, who are well positioned to interact with the local population, make use of flood hazard maps for risk communication purposes. A qualitative case study of this issue in the German state of Baden-Württemberg suggests that many municipalities lack a clear strategy for using this new information tool for hazard and risk communication. Four barriers in this regard are identified: perceived disinterest/sufficient awareness on behalf of the population at risk; unwillingness to cause worry or distress; lack of skills and resources; and insufficient support. These barriers are important to address - in research as well as in practice - since it is only if flood hazard maps are used to enhance local knowledge resources that they can be expected to contribute to social capacity building.

Utilization of Local Law Enforcement Aerial Resources in Consequence Management (CM) Response

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

Wasiolek, Piotr T.; Malchow, Russell L.

2013-03-12

During the past decade the U.S. Department of Homeland Security (DHS) was instrumental in enhancing the nation’s ability to detect and prevent a radiological or nuclear attack in the highest risk cities. Under the DHS Securing the Cities initiative, nearly 13,000 personnel in the New York City region have been trained in preventive radiological and nuclear detection operations, and nearly 8,500 pieces of radiological detection equipment have been funded. As part of the preventive radiological/nuclear detection (PRND) mission, several cities have received funding to purchase commercial aerial radiation detection systems. In 2008, the U.S. Department of Energy, National Nuclear Securitymore » Administration Aerial Measuring System (AMS) program started providing Mobile Aerial Radiological Surveillance (MARS) training to such assets, resulting in over 150 HAZMAT teams’ officers and pilots from 10 law enforcement organizations and fire departments being trained in the aerial radiation detection. From the beginning, the MARS training course covered both the PRND and consequence management (CM) missions. Even if the law enforcement main focus is PRND, their aerial assets can be utilized in the collection of initial radiation data for post-event radiological CM response. Based on over 50 years of AMS operational experience and information collected during MARS training, this presentation will focus on the concepts of CM response using aerial assets as well as utilizing law enforcement/fire department aerial assets in CM. Also discussed will be the need for establishing closer relationships between local jurisdictions’ aerial radiation detection capabilities and state and local radiation control program directors, radiological health department managers, etc. During radiological events these individuals may become primary experts/advisers to Incident Commanders for radiological emergency response, especially in the early stages of a response. The knowledge of the existence, specific capabilities, and use of local aerial radiation detection systems would be critical in planning the response, even before federal assets arrive on the scene. The relationship between local and federal aerial assets and the potential role for the further use of the MARS training and expanded AMS Reachback capabilities in facilitating such interactions will be discussed.« less

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking... the consequences of failing to continue to meet applicable capital and management requirements? (a...

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking... the consequences of failing to continue to meet applicable capital and management requirements? (a...

[Teaching practices and the position concerning medical education].

PubMed

Medina-Figueroa, Alda María; Espinosa-Alarcón, Patricia Atzimba; Viniegra-Velázquez, Leonardo

2008-01-01

Estimate the degree of development of a position concerning medical education, in a phisician population. We carried out a cross-sectional study at with 1580 physicians; we selected 395 participants by non-proportional stratified sampling of an IMSS health facility; 244 (62 %) was medical professors, included 15 physicians responsible for education. A previously validated instrument was applied to these participants. Three indicators were evaluated: agreement in general, most popular trend, and consequence. Group grading was done blindly. Kuder-Richardson test was utilized to calculate the value of internal instrument consistency and nonparametric statistics < 0.05. Answering tendency in agreement were similar among physicians; heads or managers were statistically significant. The most popular trend was participative. In terms of consequence in physicians, there were some without consequent sentences in pair. The most popular trend was participative, although it would appear that this has not been pondered, in that on exploring the indicator, that of consequence. Teaching practices do not have any significant influence on the development of a position concerning medical education.

Managing perceived operational risk factors for effective supply-chain management

NASA Astrophysics Data System (ADS)

Sylla, Cheickna

2014-12-01

This research is part of a large scale comprehensive mathematical and empirical modeling investigation projects aimed at developing a better understanding of supply-chain risk management by offering a comprehensive framework including theoretical elements and empirical evidence based on managers' perception of improved organizational level of preparedness to safeguard against the threats of disruptions, delays and stoppage in the supply chain. More specifically, this paper reports the empirical investigation conducted using 92 companies in several eastern USA regions involved in international trades with global supply chains. Among the 56 general hypotheses investigated, the results support that managers strive to balance their control and decision impacts to mold their responses to risk factors with knowledge of the extent of cost consequences as stated in previous research. However, the results also propose new findings which significantly vary from previous research reports.

Ecological Consequences of Shifting the Timing of Burning Tallgrass Prairie

PubMed Central

Towne, E. Gene; Craine, Joseph M.

2014-01-01

In the Kansas Flint Hills, grassland burning is conducted during a relatively narrow window because management recommendations for the past 40 years have been to burn only in late spring. Widespread prescribed burning within this restricted time frame frequently creates smoke management issues downwind. A potential remedy for the concentrated smoke production in late spring is to expand burning to times earlier in the year. Yet, previous research suggested that burning in winter or early spring reduces plant productivity and cattle weight gain while increasing the proportion of undesirable plant species. In order to better understand the ecological consequences of burning at different times of the year, plant production and species abundance were measured for 20 years on ungrazed watersheds burned annually in autumn, winter, or spring. We found that there were no significant differences in total grass production among the burns on either upland or lowland topographic positions, although spring burned watersheds had higher grass culm production and lower forb biomass than autumn and winter burned watersheds. Burning in autumn or winter broadened the window of grass productivity response to precipitation, which reduces susceptibility to mid-season drought. Burning in autumn or winter also increased the phenological range of species by promoting cool-season graminoids without a concomitant decrease in warm-season grasses, potentially widening the seasonal window of high-quality forage. Incorporating autumn and winter burns into the overall portfolio of tallgrass prairie management should increase the flexibility in managing grasslands, promote biodiversity, and minimize air quality issues caused by en masse late-spring burning with little negative consequences for cattle production. PMID:25077487

Ecological consequences of shifting the timing of burning tallgrass prairie.

PubMed

Towne, E Gene; Craine, Joseph M

2014-01-01

In the Kansas Flint Hills, grassland burning is conducted during a relatively narrow window because management recommendations for the past 40 years have been to burn only in late spring. Widespread prescribed burning within this restricted time frame frequently creates smoke management issues downwind. A potential remedy for the concentrated smoke production in late spring is to expand burning to times earlier in the year. Yet, previous research suggested that burning in winter or early spring reduces plant productivity and cattle weight gain while increasing the proportion of undesirable plant species. In order to better understand the ecological consequences of burning at different times of the year, plant production and species abundance were measured for 20 years on ungrazed watersheds burned annually in autumn, winter, or spring. We found that there were no significant differences in total grass production among the burns on either upland or lowland topographic positions, although spring burned watersheds had higher grass culm production and lower forb biomass than autumn and winter burned watersheds. Burning in autumn or winter broadened the window of grass productivity response to precipitation, which reduces susceptibility to mid-season drought. Burning in autumn or winter also increased the phenological range of species by promoting cool-season graminoids without a concomitant decrease in warm-season grasses, potentially widening the seasonal window of high-quality forage. Incorporating autumn and winter burns into the overall portfolio of tallgrass prairie management should increase the flexibility in managing grasslands, promote biodiversity, and minimize air quality issues caused by en masse late-spring burning with little negative consequences for cattle production.

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

PubMed Central

Baloye, David O.

2016-01-01

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

Clinical factors affecting physicians' management decisions in cases of female partner abuse.

PubMed

Ferris, L E; Norton, P; Dunn, E V; Gort, E H

1999-06-01

This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.

Extended producer responsibility: The impact of organizational dimensions on WEEE collection from households.

PubMed

Corsini, Filippo; Rizzi, Francesco; Frey, Marco

2017-01-01

Extended Producer Responsibility (EPR) has been the backbone of product life cycle management in Europe since the 2000s. Unfortunately, EPR implementation has multiple impacts on the supply chain and, thus, its consequences are not always easily manageable. Although several studies have explored various examples within the EU, the determinants of the effectiveness of EPR management are still not fully understood. This research seeks to bridge this gap by making use of quantitative analyses to investigate how key issues related to: WEEE Directive transposition and organizational settings adopted by each Member State, influenced the results achieved in those Member States in terms of collection from households. In details, a latent class analysis (LCA) has been used to analyse different EPR management strategies based on the policy set, the supply chain structure, and the performance of the household collection of electronic waste. Results highlight the strong connection between allocation of responsibility and organizational model adopted in Member States and performance related to small households equipment's. Conclusions shows the need for stronger coordination of EPR and waste policies in order to achieve adequate levels of Waste Electrical and Electronic Equipment (WEEE) collection, the need of a clear delineation of the responsibilities of each subject of the supply chain and also the importance of "clearing houses" in moderating the impacts of short-sighted competition between collective schemes. Copyright © 2016 Elsevier Ltd. All rights reserved.

A three-step approach to minimise the impact of a mining site on vicuña (Vicugna vicugna) and to restore landscape connectivity.

PubMed

Mata, Cristina; Malo, Juan E; Galaz, José Luis; Cadorzo, César; Lagunas, Héctor

2016-07-01

Resource extraction projects generate a diversity of negative effects on the environment that are difficult to predict and mitigate. Consequently, adaptive management approaches have been advocated to develop effective responses to impacts that were not predicted. Mammal populations living in or around mine sites are frequently of management concern; yet, there is a dearth of published information on how to minimise the negative effects of different phases of mining operations on them. Here, we present the case study of a copper mine in the Chilean Altiplano, which caused roadkills of the protected vicuña (Vicugna vicugna). This issue led to a three-step solution being implemented: (1) the initial identification of the problem and implementation of an emergency response, (2) the scientific analysis for decision making and (3) the planning and informed implementation of responses for different future scenarios and timescales. The measures taken under each of these steps provide examples of environmental management approaches that make use of scientific information to develop integrated management responses. In brief, our case study showed how (1) the timescale and the necessity/urgency of the case were addressed, (2) the various stakeholders involved were taken into account and (3) changes were included into the physical, human and organisational elements of the company to achieve the stated objectives.

12 CFR 225.83 - What are the consequences of failing to continue to meet applicable capital and management...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false What are the consequences of failing to continue to meet applicable capital and management requirements? 225.83 Section 225.83 Banks and Banking....83 What are the consequences of failing to continue to meet applicable capital and management...

Counter-Chemical, Biological, Radiological, and Nuclear Operations

DTIC Science & Technology

2007-01-26

environment. (Page 10) Consequence management activities serve to reduce the effects of a CBRN attack or event, and assist in the restoration of...can be used quite effectively as attack agents. Toxic Industrial Chemicals (TICs), Toxic Industrial Materials (TIMs), and other potentially...CBRN pillars. Consequence Management Consequence management (CM) activities serve to reduce the effects of a CBRN attack or event, and assist in

Fever--an update.

PubMed

Becker, John H; Wu, Stephanie C

2010-01-01

Fever is an active yet nonspecific response of the body to infections and other insults that cause immune cells to release cytokines, resulting in a brain prostanoid-mediated rise in body temperature. The causes, types, clinical management, and postoperative consequences of fever are reviewed in this article. Physicians use fever as a clinical sign for diagnoses and prognoses, but "fevers of unknown origin" continue to be problematic. Fevers that arise 1 or 2 days after surgery are usually due to stress and trauma, but later postoperative fevers often have more serious causes and consequences, such as wound infection. Fever is commonly encountered by podiatric physicians and surgeons, and certain procedures with the lower extremity are more likely to eventuate in fever.

Reducing disaster risk in rural Arctic communities through effective communication strategies

NASA Astrophysics Data System (ADS)

Kontar, Y. Y.

2015-12-01

Communication is the process of exchanging and relaying vital information that has bearing on the effectiveness of all phases of emergency management: mitigation, preparedness, response, and recovery, making it one of the most important activities in disasters. Lack of communication between emergency managers, policy makers, and communities at risk may result in an inability to accurately identify disaster risk, and failure to determine priorities during a hazard event. Specific goals of communication change during the four phases of emergency management. Consequently, the communication strategy changes as well. Communication strategy also depends on a variety of attitudinal and motivational characteristics of the population at risk, as well as socioeconomic, cultural, and geographical features of the disaster-prone region. In May 2013, insufficient communication patterns between federal, state, tribal agencies, and affected communities significantly contributed to delays in the flood response and recovery in several rural villages along the Yukon River in central Alaska. This case study finds that long term dialogue is critical for managing disaster risk and increasing disaster resilience in rural Northern communities. It introduces new ideas and highlights best practices in disaster communication.

Wind disasters: A comprehensive review of current management strategies

PubMed Central

Marchigiani, Raffaele; Gordy, Stephanie; Cipolla, James; Adams, Raeanna C; Evans, David C; Stehly, Christy; Galwankar, Sagar; Russell, Sarah; Marco, Alan P; Kman, Nicholas; Bhoi, Sanjeev; Stawicki, Stanislaw P A; Papadimos, Thomas J

2013-01-01

Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed. The authors highlight the importance of advance planning and adequate preparation as well as prompt and well-organized response to potential damage involving healthcare infrastructure and the associated consequences to the medical response system. Ways to minimize both the extent of infrastructure damage and its effects on the healthcare system are discussed, focusing on lessons learned from recent major wind disasters around the globe. Finally, aspects of healthcare delivery in disaster zones are reviewed. PMID:23961458

Emergency Response Health Physics

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

Mena, RaJah; Pemberton, Wendy; Beal, William

2012-05-01

Health physics is an important discipline with regard to understanding the effects of radiation on human health; however, there are major differences between health physics for research or occupational safety and health physics during a large-scale radiological emergency. The deployment of a U.S. Department of Energy/National Nuclear Security Administration (DOE/NNSA) monitoring and assessment team to Japan in the wake of the March 2011 accident at Fukushima Daiichi Nuclear Power Plant yielded a wealth of lessons on these difference. Critical teams (CMOC (Consequence Management Outside the Continental U.S.) and CMHT (Consequence Management Home Team) ) worked together to collect, compile, review,more » and analyze radiological data from Japan to support the response needs of and answer questions from the Government of Japan, the U.S. military in Japan, the U.S. Embassy and U.S. citizens in Japan, and U.S. citizens in America. This paper addresses the unique challenges presented to the health physicist or analyst of radiological data in a large-scale emergency. A key lesson learned was that public perception and the availability of technology with social media requires a diligent effort to keep the public informed of the science behind the decisions in a manner that is meaningful to them.« less

Ecological responses to el Niño-induced surface fires in central Brazilian Amazonia: management implications for flammable tropical forests.

PubMed Central

Barlow, Jos; Peres, Carlos A

2004-01-01

Over the past 20 years the combined effects of El Niño-induced droughts and land-use change have dramatically increased the frequency of fire in humid tropical forests. Despite the potential for rapid ecosystem alteration and the current prevalence of wildfire disturbance, the consequences of such fires for tropical forest biodiversity remain poorly understood. We provide a pan-tropical review of the current state of knowledge of these fires, and include data from a study in a seasonally dry terra firme forest of central Brazilian Amazonia. Overall, this study supports predictions that rates of tree mortality and changes in forest structure are strongly linked to burn severity. The potential consequences for biomass loss and carbon emissions are explored. Despite the paucity of data on faunal responses to tropical forest fires, some trends are becoming apparent; for example, large canopy frugivores and understorey insectivorous birds appear to be highly sensitive to changes in forest structure and composition during the first 3 years after fires. Finally, we appraise the management implications of fires and evaluate the viability of techniques and legislation that can be used to reduce forest flammability, prevent anthropogenic ignition sources from coming into contact with flammable forests and aid the post-fire recovery process. PMID:15212091

The hospital doctor of today - still continuously on duty.

PubMed

Hertzberg, Tuva Kolstad; Skirbekk, Helge; Tyssen, Reidar; Aasland, Olaf Gjerløw; Rø, Karin Isaksson

2016-10-01

Norwegian hospital doctors emphasise the value of working hard and efficiently and of a high degree of attendance in the workplace. This helps establish social norms that guide behaviour within the professional culture. It is important to examine what consequences these values may entail when the doctor also needs to cater to his or her own needs. We conducted eight focus-group interviews and three individual interviews among a total of 48 senior consultants and specialty registrars working in the areas of surgery, psychiatry and internal medicine. Total N = 48; 56  % women. The interviews were analysed with the aid of systematic text condensation. When Norwegian hospital doctors wish to appear as good doctors, they see that this entails consequences for the interrelationships with colleagues, the management and the work-life balance. Conflicts of interest arose between senior consultants and specialty registrars. Management initiatives to deal with absence, adaptation of the job to the life stage of each individual doctor and increased management involvement among doctors were among the measures proposed. Better mutual knowledge between doctors and management with regard to each other’s values and responsibilities could constitute key premises for structural changes, for example in terms of better planning of leaves of absence and opportunities for adaptation of work schedules to the life stage of the persons concerned.

Stress and ways of coping among nurse managers: An integrative review.

PubMed

Labrague, Leodoro J; McEnroe-Petitte, Denise M; Leocadio, Michael C; Van Bogaert, Peter; Cummings, Greta G

2018-04-01

To appraise and synthesise empirical studies examining sources of occupational stress and ways of coping utilised by nurse managers when dealing with stress. The Nurse Manager's role is challenging yet draining and stressful and has adverse consequences on an individual's overall health and well-being, patients' outcomes and organisational productivity. Considerable research has been carried out; however, an updated and broader perspective on this critical organisational issue has not been performed. An integrative review. Five databases (Cumulative Index to Nursing and Allied Health Literature, SCOPUS, PubMed, PsychINFO and MEDLINE) were searched to identify relevant articles. Search terms and MeSH terms included: "charge nurse," "coping," "coping strategy," "coping style," "psychological adaptation," "psychological stress," "stressors," "nurse manager" and "unit manager." Twenty-two articles were included in this review. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Four themes were identified: moderate stress levels, common sources of stress, ways of coping and the impact of nurses' characteristics on stress. Nurse managers experienced moderate levels of stress mainly from heavy workloads, lack of resources and financial responsibilities. Enhancing social support and promoting job control were seen as important in reducing work stress and its related consequences. Additional studies using a more rigorous method and a larger sample size preferably in multicultural settings would shed more light on this topic. Hospital and nurse administrators play an important role in promoting supportive structures for daily professional practice for nurse managers through staffing, organisational resources, support services, leadership and stress management training. © 2017 John Wiley & Sons Ltd.

The impacts of different management strategies and environmental forcing in ecological communities

PubMed Central

Enberg, Katja; Fowler, Mike S; Ranta, Esa

2006-01-01

Understanding the effects of population management on the community a target species belongs to is of key importance for successful management. It is known that the removal or extinction of a single species in a community may lead to extinctions of other community members. In our study, we assess the impacts of population management on competitive communities, studying the response of both locally stable and unstable communities of varying size (between four and 10 species) to three different management strategies; harvesting of a target species, harvesting with non-targeted catch, and stocking of the target species. We also studied the consequences of selecting target species with different relative abundances, as well as the effects of varying environmental conditions. We show here how the effects of management in competitive communities extend far beyond the target population. A crucial role is played by the underlying stability properties of the community under management. In general, locally unstable communities are more vulnerable to perturbation through management. Furthermore, the community response is shown to be sensitive to the relative density of the target species. Of considerable interest is the result that even a small (2.5%) increase in the population size of the target species through stocking may lead to extinction of other community members. These results emphasize the importance of considering and understanding multi-species interactions in population management. PMID:16959640

Urbanization, Extreme Events, and Health: The Case for Systems Approaches in Mitigation, Management, and Response.

PubMed

Siri, José Gabriel; Newell, Barry; Proust, Katrina; Capon, Anthony

2016-03-01

Extreme events, both natural and anthropogenic, increasingly affect cities in terms of economic losses and impacts on health and well-being. Most people now live in cities, and Asian cities, in particular, are experiencing growth on unprecedented scales. Meanwhile, the economic and health consequences of climate-related events are worsening, a trend projected to continue. Urbanization, climate change and other geophysical and social forces interact with urban systems in ways that give rise to complex and in many cases synergistic relationships. Such effects may be mediated by location, scale, density, or connectivity, and also involve feedbacks and cascading outcomes. In this context, traditional, siloed, reductionist approaches to understanding and dealing with extreme events are unlikely to be adequate. Systems approaches to mitigation, management and response for extreme events offer a more effective way forward. Well-managed urban systems can decrease risk and increase resilience in the face of such events. © 2015 APJPH.

REASONS AND CONSEQUENCES OF APPLIED LEADERSHIP STYLES IN ETHICAL DILEMMAS WHEN NURSE MANAGERS MAKE DECISIONS.

PubMed

Zydziunaite, V; Suominen, T

2014-09-21

Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. Purpose: To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. Methods: The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (n=278) were nurse managers. The data were analyzed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. Results: The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients', relatives' and nurse managers' needs. Conclusions: Nurse managers exhibited leadership styles oriented to maintenance, focusing more on the "doing the job" than on managing the decision-making in ethical dilemmas.

Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences.

PubMed

Zydziunaite, Vilma; Suominen, Tarja

2014-01-01

Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (N = 278) were nurse managers. The data were analysed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients,' relatives' and nurse managers' needs. Nurse managers exhibited leadership styles oriented to maintenance, focussing more on the 'doing the job' than on managing the decision-making in ethical dilemmas.

Food for contagion: synthesis and future directions for studying host-parasite responses to resource shifts in anthropogenic environments.

PubMed

Altizer, Sonia; Becker, Daniel J; Epstein, Jonathan H; Forbes, Kristian M; Gillespie, Thomas R; Hall, Richard J; Hawley, Dana M; Hernandez, Sonia M; Martin, Lynn B; Plowright, Raina K; Satterfield, Dara A; Streicker, Daniel G

2018-05-05

Human-provided resource subsidies for wildlife are diverse, common and have profound consequences for wildlife-pathogen interactions, as demonstrated by papers in this themed issue spanning empirical, theoretical and management perspectives from a range of study systems. Contributions cut across scales of organization, from the within-host dynamics of immune function, to population-level impacts on parasite transmission, to landscape- and regional-scale patterns of infection. In this concluding paper, we identify common threads and key findings from author contributions, including the consequences of resource subsidies for (i) host immunity; (ii) animal aggregation and contact rates; (iii) host movement and landscape-level infection patterns; and (iv) interspecific contacts and cross-species transmission. Exciting avenues for future work include studies that integrate mechanistic modelling and empirical approaches to better explore cross-scale processes, and experimental manipulations of food resources to quantify host and pathogen responses. Work is also needed to examine evolutionary responses to provisioning, and ask how diet-altered changes to the host microbiome influence infection processes. Given the massive public health and conservation implications of anthropogenic resource shifts, we end by underscoring the need for practical recommendations to manage supplemental feeding practices, limit human-wildlife conflicts over shared food resources and reduce cross-species transmission risks, including to humans.This article is part of the theme issue 'Anthropogenic resource subsidies and host-parasite dynamics in wildlife'. © 2018 The Author(s).

Bhopal: lessons learned

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

Greenly, G.D. Jr.

1986-03-01

The risk assessment lesson learned from the Bhopal tragedy is both simple and complex. Practical planning for toxic material releases must start with an understanding of what the risks and possible consequences are. Additionally, plans must be formulated to ensure immediate decisive actions tailored to site specific scenarios, and the possible impacts projected on both the plant and surrounding communities. Most importantly, the planning process must include the communities that could be affected. Such planning will ultimately provide significant financial savings and provide for good public relations, and this makes good business sense in both developed and developing countries. Paraphrasingmore » the adage ''a penny saved is a penny earned,'' a penny spent on emergency preparedness is dollars earned through public awareness. The complex aspect of these simple concepts is overcoming human inertia, i.e., overcoming the ''it can't happen here'' syndrome in both government and private industry. A world center of excellence (ITRAC), acting as a center for education, research, and development in the area of emergency planning and response, will be the conduit for needed technology transfer to national centers of excellence in emergency planning and response. These national emergency planning and response centers (NARACS), managed by private industry for governments, will be catalysts to action in formulating effective plans involving potentially affected communities and plant management. The ITRAC/NARAC proposal is a simple concept involving complex ideas to solve the simple problem of being prepared for the Bhopal-like emergency which, as experience has demonstrated, will have complex consequences for the unprepared.« less

P4 medicine approach to obstructive sleep apnoea.

PubMed

Lim, Diane C; Sutherland, Kate; Cistulli, Peter A; Pack, Allan I

2017-07-01

P4 medicine is an evolving approach to personalized medicine. The four Ps offer a means to: Predict who will develop disease and co-morbidities; Prevent rather than react to disease; Personalize diagnosis and treatment; have patients Participate in their own care. P4 medicine is very applicable to obstructive sleep apnoea (OSA) because each OSA patient has a different pathway to disease and its consequences. OSA has both structural and physiological mechanisms with different clinical subgroups, different molecular profiles and different consequences. This may explain why there are different responses to alternative therapies, such as intraoral devices and hypoglossal nerve stimulation therapy. Currently, technology facilitates patients to participate in their own care from screening for OSA (snoring and apnoea apps) to monitoring response to therapy (sleep monitoring, blood pressure, oxygen saturation and heart rate) as well as monitoring their own continuous positive airway pressure (CPAP) compliance. We present a conceptual framework that provides the basis for a new, P4 medicine approach to OSA and should be considered more in depth: predict and prevent those at high risk for OSA and consequences, personalize the diagnosis and treatment of OSA and build in patient participation to manage OSA. © 2017 Asian Pacific Society of Respirology.

Behavioural responses to human-induced change: Why fishing should not be ignored.

PubMed

Diaz Pauli, Beatriz; Sih, Andrew

2017-03-01

Change in behaviour is usually the first response to human-induced environmental change and key for determining whether a species adapts to environmental change or becomes maladapted. Thus, understanding the behavioural response to human-induced changes is crucial in the interplay between ecology, evolution, conservation and management. Yet the behavioural response to fishing activities has been largely ignored. We review studies contrasting how fish behaviour affects catch by passive (e.g., long lines, angling) versus active gears (e.g., trawls, seines). We show that fishing not only targets certain behaviours, but it leads to a multitrait response including behavioural, physiological and life-history traits with population, community and ecosystem consequences. Fisheries-driven change (plastic or evolutionary) of fish behaviour and its correlated traits could impact fish populations well beyond their survival per se , affecting predation risk, foraging behaviour, dispersal, parental care, etc., and hence numerous ecological issues including population dynamics and trophic cascades . In particular, we discuss implications of behavioural responses to fishing for fisheries management and population resilience. More research on these topics, however, is needed to draw general conclusions, and we suggest fruitful directions for future studies.

Characterization of post-disaster environmental management for Hazardous Materials Incidents: Lessons learnt from the Tianjin warehouse explosion, China.

PubMed

Zhang, Hui; Duan, Huabo; Zuo, Jian; Song, MingWei; Zhang, Yukui; Yang, Bo; Niu, Yongning

2017-09-01

Hazardous Materials Incidents (HMIs) have attracted a growing public concern worldwide. The health risks and environmental implications associated with HMIs are almost invariably severe, and underscore the urgency for sound management. Hazardous Materials Explosion incidents (HMEIs) belong to a category of extremely serious HMIs. Existing studies placed focuses predominately on the promptness and efficiency of emergency responses to HMIs and HMEIs. By contrast, post-disaster environmental management has been largely overlooked. Very few studies attempted to examine the post-disaster environmental management plan particularly its effectiveness and sufficiency. In the event of the Tianjin warehouse explosion (TWE), apart from the immediate emergency response, the post-disaster environmental management systems (P-EMSs) have been reported to be effective and sufficient in dealing with the environmental concerns. Therefore, this study aims to critically investigate the P-EMSs for the TWE, and consequently to propose a framework and procedures for P-EMSs in general for HMIs, particularly for HMEIs. These findings provide a useful reference to develop P-EMSs for HMIs in the future, not only in China but also other countries. Copyright © 2017. Published by Elsevier Ltd.

Aircraft Capability Management

NASA Technical Reports Server (NTRS)

Mumaw, Randy; Feary, Mike

2018-01-01

This presentation presents an overview of work performed at NASA Ames Research Center in 2017. The work concerns the analysis of current aircraft system management displays, and the initial development of an interface for providing information about aircraft system status. The new interface proposes a shift away from current aircraft system alerting interfaces that report the status of physical components, and towards displaying the implications of degradations on mission capability. The proposed interface describes these component failures in terms of operational consequences of aircraft system degradations. The research activity was an effort to examine the utility of different representations of complex systems and operating environments to support real-time decision making of off-nominal situations. A specific focus was to develop representations that provide better integrated information to allow pilots to more easily reason about the operational consequences of the off-nominal situations. The work is also seen as a pathway to autonomy, as information is integrated and understood in a form that automated responses could be developed for the off-nominal situations in the future.

Spatial variation in risk and consequence of Batrachochytrium salamandrivorans introduction in the USA

USGS Publications Warehouse

Richgels, Katherine L. D.; Russell, Robin E.; Adams, Michael J.; White, C. LeAnn; Campbell Grant, Evan H.

2016-01-01

A newly identified fungal pathogen, Batrachochytrium salamandrivorans (Bsal), is responsible for mass mortality events and severe population declines in European salamanders. The eastern USA has the highest diversity of salamanders in the world and the introduction of this pathogen is likely to be devastating. Although data are inevitably limited for new pathogens, disease-risk assessments use best available data to inform management decisions. Using characteristics of Bsal ecology, spatial data on imports and pet trade establishments, and salamander species diversity, we identify high-risk areas with both a high likelihood of introduction and severe consequences for local salamanders. We predict that the Pacific coast, southern Appalachian Mountains and mid-Atlantic regions will have the highest relative risk from Bsal. Management of invasive pathogens becomes difficult once they are established in wildlife populations; therefore, import restrictions to limit pathogen introduction and early detection through surveillance of high-risk areas are priorities for preventing the next crisis for North American salamanders.

Estimating the strength of bone using linear response

NASA Astrophysics Data System (ADS)

Gunaratne, Gemunu H.

2002-12-01

Accurate diagnostic tools are required for effective management of osteoporosis; one method to identify additional diagnostics is to search for observable consequences of bone loss. An analysis of a model system is used to show that weakening of a bone is accompanied by a reduction of the fraction of the bone that participates in load transmission. On the basis of this observation, it is argued that the ratio Γ of linear responses of a network to dc and high-frequency ac driving can be used as a surrogate for their strength. Protocols needed to obtain Γ for bone samples are discussed.

Y chromosome microdeletions and alterations of spermatogenesis, patient approach and genetic counseling.

PubMed

Rives, Nathalie

2014-05-01

Infertility affects 15% of couples at reproductive age and human male infertility appears frequently idiopathic. The main genetic causes of spermatogenesis defect responsible for non-obstructive azoospermia and severe oligozoospermia are constitutional chromosomal abnormalities and microdeletions in the azoospermia factor region of the Y chromosome. The improvement of the Yq microdeletion screening method gave new insights in the mechanism responsible for the genesis of Yq microdeletions and for the consequences of the management of male infertility and genetic counselling in case of assisted reproductive technology. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Immunotherapy in the management of sepsis.

PubMed Central

Fagan, E. A.; Singer, M.

1995-01-01

The pathophysiological effects of severe sepsis, septic shock and related syndromes result from tissues damaged by the uncontrolled production of the mediators of inflammation. Early deaths are related primarily to the acute effects of the systemic inflammatory response. Later deaths are related more closely to the consequences of multiple organ dysfunction. Monoclonal antibodies and other immunotherapies have been developed against bacterial products, cytokines and other mediators involved in this systemic inflammatory response. Immunotherapies may improve outcome in the critically ill with sepsis if used early and as part of the therapeutic regimen of antimicrobial agents and intensive care support. PMID:7724438

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

NASA Technical Reports Server (NTRS)

Potter, Scott S.; Woods, David D.

1994-01-01

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

Treatment Nonadherence in Inflammatory Bowel Disease: Identification, Scope, and Management Strategies.

PubMed

Herman, Margot L; Kane, Sunanda V

2015-12-01

Treatment adherence is of critical importance in the management of patients with IBD. Poor adherence can lead to increased disease activity, loss of response to therapy, and increased costs of care. It has been well established that adherence to long-term therapy for chronic illnesses is extremely poor, averaging around 50% in developed countries. Measured rates of nonadherence in IBD are similar, but vary depending on the type of therapy and the population being observed. This article reviews the scientific data on treatment nonadherence in IBD. The methods commonly used to evaluate treatment adherence investigation are reviewed. The consequences and scope of treatment nonadherence are summarized. Finally, the scientific data on management strategies to address the problem of treatment nonadherence are explored.

Rapid Response Team activation for pediatric patients on the acute pain service.

PubMed

Teets, Maxwell; Tumin, Dmitry; Walia, Hina; Stevens, Jenna; Wrona, Sharon; Martin, David; Bhalla, Tarun; Tobias, Joseph D

2017-11-01

Untreated pain or overly aggressive pain management may lead to adverse physiologic consequences and activation of the hospital's Rapid Response Team. This study is a quality improvement initiative that attempts to identify patient demographics and patterns associated with Rapid Response Team consultations for patients on the acute pain service. A retrospective review of all patients on the acute pain service from February 2011 until June 2015 was cross-referenced with inpatients requiring consultation from the Rapid Response Team. Two independent practitioners reviewed electronic medical records to determine which events were likely associated with pain management interventions. Over a 4-year period, 4872 patients were admitted to the acute pain service of whom 135 unique patients required Rapid Response Team consults. There were 159 unique Rapid Response Team activations among 6538 unique acute pain service consults. A subset of 27 pain management-related Rapid Response Team consultations was identified. The largest percentage of patients on the acute pain service were adolescents aged 12-17 (36%). Compared to this age group, the odds of Rapid Response Team activation were higher among infants <1 year old (odds ratio = 2.85; 95% confidence interval: 1.59, 5.10; P < .001) and adults over 18 years (odds ratio = 1.68; 95% confidence interval: 1.01, 2.80; P = .046). Identifying demographics and etiologies of acute pain service patients requiring Rapid Response Team consultations may help to identify patients at risk for clinical decompensation. © 2017 John Wiley & Sons Ltd.

Climate Observations from Space

NASA Astrophysics Data System (ADS)

Briggs, Stephen

2016-07-01

The latest Global Climate Observing System (GCOS) Status Report on global climate observations, delivered to the UNFCCC COP21 in November 2016, showed how satellite data are critical for observations relating to climate. Of the 50 Essential Climate Variables (ECVs) identified by GCOS as necessary for understanding climate change, about half are derived only from satellite data while half of the remainder have a significant input from satellites. Hence data from Earth observing satellite systems are now a fundamental requirement for understanding the climate system and for managing the consequences of climate change. Following the Paris Agreement of COP21 this need is only greater. Not only will satellites have to continue to provide data for modelling and predicting climate change but also for a much wider range of actions relating to climate. These include better information on loss and damage, resilience, improved adaptation to change, and on mitigation including information on greenhouse gas emissions. In addition there is an emerging need for indicators of the risks associated with future climate change which need to be better quantified, allowing policy makers both to understand what decisions need to be taken, and to see the consequences of their actions. The presentation will set out some of the ways in which satellite data are important in all aspects of understanding, managing and predicting climate change and how they may be used to support future decisions by those responsible for policy related to managing climate change and its consequences.

Business recovery at an arson damaged office.

PubMed

Stewart, Russell

2010-07-01

This paper is in the form of a case study that relates how KPMG's crisis management, business recovery and risk mitigation plans, methods and organisation were applied to ensure its clients' services were not compromised following significant damage to a major office following an arson attack. The paper describes the firm's overall business continuity management (BCM) approach and its key principles, drawn from established BCM, emergency services and psychology sources. The narrative element of the article tracks the event timeline and the firm's corresponding response. The overall management of the incident and its consequences were deemed successful, validating a lean BCM training and exercise regime. A significant learning point was the need to manage numerous stakeholders' interests, engaging on several fronts in parallel, to engender consensus and to expedite decision making. The paper offers practical suggestions to help organisations manage the impact of crisis events on their employees and clients.

Species distributions models in wildlife planning: agricultural policy and wildlife management in the great plains

USGS Publications Warehouse

Fontaine, Joseph J.; Jorgensen, Christopher; Stuber, Erica F.; Gruber, Lutz F.; Bishop, Andrew A.; Lusk, Jeffrey J.; Zach, Eric S.; Decker, Karie L.

2017-01-01

We know economic and social policy has implications for ecosystems at large, but the consequences for a given geographic area or specific wildlife population are more difficult to conceptualize and communicate. Species distribution models, which extrapolate species-habitat relationships across ecological scales, are capable of predicting population changes in distribution and abundance in response to management and policy, and thus, are an ideal means for facilitating proactive management within a larger policy framework. To illustrate the capabilities of species distribution modeling in scenario planning for wildlife populations, we projected an existing distribution model for ring-necked pheasants (Phasianus colchicus) onto a series of alternative future landscape scenarios for Nebraska, USA. Based on our scenarios, we qualitatively and quantitatively estimated the effects of agricultural policy decisions on pheasant populations across Nebraska, in specific management regions, and at wildlife management areas. 

Towards understanding and managing chronic cough.

PubMed

Satia, Imran; Badri, Huda; Al-Sheklly, Bashar; Smith, Jaclyn Ann; Woodcock, Ashley A

2016-12-01

Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological, social and physical consequences. Patients typically complain of a dry irritating cough, driven by a strong urge to cough associated with a sensation or irritation located in the throat. Treatment of potential 'causes', ie asthma, gastro-oesophageal reflux disease and rhino-sinusitis, may produce a complete or partial response, but the response of some patients to opiates and alpha-2-delta ligand antagonists (gabapentin and pregabalin) supports the concept that this is primarily a neurological disorder, characterised by hyper-responsiveness of the nerves. Novel and highly effective neuronal treatments are in development and offer hope of better symptom control with fewer side effects within a few years. This review focuses on understanding the mechanism of chronic cough, current management approaches and research that may lead to novel therapies. © Royal College of Physicians 2016. All rights reserved.

Short- and long-term health consequences of sleep disruption.

PubMed

Medic, Goran; Wille, Micheline; Hemels, Michiel Eh

2017-01-01

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption.

Short- and long-term health consequences of sleep disruption

PubMed Central

Medic, Goran; Wille, Micheline; Hemels, Michiel EH

2017-01-01

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption. PMID:28579842

Managing an epidemic: Zika interventions and community responses in Belize.

PubMed

Gray, Deven; Mishtal, Joanna

2018-05-07

Implementing effective health interventions in recent epidemics has been difficult due to the potentially global nature of their spread and sociocultural dynamics, raising questions concerning how to develop culturally-appropriate preventive measures, and how these health threats are understood locally. In Belize, health policy makers have only been marginally effective in managing infections and mosquito vectors, and Zika has been declared endemic in certain regions, particularly on the island of Caye Caulker. Based on ethnographic research conducted primarily in 2017, we examine how perspectives of Zika-related health consequences are shaped, and how state interventions to manage Zika are understood. We argue that despite its declared endemic status, Zika is not perceived as a true health concern for community members due to numerous neoliberal structural challenges. Moreover, the state's restrictive form of reproductive governance which limits family planning services is forcing individuals to weigh conflicting conceptions of health consequences. This also contributes to an ambiguous healthcare environment for health practitioners, giving them an unclear picture of the scope of Zika as a public health concern. We also consider how critical medical anthropology and feminist analytical approaches are useful in exploring these questions and contributing to understandings of the health impacts of Zika.

Perceiving Cardiac Rehabilitation Staff as Mainly Responsible for Exercise: A Dilemma for Future Self-Management.

PubMed

Flora, Parminder K; McMahon, Casey J; Locke, Sean R; Brawley, Lawrence R

2018-03-01

Cardiac rehabilitation (CR) exercise therapy facilitates patient recovery and better health following a cardiovascular event. However, post-CR adherence to self-managed (SM)-exercise is suboptimal. Part of this problem may be participants' view of CR staff as mainly responsible for help and program structure. Does post-CR exercise adherence for those perceiving high CR staff responsibility suffer as a consequence? Participants in this prospective, observational study were followed over 12 weeks of CR and one month afterward. High perceived staff responsibility individuals were examined for a decline in the strength of adherence-related social cognitions and exercise. Those high and low in perceived staff responsibility were also compared. High perceived staff responsibility individuals reported significant declines in anticipated exercise persistence (d = .58) and number of different SM-exercise options (d = .44). High versus low responsibility comparisons revealed a significant difference in one-month post-CR SM-exercise volume (d = .67). High perceived staff responsibility individuals exercised half of the amount of low responsibility counterparts at one month post-CR. Perceived staff responsibility and CR SRE significantly predicted SM-exercise volume, R 2 adj = .10, and persistence, R 2 adj = .18, one month post-CR. Viewing helpful well-trained CR staff as mainly responsible for participant behavior may be problematic for post-CR exercise maintenance among those more staff dependent. © 2017 The International Association of Applied Psychology.

The relevance of sleep abnormalities to chronic inflammatory conditions.

PubMed

Ranjbaran, Z; Keefer, L; Stepanski, E; Farhadi, A; Keshavarzian, A

2007-02-01

Sleep is vital to health and quality of life while sleep abnormalities are associated with adverse health consequences. Nevertheless, sleep problems are not generally considered by clinicians in the management of chronic inflammatory conditions (CIC) such as asthma, RA, SLE and IBD. To determine whether this practice is justified, we reviewed the literature on sleep and chronic inflammatory diseases, including effects of sleep on immune system and inflammation. We found that a change in the sleep-wake cycle is often one of the first responses to acute inflammation and infection and that the reciprocal effect of sleep on the immune system in acute states is often protective and restorative. For example, slow wave sleep can attenuate proinflammatory immune responses while sleep deprivation can aggravate those responses. The role of sleep in CIC is not well explored. We found a substantial body of published evidence that sleep disturbances can worsen the course of CIC, aggravate disease symptoms such as pain and fatigue, and increase disease activity and lower quality of life. The mechanism underlying these effects probably involves dysregulation of the immune system. All this suggests that managing sleep disturbances should be considered as an important factor in the overall management of CIC.

The Lynch syndrome: a management dilemma.

PubMed

Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Dezzi, Claudia; Girolami, Marco; Illuminati, Giulio; Angelici, Alberto M

2013-05-01

The case of a familial Lynch syndrome is reported. The criteria for early diagnosis, management and surveillance are briefly reviewed. A germline mutation of genes responsible for mismatch repair is at the basis of the Lynch syndrome. Carriers are predisposed to colorectal cancer and other tumors. Two members of the presently reported family developed colorectal cancer, whereas two others developed other neoplasms. The syndrome was confirmed in members of the same family with appropriate genetic workup. Clinical examination and endoscopy were consequently scheduled once-a-year. Given the high risk of neoplastic disease, such yearly controls can be proposed as the standard follow-up of this condition.

Combating Terrorism: Issues in Managing Counterterrorist Programs

DTIC Science & Technology

2000-04-06

major effort to develop a national strategy, to date the strategy does not include a clear desired outcome to be achieved. Resources to combat...Federal exercises, in contrast to earlier years, are now practicing crisis and consequence management simultaneously and including state and local...categories—crisis management and consequence management. Crisis management includes efforts to stop a terrorist attack, arrest terrorists, and gather

Exercise, appetite and weight management: understanding the compensatory responses in eating behaviour and how they contribute to variability in exercise-induced weight loss.

PubMed

King, N A; Horner, K; Hills, A P; Byrne, N M; Wood, R E; Bryant, E; Caudwell, P; Finlayson, G; Gibbons, C; Hopkins, M; Martins, C; Blundell, J E

2012-04-01

Does exercise promote weight loss? One of the key problems with studies assessing the efficacy of exercise as a method of weight management and obesity is that mean data are presented and the individual variability in response is overlooked. Recent data have highlighted the need to demonstrate and characterise the individual variability in response to exercise. Do people who exercise compensate for the increase in energy expenditure via compensatory increases in hunger and food intake? The authors address the physiological, psychological and behavioural factors potentially involved in the relationship between exercise and appetite, and identify the research questions that remain unanswered. A negative consequence of the phenomena of individual variability and compensatory responses has been the focus on those who lose little weight in response to exercise; this has been used unreasonably as evidence to suggest that exercise is a futile method of controlling weight and managing obesity. Most of the evidence suggests that exercise is useful for improving body composition and health. For example, when exercise-induced mean weight loss is <1.0 kg, significant improvements in aerobic capacity (+6.3 ml/kg/min), systolic (-6.00 mm Hg) and diastolic (-3.9 mm Hg) blood pressure, waist circumference (-3.7 cm) and positive mood still occur. However, people will vary in their responses to exercise; understanding and characterising this variability will help tailor weight loss strategies to suit individuals.

The Microbiome Structure of Oklahoma Cropland and Prairie Soils and its Response to Seasonal Forcing and Management Practices

NASA Astrophysics Data System (ADS)

Cornell, C. R.; Peterson, B.; Zhou, J.; Xiao, X.; Wawrik, B.

2017-12-01

Greenhouse gases (GHG) emissions from soils are primarily the consequence of microbial processes. Agricultural management of soils is known to affect the structure of microbial communities, and it is likely that dominant GHG emitting microbial activities are impacted via requisite practices. To gain better insight into the impact of seasonal forcing and management practices on the microbiome structure in Oklahoma agricultural soils, a seasonal study was conducted. Over a year period, samples were collected bi-weekly during wet months, and monthly during dry months from two grassland and two managed agricultural sites in El Reno, Oklahoma. Microbial community structure was determined in quadruplicate for each site and time point via 16S rRNA gene sequencing. Measures of soil water content, subsoil nitrate, ammonium, organic matter, total nitrogen, and biomass were also taken for each time point. Data analysis revealed several important trends, indicating greater microbial diversity in native grassland and distinct microbial community changes in response to management practices. The native grassland soils also contained greater microbial biomass than managed soils and both varied in response to rainfall events. Native grassland soils harbor more diverse microbial communities, with the diversity and biomass decreasing along a gradient of agricultural management intensity. These data indicate that microbial community structure in El Reno soils occurs along a continuum in which native grasslands and highly managed agricultural soils (tilling and manure application) form end members. Integration with measurements from eddy flux towers into modelling efforts using the DeNitrification-DeComposition (DNDC) model is currently being explored to improve predictions of GHG emissions from grassland soils.

USGS Multi-Hazards Winter Storm Scenario

NASA Astrophysics Data System (ADS)

Cox, D. A.; Jones, L. M.; Perry, S. C.

2008-12-01

The USGS began an inter-disciplinary effort, the Multi Hazards Demonstration Project (MHDP), in 2007 to demonstrate how hazards science can improve a community's resiliency to natural disasters including earthquakes, tsunamis, wildfires, landslides, floods and coastal erosion. The project engages the user community in setting research goals and directs efforts towards research products that can be applied to loss reduction and improved resiliency. The first public product of the MHDP was the ShakeOut Earthquake Scenario published in May 2008. It detailed the realistic outcomes of a hypothetical, but plausible, magnitude 7.8 earthquake on the San Andreas Fault in southern California. Over 300 scientist and experts contributed to designing the earthquake and understanding the impacts of such a disaster, including the geotechnical, engineering, social, cultural, environmental, and economic consequences. The scenario advanced scientific understanding and exposed numerous vulnerabilities related to emergency response and lifeline continuity management. The ShakeOut Scenario was the centerpiece of the Nation's largest-ever emergency response exercise in November 2008, dubbed "The Great Southern California ShakeOut" (www.shakeout.org). USGS Multi-Hazards is now preparing for its next major public project, a Winter Storm Scenario. Like the earthquake scenario, experts will be brought together to examine in detail the possibility, cost and consequences of a winter storm disaster including floods, landslides, coastal erosion and inundation; debris flows; biologic consequences like extirpation of endangered species; physical damages like bridge scour, road closures, dam failure, property loss, and water system collapse. Consideration will be given to the vulnerabilities associated with a catastrophic disruption to the water supply to southern California; the resulting impacts on ground water pumping, seawater intrusion, water supply degradation, and land subsidence; and a detailed examination on climatic change forces that could exacerbate the problems. Similar to the ShakeOut Scenario, the Winter Storm Scenario is designing a large but scientifically plausible physical event followed by an expert analysis of the secondary hazards, and the physical, social, and economic consequences. Unlike the earthquake scenario, the winter storm event may occur over days, weeks, and possibly months, and the stakeholder community is broadening to include resource managers as well as local governments and the emergency and lifeline management communities. Developing plans for this Scenario will be presented at this session, and feedback will be welcomed.

Insecticide-induced hormesis and arthropod pest management.

PubMed

Guedes, Raul Narciso C; Cutler, G Christopher

2014-05-01

Ecological backlashes such as insecticide resistance, resurgence and secondary pest outbreaks are frequent problems associated with insecticide use against arthropod pest species. The last two have been particularly important in sparking interest in the phenomenon of insecticide-induced hormesis within entomology and acarology. Hormesis describes a biphasic dose-response relationship that is characterized by a reversal of response between low and high doses of a stressor (e.g. insecticides). Although the concept of insecticide-induced hormesis often does not receive sufficient attention, or has been subject to semantic confusion, it has been reported in many arthropod pest species and natural enemies, and has been linked to pest outbreaks and potential problems with insecticide resistance. The study of hormesis remains largely neglected in entomology and acarology. Here, we examined the concept of insecticide-induced hormesis in arthropods, its functional basis and potential fitness consequences, and its importance in arthropod pest management and other areas. © 2013 Society of Chemical Industry.

Improving supplementary feeding in species conservation.

PubMed

Ewen, John G; Walker, Leila; Canessa, Stefano; Groombridge, Jim J

2015-04-01

Supplementary feeding is often a knee-jerk reaction to population declines, and its application is not critically evaluated, leading to polarized views among managers on its usefulness. Here, we advocate a more strategic approach to supplementary feeding so that the choice to use it is clearly justified over, or in combination with, other management actions and the predicted consequences are then critically assessed following implementation. We propose combining methods from a set of specialist disciplines that will allow critical evaluation of the need, benefit, and risks of food supplementation. Through the use of nutritional ecology, population ecology, and structured decision making, conservation managers can make better choices about what and how to feed by estimating consequences on population recovery across a range of possible actions. This structured approach also informs targeted monitoring and more clearly allows supplementary feeding to be integrated in recovery plans and reduces the risk of inefficient decisions. In New Zealand, managers of the endangered Hihi (Notiomystis cincta) often rely on supplementary feeding to support reintroduced populations. On Kapiti island the reintroduced Hihi population has responded well to food supplementation, but the logistics of providing an increasing demand recently outstretched management capacity. To decide whether and how the feeding regime should be revised, managers used a structured decision making approach informed by population responses to alternative feeding regimes. The decision was made to reduce the spatial distribution of feeders and invest saved time in increasing volume of food delivered into a smaller core area. The approach used allowed a transparent and defendable management decision in regard to supplementary feeding, reflecting the multiple objectives of managers and their priorities. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of Society for Conservation Biology.

Does the law stymie the science? The role of law in achieving sustainable groundwater management

NASA Astrophysics Data System (ADS)

Allan, A.

2012-04-01

Legal frameworks for the management of groundwater evolved in an environment where scientific understanding of the resource was sketchy. As hydrogeological knowledge has improved over time, the law has often failed to catch up and enforcement of those laws that are in place has proved difficult. Consequently, groundwater in many countries is still managed by inadequate regimes that are unable to effectively integrate the impacts of land use management and surface water interactions. The Water Framework Directive and its associated Groundwater Directive require the integrated management of both ground and surface waters, but on a global level, this is unusual. Institutional frameworks often perpetuate this split, and the legal regime for the management of transboundary shared aquifers is a work in progress. Both national and international frameworks encourage a race to over-exploit groundwater resources. Symptomatic of the problems currently seen in groundwater management is a widespread inability to adapt to changing climate and environmental conditions. Users may be granted unchangeable rights of use in perpetuity, and the impacts of aquifer over-exploitation on dependent ecosystems may be ignored. There are therefore significant barriers to the application of existing science in many countries, and this seriously jeopardises efforts to sustainably manage groundwater. This presentation will assess current developments in the laws relating to the use of groundwater around the world, highlighting case studies from India, Australia and the USA, and assessing the implementation of the Groundwater Directive in selected European countries (in work derived from the EU-funded GENESIS project). It will also examine the legal architecture relating to international shared aquifers, and the extent to which it can cope with national groundwater use patterns that will shift in response to climate change and its consequences.

Cognitive Learning Theory Takes a Backseat: Consequences of a Management Development Program for Work Practice

ERIC Educational Resources Information Center

Moesby-Jensen, Cecilie K.

2008-01-01

This paper describes the consequences of a cognitive management development program for middle managers in a public organization. The objective was to teach transformational leadership and teamwork but it occasioned a very limited improved articulation of transformational leadership and teamwork and only a modest change in the managers' actions in…

Typological review of environmental performance metrics (with illustrative examples for oil spill response).

PubMed

Seager, Thomas P; Satterstrom, F Kyle; Linkov, Igor; Tuler, Seth P; Kay, Rebecca

2007-07-01

An intensification of interest in environmental assessment during the last 2 decades has driven corporate efforts to better document environmental goals, improve environmental management systems, and increase awareness of the environmental and ecological effects of business operations. This trend has been motivated partly by regulatory requirements (such as the Toxics Release Inventory in the United States) and partly by the inclination of some large manufacturing firms to embrace a broader social and environmental mission characterized as "sustainability" or "ecoefficiency." Moreover, the importance of measurable objectives in the US government has been recognized at least since the Government Performance Results Act of 1993, which was intended to both improve the efficiency of government and the confidence of the American public in government managers. However, in management of environmental crises - such as catastrophic oil or chemical spills - development of measurable performance standards has lagged. Consequently, government spill managers are unable to define success in terms that are easily communicated to public and other stakeholder groups, and they could be disadvantaged in their efforts to deploy response resources with maximum efficiency. In this paper, we present a typological review of environmental assessment measures and summarize some of the current practices and strategic goals among federal agencies with regard to oil and chemical spills. A general approach to organizing metrics for oil spill response, restoration, and recovery is also presented. The results could improve planning efforts and communication among different federal, state, and local agencies and public or stakeholder groups involved in spill management.

Why do managers allocate resources to workplace health promotion programmes in countries with national health coverage?

PubMed

Downey, Angela M; Sharp, David J

2007-06-01

There is extensive evidence that worksite health promotion (WHP) programmes reduce healthcare costs and improve employee productivity. In many countries, a large proportion of healthcare costs are borne by the state. While the full benefits of WHP are still created, they are shared between employers and the state, even though the employer bears the full (after-tax) cost. Employers therefore have a lower incentive to implement WHP activity. We know little about the beliefs of managers with decision responsibility for the approval and implementation of WHP programmes in this context. This article reports the results of a study of the attitudes of Canadian senior general managers (GMs) and human resource managers (HRMs) in the auto parts industry in Ontario, Canada towards the consequences of increasing discretionary spending on WHP, using Structural Equation Modelling and the Theory of Planned Behaviour. We identified factors that explain managers' intentions to increase discretionary spending on wellness programmes. While both senior GMs and HRMs are motivated primarily by their beliefs that WHP reduces indirect costs of health failure, GMs were also motivated by their moral responsibility towards employees (but surprisingly HRMs were not). Importantly, HRMs, who usually have responsibility for WHP, felt constrained by a lack of power to commit resources. Most importantly, we found no social expectation that organizations should provide WHP programmes. This has important implications in an environment where the adoption of WHP is very limited and cost containment within the healthcare system is paramount.

Transfusion reaction identification and management at the bedside.

PubMed

Crookston, Kendall P; Koenig, Sara C; Reyes, Michael D

2015-01-01

Blood product transfusion is one of the most common invasive procedures performed in the health care setting. In contrast to pharmaceuticals, blood is actually a liquid transplant. Transfusion complications consequently encompass complex biological processes and infectious possibilities. Changes in vital signs are regularly seen during transfusion. Knowledge of common transfusion reaction signs and symptoms enables the clinical team to differentiate a normal patient response from a life-threatening reaction. Direct care nurses responsible for this procedure play a vital role in its success. Understanding the possible complications of transfusion and how to quickly recognize reactions at the bedside helps ensure the best patient outcomes.

The costs of chronic noise exposure for terrestrial organisms.

PubMed

Barber, Jesse R; Crooks, Kevin R; Fristrup, Kurt M

2010-03-01

Growth in transportation networks, resource extraction, motorized recreation and urban development is responsible for chronic noise exposure in most terrestrial areas, including remote wilderness sites. Increased noise levels reduce the distance and area over which acoustic signals can be perceived by animals. Here, we review a broad range of findings that indicate the potential severity of this threat to diverse taxa, and recent studies that document substantial changes in foraging and anti-predator behavior, reproductive success, density and community structure in response to noise. Effective management of protected areas must include noise assessment, and research is needed to further quantify the ecological consequences of chronic noise exposure in terrestrial environments.

Using typing techniques in a specific outbreak: the ethical reflection of public health professionals.

PubMed

Rump, B; Cornelis, C; Woonink, F; VAN Steenbergen, J; Verweij, M; Hulscher, M

2017-05-01

Typing techniques are laboratory methods used in outbreak management to investigate the degree to which microbes found within an outbreak are related. Knowledge about relational patterns between microbes benefits outbreak management, but inevitably also tells us something about the relational patterns of the people hosting them. Since the technique is often used without explicit consent of all individuals involved, this may raise ethical questions. The aim of this study was to unravel the complex ethical deliberation of professionals over the use of such techniques. We organised group discussions (n = 3) with Dutch outbreak managers (n = 23). The topic list was based on previously identified ethical issues and discussions were analysed for recurrent themes. We found that outbreak managers first and foremost reflect on the balance of individual harm with public health benefit. This key question was approached by way of discussing four more specific ethical themes: (1) justification of governmental intervention, (2) responsibility to prevent infections, (3) scientific uncertainty and (4) legal consequences. The themes found in this study, rephrased into accessible questions, represent the shared ethical understanding of professionals and can help to articulate the ethical dimensions of using molecular science in response to infectious disease outbreaks.

All-Hazard Consequence Management Planning for the Water Sector: Preparedness, Emergency Response, and Recovery CIPAC Workshop

DTIC Science & Technology

2009-11-01

subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE...of Health Mark Miller Centers for Disease Control and Prevention National Center for Environmental Health Debbie Newberry, co-chair US EPA...Utilities Linda Eichmiller Association of State and Interstate Water Pollution Control Administrators Jeff Fencil US EPA Office of Ground Water and

Intelligent Adversary Risk Analysis: A Bioterrorism Risk Management Model (PREPRINT)

DTIC Science & Technology

2009-02-20

Dengue • Listeria monocytogenes • Filoviruses coronavirus ( SARS -CoV) • Campylobacter jejuni • Ebola • Yersinia enterocolitica) • Marburg...OF: 17. LIMITATION OF ABSTRACT Same as Report ( SAR ) 18. NUMBER OF PAGES 29 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT...which may be to maximize the consequences they can inflict (Golany et al., Figure 2: Decision Tree Example  7    Submitted to Risk Analysis

Considering culture in evacuation planning and consequence management.

PubMed

Bergeron, Wayne P

2015-01-01

Because culture profoundly affects human behavior, it is important that emergency management decision makers from both government and the private sector who will be involved in the management of evacuation operations build cultural considerations into their planning, preparations, education, and training from the very beginning. Preparation in this regard ensures that when the crisis hits, the response efforts undertaken will at a minimum not disregard culture or make situations worse because of a lack of cultural understanding and optimally will use the consideration of culture to frame the most effective response possible to ultimately save lives and relieve suffering. Whether it is recognizing that in some cultures the decision to comply with evacuation advice and orders will be made by a matriarch or patriarch of the family, or that the ability of an entire extended family unit to remain together in the evacuation process will be the key to compliance, culture may be the pivotal factor in a successful outcome. It is these (and many more) small cultural considerations and an overall understanding of the effect that culture has on behavior that can enhance the overall effectiveness of a culturally aware organization involved in the management of evacuation operations and emergency response. Hopefully, this initial work begins a deeper discussion and evaluation of cultural aspects both concerning the populations and cultures impacted by events, but just as importantly, the cultures and cultural understanding of the responding organizations.

Reducing the Consequences of a Nuclear Detonation.

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

Buddemeier, B R

2007-11-09

The 2002 National Strategy to Combat Weapons of Mass Destruction states that 'the United States must be prepared to respond to the use of WMD against our citizens, our military forces, and those of friends and allies'. Scenario No.1 of the 15 Department of Homeland Security national planning scenarios is an improvised nuclear detonation in the national capitol region. An effective response involves managing large-scale incident response, mass casualty, mass evacuation, and mass decontamination issues. Preparedness planning activities based on this scenario provided difficult challenges in time critical decision making and managing a large number of casualties within the hazardmore » area. Perhaps even more challenging is the need to coordinate a large scale response across multiple jurisdictions and effectively responding with limited infrastructure and resources. Federal response planning continues to make improvements in coordination and recommending protective actions, but much work remains. The most critical life-saving activity depends on actions taken in the first few minutes and hours of an event. The most effective way to reduce the enormous national and international social and economic disruptions from a domestic nuclear explosion is through planning and rapid action, from the individual to the federal response. Anticipating response resources for survivors based on predicted types and distributions of injuries needs to be addressed.« less

Management of ionizing radiation injuries and illnesses, part 1: physics, radiation protection, and radiation instrumentation.

PubMed

Christensen, Doran M; Jenkins, Mark S; Sugarman, Stephen L; Glassman, Erik S

2014-03-01

Ionizing radiation injuries and illnesses are exceedingly rare; therefore, most physicians have never managed such conditions. When confronted with a possible radiation injury or illness, most physicians must seek specialty consultation. Protection of responders, health care workers, and patients is an absolute priority for the delivery of medical care. Management of ionizing radiation injuries and illnesses, as well as radiation protection, requires a basic understanding of physics. Also, to provide a greater measure of safety when working with radioactive materials, instrumentation for detection and identification of radiation is needed. Because any health care professional could face a radiation emergency, it is imperative that all institutions have emergency response plans in place before an incident occurs. The present article is an introduction to basic physics, ionizing radiation, radiation protection, and radiation instrumentation, and it provides a basis for management of the consequences of a radiologic or nuclear incident.

The peculiarities of process-based approach realization in transport sector company management

NASA Astrophysics Data System (ADS)

Khripko, Elena; Sidorov, Gennadiy

2017-10-01

In the present article we study the phenomena of multiple meaning in understanding process-based management method in construction of transport infrastructure facilities. The idea of multiple meaning is in distortions which appear during reception of the management process paradigm in organizational environment of transport sector. The cause of distortion in process management is organizational resistance. The distortions of management processes are discovered at the level of diffusion among spheres of responsibility, collision in forms of functional, project and process interaction between the owner of the process and its participants. The level of distortion is affected by the attitude towards the result of work which means that process understanding of the result is replaced by the functional one in practice of management. This transfiguration is the consequence of regressive defensive mechanisms of the organizational environment. On the base of experience of forming process management in construction of transport infrastructure facilities company of the issues of diagnostics of various forms of organizational resistance and ways of reducing the destructive influence on managing processes are reviewed.

Plant trait-based models identify direct and indirect effects of climate change on bundles of grassland ecosystem services

PubMed Central

Lamarque, Pénélope; Lavorel, Sandra; Mouchet, Maud; Quétier, Fabien

2014-01-01

Land use and climate change are primary causes of changes in the supply of ecosystem services (ESs). Although the consequences of climate change on ecosystem properties and associated services are well documented, the cascading impacts of climate change on ESs through changes in land use are largely overlooked. We present a trait-based framework based on an empirical model to elucidate how climate change affects tradeoffs among ESs. Using alternative scenarios for mountain grasslands, we predicted how direct effects of climate change on ecosystems and indirect effects through farmers’ adaptations are likely to affect ES bundles through changes in plant functional properties. ES supply was overall more sensitive to climate than to induced management change, and ES bundles remained stable across scenarios. These responses largely reflected the restricted extent of management change in this constrained system, which was incorporated when scaling up plot level climate and management effects on ecosystem properties to the entire landscape. The trait-based approach revealed how the combination of common driving traits and common responses to changed fertility determined interactions and tradeoffs among ESs. PMID:25225382

Atrial fibrillation pearls and perils of management.

PubMed Central

Kudenchuk, P J

1996-01-01

Atrial fibrillation, a common arrhythmia, is responsible for considerable cardiovascular morbidity. Its management demands more than antiarrhythmic therapy alone, but must address the causes and consequences of the arrhythmia. Although remediable causes are infrequently found, a thorough search for associated heart disease or its risk factors results in better-informed patient management. Controlling the ventricular response and protecting from thromboembolic complications are important initial goals of therapy and may include the administration of aspirin in younger, low-risk patients. Older patients and those with risk factors for systemic embolism are not adequately protected from stroke complications by aspirin therapy alone. It remains controversial whether all high-risk patients should receive warfarin and at what intensity. Whether and how sinus rhythm should be restored and maintained poses the greatest therapeutic controversy for atrial fibrillation. The mortal risk of antiarrhythmic therapy is substantially greater in patients with evidence of heart failure. In such persons, the risks and benefits of maintaining normal sinus rhythm with antiarrhythmic medications should be weighted carefully. A definitive cure for atrial fibrillation remains elusive, but promising surgical and catheter ablation therapies are being developed. PMID:8686300

Plant trait-based models identify direct and indirect effects of climate change on bundles of grassland ecosystem services.

PubMed

Lamarque, Pénélope; Lavorel, Sandra; Mouchet, Maud; Quétier, Fabien

2014-09-23

Land use and climate change are primary causes of changes in the supply of ecosystem services (ESs). Although the consequences of climate change on ecosystem properties and associated services are well documented, the cascading impacts of climate change on ESs through changes in land use are largely overlooked. We present a trait-based framework based on an empirical model to elucidate how climate change affects tradeoffs among ESs. Using alternative scenarios for mountain grasslands, we predicted how direct effects of climate change on ecosystems and indirect effects through farmers' adaptations are likely to affect ES bundles through changes in plant functional properties. ES supply was overall more sensitive to climate than to induced management change, and ES bundles remained stable across scenarios. These responses largely reflected the restricted extent of management change in this constrained system, which was incorporated when scaling up plot level climate and management effects on ecosystem properties to the entire landscape. The trait-based approach revealed how the combination of common driving traits and common responses to changed fertility determined interactions and tradeoffs among ESs.

National health and medical services response to incidents of chemical and biological terrorism.

PubMed

Tucker, J B

1997-08-06

In response to the growing threat of terrorism with chemical and biological weapons, the US government has developed a national concept of operations for emergency health and medical services response. This capability was developed and tested for the first time during the Atlanta Olympic Games in the summer of 1996. In the event of a chemical or biological terrorist incident that exceeded local and state-level response capabilities, federal agencies would provide specialized teams and equipment to help manage the consequences of the attack and treat, decontaminate, and evacuate casualties. The US Congress has also established a Domestic Preparedness Program that provides for enhanced training of local first-responders and the formation of metropolitan medical strike teams in major cities around the country. While these national response capabilities are promising, their implementation to date has been problematic and their ultimate effectiveness is uncertain.

Role delineation study for the American Society for Pain Management Nursing.

PubMed

Willens, Joyce S; DePascale, Christine; Penny, James

2010-06-01

A role delineation study, or job analysis, is a necessary step in the development of a quality credentialing program. The process requires a logical approach and systematic methods to have an examination that is legally defensible. There are three main phases: initial development and evaluation, validation study, and development of test specifications. In the first phase, the content expert panel discussed performance domains that exist in pain management nursing. The six domains developed were: 1) assessment, monitoring, and evaluation of pain; 2) pharmacologic pain management; 3) nonpharmacologic pain management; 4) therapeutic communication and counseling; 5) patient and family teaching; and 6) collaborative and organizational activities. The panel then produced a list of 70 task statements to develop an online survey which was sent to independent reviewers with expertise in pain management nursing. After the panel reviewed the results of the pilot test, it was decided to clarify a few items that did not perform as expected. After the questionnaire was finalized it was distributed to 1,500 pain management nurses. The final yield was 585 usable returns, for a response rate of 39%. Thirty-three percent of the respondents reported a bachelor's degree in nursing as the highest degree awarded. Over 80% indicated that they were certified in pain management. Over 35% reported working in a staff position, 14% as a nurse practitioner, and 13% as a clinical nurse specialist. Part of the questionnaire asked the participants to rate performance expectation, consequence or the likelihood that the newly certified pain management nurse could cause harm, and the frequency of how often that nurse performs in each of the performance domains. The performance expectation was rated from 0 (the newly certified pain management nurse was not at all expected to perform the domain task) to 2 (after 6 months the newly certified pain management nurse would be expected to perform the domain task). The consequences of the degree would be the inability of the newly certified pain management nurse to perform duties or tasks in each domain was rated from 0 (no harm) to 4 (extreme harm). The first domain received the highest average frequency rating. The pharmacologic domain received the highest mean rating on consequence. The reliability of all scales was 0.95 or higher, which indicated that the questionnaire consistently measured what it was intended to measure. The quality of the questionnaire is an indicator that certification is one measure of nursing excellence. (c) 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Connecting Hazard Analysts and Risk Managers to Sensor Information.

PubMed

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-06-11

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes.

Connecting Hazard Analysts and Risk Managers to Sensor Information

PubMed Central

Le Cozannet, Gonéri; Hosford, Steven; Douglas, John; Serrano, Jean-Jacques; Coraboeuf, Damien; Comte, Jérémie

2008-01-01

Hazard analysts and risk managers of natural perils, such as earthquakes, landslides and floods, need to access information from sensor networks surveying their regions of interest. However, currently information about these networks is difficult to obtain and is available in varying formats, thereby restricting accesses and consequently possibly leading to decision-making based on limited information. As a response to this issue, state-of-the-art interoperable catalogues are being currently developed within the framework of the Group on Earth Observations (GEO) workplan. This article provides an overview of the prototype catalogue that was developed to improve access to information about the sensor networks surveying geological hazards (geohazards), such as earthquakes, landslides and volcanoes. PMID:27879915

Preparing for veterinary emergencies: disaster management and the Incident Command System.

PubMed

Madigan, J; Dacre, I

2009-08-01

An important question that all veterinary schools should consider is whether veterinary students should be trained to deal with local or regional states of emergency or disasters, such as hurricanes, tornadoes, wildfires, hail and ice storms, wind storms, fires, earthquakes, tsunamis, floods and epidemics. When a large-scale emergency or disaster does strike, the consequences can be dire for the domestic and wild animals of the region and for the humans within the vicinity of seriously and painfully injured animals. The authors argue that emergency preparedness is essential for the veterinary profession to meet its obligations to both animals and humans. The four basic components of disaster management are: mitigation, preparedness, response/emergency relief and recovery.

Motivation and drives in bottom-up developments in natural hazards management: multiple-use of adaptation strategies in Austria

NASA Astrophysics Data System (ADS)

Thaler, Thomas; Fuchs, Sven

2015-04-01

Losses from extreme hydrological events, such as recently experienced in Europe have focused the attention of policymakers as well as researchers on vulnerability to natural hazards. In parallel, the context of changing flood risks under climate and societal change is driving transformation in the role of the state in responsibility sharing and individual responsibilities for risk management and precaution. The new policy agenda enhances the responsibilities of local authorities and private citizens in hazard management and reduces the role of central governments. Within the objective is to place added responsibility on local organisations and citizens to determine locally-based strategies for risk reduction. A major challenge of modelling adaptation is to represent the complexity of coupled human-environmental systems and particularly the feedback loops between environmental dynamics and human decision-making processes on different scales. This paper focuses on bottom-up initiatives to flood risk management which are, by definition, different from the mainstream. These initiatives are clearly influenced (positively or negatively) by a number of factors, where the combination of these interdependences can create specific conditions that alter the opportunity for effective governance arrangements in a local scheme approach. In total, this study identified six general drivers which encourage the implementation of flood storages, such as direct relation to recent major flood frequency and history, the initiative of individual stakeholders (promoters), political pressures from outside (e.g. business companies, private households) and a strong solidarity attitude of municipalities and the stakeholders involved. Although partnership approach may be seen as an 'optimal' solution for flood risk management, in practice there are many limitations and barriers in establishing these collaborations and making them effective (especially in the long term) with the consequences that rhetoric may not be matched by reality. Key words: catchment; land use management; flood risk management; partnership; power dynamics

The aging of America's reservoirs: In-reservoir and downstream physical changes and habitat implications

USGS Publications Warehouse

Juracek, Kyle E.

2015-01-01

Reservoirs are important for various purposes including flood control, water supply, power generation, and recreation. The aging of America's reservoirs and progressive loss of water storage capacity resulting from ongoing sedimentation, coupled with increasing societal needs, will cause the social, economic, environmental, and political importance of reservoirs to continually increase. The short- and medium-term (<50 years) environmental consequences of reservoir construction and operation are well known and include an altered flow regime, lost connectivity (longitudinal, floodplain), an altered sediment regime, substrate compositional change, and downstream channel degradation. In general, reservoir-related changes have had adverse consequences for the natural ecosystem. Longer term (>50 years) environmental changes as reservoirs enter “old” age are less understood. Additional research is needed to help guide the future management of aging reservoir systems and support the difficult decisions that will have to be made. Important research directions include assessment of climate change effects on aging and determination of ecosystem response to ongoing aging and various management actions that may be taken with the intent of minimizing or reversing the physical effects of aging.

Phenology research for natural resource management in the United States.

PubMed

Enquist, Carolyn A F; Kellermann, Jherime L; Gerst, Katharine L; Miller-Rushing, Abraham J

2014-05-01

Natural resource professionals in the United States recognize that climate-induced changes in phenology can substantially affect resource management. This is reflected in national climate change response plans recently released by major resource agencies. However, managers on-the-ground are often unclear about how to use phenological information to inform their management practices. Until recently, this was at least partially due to the lack of broad-based, standardized phenology data collection across taxa and geographic regions. Such efforts are now underway, albeit in very early stages. Nonetheless, a major hurdle still exists: phenology-linked climate change research has focused more on describing broad ecological changes rather than making direct connections to local to regional management concerns. To help researchers better design relevant research for use in conservation and management decision-making processes, we describe phenology-related research topics that facilitate "actionable" science. Examples include research on evolution and phenotypic plasticity related to vulnerability, the demographic consequences of trophic mismatch, the role of invasive species, and building robust ecological forecast models. Such efforts will increase phenology literacy among on-the-ground resource managers and provide information relevant for short- and long-term decision-making, particularly as related to climate response planning and implementing climate-informed monitoring in the context of adaptive management. In sum, we argue that phenological information is a crucial component of the resource management toolbox that facilitates identification and evaluation of strategies that will reduce the vulnerability of natural systems to climate change. Management-savvy researchers can play an important role in reaching this goal.

Flight crew fatigue management in a more flexible regulatory environment: an overview of the New Zealand aviation industry.

PubMed

Signal, T Leigh; Ratieta, Denise; Gander, Philippa H

2008-04-01

Since 1995, air transport operators in New Zealand have been able to meet the flight and duty time (FDT) regulations by operating according to prescriptive FDT limits or by seeking approval to operate under a potentially more flexible company-specific FDT scheme. There has been no formal assessment of the impact of this increased flexibility on fatigue management processes. The aim of the present study was to determine the strategies and processes that commercial aircraft operators in New Zealand have in place for managing fatigue and whether these differed according to the type of FDT system under which organizations were operating. All air transport operators in New Zealand were sent questionnaires that were to be completed by an individual in a management role, a line pilot, and an individual in a rostering role. Questions were asked about the FDT system under which the organization operated, the strategies and processes in place for managing fatigue, and the consequences of the organization's approach to managing fatigue. One hundred and fifty-three responses were received from 88 organizations (55% of all air operators) and were representative of the structure of the New Zealand industry. Air operators were most likely to report that they monitored flight and duty times and pilot workload to manage fatigue (used by 90-99% and 70-90%, respectively), while educating rostering staff and reviewing the processes for managing fatigue were the least utilized strategies (used by 36-50% and 39-60%, respectively). Within the same organization, managers were more likely than line pilots to report the use of specific fatigue management strategies. There were no differences found between organizations operating under prescriptive regulations and those using a company-specific scheme on ratings of how well fatigue was managed, the number of fatigue management strategies employed, or the frequency of use of selected strategies. Across the industry as a whole, the provision of more flexible regulatory options has not greatly changed fatigue management practices, although some operators have implemented innovative strategies. The findings suggest a need to raise the level of knowledge within the industry regarding the causes and consequences of fatigue and of processes for its management. This is further supported by the discrepancies between the responses of line pilots and managers, which raise doubts about the effectiveness of some strategies nominally being employed. The regulator and other relevant industry groups should consider how to move the industry toward a mature safety culture and solid knowledge base because these are fundamental to more flexible fatigue management regimes, as is adequate regulatory knowledge, support, and oversight.

Variability of community interaction networks in marine reserves and adjacent exploited areas

USGS Publications Warehouse

Montano-Moctezuma, G.; Li, H.W.; Rossignol, P.A.

2008-01-01

Regional and small-scale local oceanographic conditions can lead to high variability in community structure even among similar habitats. Communities with identical species composition can depict distinct networks due to different levels of disturbance as well as physical and biological processes. In this study we reconstruct community networks in four different areas off the Oregon Coast by matching simulated communities with observed dynamics. We compared reserves with harvested areas. Simulations suggested that different community networks, but with the same species composition, can represent each study site. Differences were found in predator-prey interactions as well as non-predatory interactions between community members. In addition, each site can be represented as a set of models, creating alternative stages among sites. The set of alternative models that characterize each study area depicts a sequence of functional responses where each specific model or interaction structure creates different species composition patterns. Different management practices, either in the past or of the present, may lead to alternative communities. Our findings suggest that management strategies should be analyzed at a community level that considers the possible consequences of shifting from one community scenario to another. This analysis provides a novel conceptual framework to assess the consequences of different management options for ecological communities. ?? 2008 Elsevier B.V. All rights reserved.

Detection and visualization of storm hydrograph changes under urbanization: an impulse response approach.

PubMed

Farahmand, Touraj; Fleming, Sean W; Quilty, Edward J

2007-10-01

Urbanization often alters catchment storm responses, with a broad range of potentially significant environmental and engineering consequences. At a practical, site-specific management level, efficient and effective assessment and control of such downstream impacts requires a technical capability to rapidly identify development-induced storm hydrograph changes. The method should also speak specifically to alteration of internal watershed dynamics, require few resources to implement, and provide results that are intuitively accessible to all watershed stakeholders. In this short paper, we propose a potential method which might satisfy these criteria. Our emphasis lies upon the integration of existing concepts to provide tools for pragmatic, relatively low-cost environmental monitoring and management. The procedure involves calibration of rainfall-runoff time-series models in each of several successive time windows, which sample varying degrees of watershed urbanization. As implemented here, only precipitation and stream discharge or stage data are required. The readily generated unit impulse response functions of these time-series models might then provide a mathematically formal, yet visually based and intuitive, representation of changes in watershed storm response. Nominally, the empirical response functions capture such changes as soon as they occur, and the assessments of storm hydrograph alteration are independent of variability in meteorological forcing. We provide a preliminary example of how the technique may be applied using a low-order linear ARX model. The technique may offer a fresh perspective on such watershed management issues, and potentially also several advantages over existing approaches. Substantial further testing is required before attempting to apply the concept as a practical environmental management technique; some possible directions for additional work are suggested.

The Efficacy of All-Positive Management as a Function of the Prior Use of Negative Consequences.

ERIC Educational Resources Information Center

Pfiffner, Linda J.; O'Leary, Susan G.

1987-01-01

The study found that in the absence of a history of negative consequences, an all-positive management system for eight first- through third-grade children with academic and/or classroom behavioral problems was not sufficient to maintain on-task rates of academic accuracy. The addition of negative consequences immediately improved on-task behavior…

[The occupational physicians' responsibilities].

PubMed

Guardavilla, A

2010-01-01

Occupational physicians can commit two kind of crimes: they can violate rules of safety and health at work with no immediate consequences for the employees but anyway creating a potential danger for them, or they can cause, because of their blame, occupational diseases or accidents at work to the employees. In both cases they can be punished. If we want to understand in detail this kind of responsibility, we must read the Supreme Court's judgements (Supreme Court, 19099/2009; 26539/2008; 20220/2006; 17838/2005; 26439/2007; 24290/2005). The numberless innovations introduced in recent years in the body of occupational safety and health laws called for a different reading of the meaning and the content of occupational physicians' functions, requiring them to collaborate, more than in the past, in the assessment of workplace risks. The responsibility of occupational physicians should be seen also in relation to the responsibility of employers and managers (see the link between health surveillance and art. 18 paragraph 1 letter c) of Legislative Decree no. 81/08). In the occupational safety and health context, the employer and his managers must also require (and ensure) occupational physicians to fulfill their obligations and professional duties.

Nothing Changes, Really: Why Women Who Break Through the Glass Ceiling End Up Reinforcing It.

PubMed

Faniko, Klea; Ellemers, Naomi; Derks, Belle; Lorenzi-Cioldi, Fabio

2017-05-01

Two correlational studies conducted in Switzerland ( N = 222) and Albania ( N = 156) explained the opposition of female managers to gender quotas by examining the origins and consequences of the "Queen Bee (QB)-phenomenon," whereby women who have been successful in male-dominated organizations do not support the advancement of junior women. Results disconfirm previous accounts of the QB-phenomenon as indicating competitiveness among women. Instead, the tendency of women managers to consider themselves as different from other women, and their opposition to gender quotas, emerged when junior women were addressed but not when they considered their direct competitors, other women managers. Personal sacrifices women managers reported having made for career success predicted self-distancing from junior women and opposition to gender quotas targeting these women. We provide a more nuanced picture of what the QB-response is really about, explaining why women managers oppose quotas for junior women, while supporting quotas for women in the same rank.

Defining disaster resilience: comparisons from key stakeholders involved in emergency management in Victoria, Australia.

PubMed

Goode, Natassia; Salmon, Paul M; Spencer, Caroline; McArdle, Dudley; Archer, Frank

2017-01-01

Three years after the introduction of the National Strategy for Disaster Resilience there remains no unanimously adopted definition of disaster resilience within Australia's emergency management sector. The aim of this study is to determine what the concept means to key stakeholders in the emergency management sector in the Australian State of Victoria, and how these conceptualisations overlap and diverge. Via an online survey, 113 people were asked how they define disaster resilience in their work in the emergency management sector. A data mining software tool, Leximancer, was employed to uncover the relationships between the definitions provided. The findings show that stakeholders see resilience as an 'ability' that encompasses emergency management activities and personal responsibility. However, the findings also highlight some possible points of conflict between stakeholders. In addition, the paper outlines and discusses a number of potential consequences for the implementation and the success of the resilience-based approach in Australia. © 2017 The Author(s). Disasters © Overseas Development Institute, 2017.

Nothing Changes, Really: Why Women Who Break Through the Glass Ceiling End Up Reinforcing It

PubMed Central

Faniko, Klea; Ellemers, Naomi; Derks, Belle; Lorenzi-Cioldi, Fabio

2017-01-01

Two correlational studies conducted in Switzerland (N = 222) and Albania (N = 156) explained the opposition of female managers to gender quotas by examining the origins and consequences of the “Queen Bee (QB)-phenomenon,” whereby women who have been successful in male-dominated organizations do not support the advancement of junior women. Results disconfirm previous accounts of the QB-phenomenon as indicating competitiveness among women. Instead, the tendency of women managers to consider themselves as different from other women, and their opposition to gender quotas, emerged when junior women were addressed but not when they considered their direct competitors, other women managers. Personal sacrifices women managers reported having made for career success predicted self-distancing from junior women and opposition to gender quotas targeting these women. We provide a more nuanced picture of what the QB-response is really about, explaining why women managers oppose quotas for junior women, while supporting quotas for women in the same rank. PMID:28903635

[Management, quality of health and occupational safety and hospital organization: is integration possible?].

PubMed

Corrao, Carmela Romana Natalina

2011-01-01

The evolution of the national and European legislation has progressively transformed the working environments into organized environments. Specific models for its management are being proposed, which should be integrated into general management strategies. In the case of hospitals this integration should consider the peculiar organizational complexity, where the management of the occupational risk needs to be integrated with clinical risk management and economic risk management. Resources management should also consider that Occupational Medicine has not a direct monetary benefit for the organisation, but only indirect health consequences in terms of reduction of accidents and occupational diseases. The deep and simultaneous analysis of the current general management systems and the current management methods of occupational safety and health protection allows one to hyphotesise a possible integration between them. For both of them the Top Management is the main responsible of the quality management strategies and the use of specific documents in the managerial process, such as the document of risks evaluation in the occupational management and the quality manual in the general management, is of paramount importance. An integrated management has also the scope to pursue a particular kind of quality management, where ethics and job satisfaction are innovative, as established by recent European guidelines, management systems and national legislations.

Puerto Rico Seismic Network Operations During and After the Hurricane Maria: Response, Continuity of Operations, and Experiences

NASA Astrophysics Data System (ADS)

Vanacore, E. A.; Baez-Sanchez, G.; Huerfano, V.; Lopez, A. M.; Lugo, J.

2017-12-01

The Puerto Rico Seismic Network (PRSN) is an integral part of earthquake and tsunami monitoring in Puerto Rico and the Virgin Islands. The PRSN conducts scientific research as part of the University of Puerto Rico Mayaguez, conducts the earthquake monitoring for the region, runs extensive earthquake and tsunami education and outreach programs, and acts as a Tsunami Warning Focal Point Alternate for Puerto Rico. During and in the immediate aftermath of Hurricane Maria, the PRSN duties and responsibilities evolved from a seismic network to a major information and communications center for the western side of Puerto Rico. Hurricane Maria effectively destroyed most communications on island, critically between the eastern side of the island where Puerto Rico's Emergency Management's (PREMA) main office and the National Weather Service (NWS) is based and the western side of the island. Additionally, many local emergency management agencies on the western side of the island lost a satellite based emergency management information system called EMWIN which provides critical tsunami and weather information. PRSN's EMWIN system remained functional and consequently via this system and radio communications PRSN became the only information source for NWS warnings and bulletins, tsunami alerts, and earthquake information for western Puerto Rico. Additionally, given the functional radio and geographic location of the PRSN, the network became a critical communications relay for local emergency management. Here we will present the PRSN response in relation to Hurricane Maria including the activation of the PRSN devolution plan, adoption of duties, experiences and lessons learned for continuity of operations and adoption of responsibilities during future catastrophic events.

Consultative Committee on Ionizing Radiation: Impact on Radionuclide Metrology

PubMed Central

Karam, L.R.; Ratel, G.

2016-01-01

In response to the CIPM MRA, and to improve radioactivity measurements in the face of advancing technologies, the CIPM’s consultative committee on ionizing radiation developed a strategic approach to the realization and validation of measurement traceability for radionuclide metrology. As a consequence, measurement institutions throughout the world have devoted no small effort to establish radionuclide metrology capabilities, supported by active quality management systems and validated through prioritized participation in international comparisons, providing a varied stakeholder community with measurement confidence. PMID:26688351

Managerial and professional collaboration in the provision of home care rehabilitation.

PubMed

Hollis, Vivien; May, Laura

2005-01-01

Demand for home care rehabilitation continues to grow in response to faster hospital discharges. One solution is to expand rehabilitation services using therapist assistants. Professionals voice concerns regarding many instances of assistants providing interventions outside their expertise and practicing without therapist supervision. This paper provides principles elicited from practitioners' experiences of an effective management culture and collaboration in one home care organization that effectively assimilated assistants, with reports of consequent improvements to rehabilitation service and client outcomes.

TennCare and academic medical centers: the lessons from Tennessee.

PubMed

Meyer, G S; Blumenthal, D

1996-09-04

To ascertain the potential impact of public-sector-driven health system reform (Medicaid and Medicare programs) on academic medical centers (AMCs). A qualitative, case-study investigation of how 2 of Tennessee's 4 AMCs were affected by the TennCare program, which enrolled all of the state's Medicaid recipients and a sizable portion of its uninsured in managed care organizations (MCOs) in January 1994. We reviewed pertinent documents related to the AMCs, response to TennCare; interviewed AMC executives and staff, state officials, and representatives of MCOs serving TennCare beneficiaries; and conducted site visits at both AMCs. Changes in clinical revenues, clinical volume, patient selection, support for the AMCs, teaching and research missions, and the AMCs' response to these changes. Both AMCs studied experienced large revenue shortfalls, the closure of some specialty services, adverse patient selection, and loss of the patient volume needed to do clinical research, and had to reduce the number of training program positions. Longer-term consequences of TennCare for AMCs may include the integration of community-based services into academic missions, the acceleration of clinical diversification, and the attainment of experience in managed care, anticipating the evolution of the private-sector market. The consequences of public-sector health system reform for AMCs are similar to, and equally as challenging as, the effects of private-sector changes in health care delivery. Important differences include the rapidity with which public-sector reforms can transform the AMC market, the vulnerability of special payments to AMCs, such as graduate medical education funding, and the accountability of managers of public-sector initiatives to the political process. It remains to be seen whether public-sector reforms will afford some competitive advantage to AMCs over the long term.

From science to policy; A road map for a sustainable resource management in Turkey's marine EEZs

NASA Astrophysics Data System (ADS)

Gazihan, A.; Salihoglu, B.; Akoglu, E.; Oguz, T.

2016-02-01

This study provides a scientific base for Ecosystem Based Fisheries Management (EBFM) decisions for Turkey's exclusive economic zones in the Black Sea, the Marmara Sea, the Aegean Sea and the Mediterranean Sea. For this aim, an interdisciplinary holistic approach is employed to explore the linkages and feedbacks between changing national societal and economic needs, managerial decisions, environmental pressures and the health of regional marine ecosystems through derived socioeconomic and ecological indicators from statistical and field data as well as Ecopath with Ecosim (EwE) model results. Results quantified the level of human induced pressures driven by increasing societal and economic demands due to human population increase, national economic crises and corresponded governmental subsidies. Cumulative effects of these pressures together with changing climatic conditions deteriorated the marine resources and, as a consequence, limited the socio-economic services provided by ecosystems (e.g. nation-wide decreases in weight (-47%) and value (-37%) of landings, economic profitability (-61%) and per capita fish consumption (-29%) over the last decade). Even though the pressures increased correspondingly in all the marine regions, their consequences in the regional marine ecosystems realized differently. Observed trends in socioeconomic and ecologic indicators and past and future model scenario simulations done by Ecopath with Ecosim (EwE) model provided region-specific optimum EBFM options. Research results were synthesized specific to each responsible stakeholder groups and communicated by means of regional stakeholder meetings, project web-side, social and national media and scientific platforms. Present study is expected to increase the stakeholders' awareness for sustainable, responsible resource co-management and will be integrated into decision-making processes and serve as a model case study. This is a contribution funded by TUBITAK (113Y040 DEKOYON Project).

Challenges to conservation: land use change and local participation in the Al Reem Biosphere Reserve, West Qatar

PubMed Central

2010-01-01

One response to humanity's unsustainable use of natural resources and consequent degradation, even destruction of the environment, is to establish conservation areas to protect Nature and preserve biodiversity at least in selected regions. In Qatar, the government has shown strong support for this approach, confronted by the environmental consequences of oil and gas extraction and rapid urban development, by designating about one-tenth of the country a conservation area. Located in the west of the peninsula, it comprises the Al Reem Reserve, subsequently declared a UNESCO Biosphere Reserve. Several approaches have figured in conservation, currently popular is co-management featuring participation of the local population, which recognises that people's activities often contribute to today's environment, with the promotion of bio-cultural diversity. However, these assumptions may not hold where rapid social and cultural change occurs, as in Qatar. We explore the implications of such change, notably in land use. We detail changes resulting with the move from nomadic to sedentary lifestyles: in land access, which now features tribal-state control, and herding strategies, which now feature migrant labour and depend on imported fodder and water, underwritten by the country's large gas and oil revenues. Current stocking arrangements - animals herded in much smaller areas than previously - are thought responsible for the degradation of natural resources. The place of animals, notably camels, in Qatari life, has also changed greatly, possibly further promoting overstocking. Many local people disagree. What are the implications of such changes for the participatory co-management of conservation areas? Do they imply turning the clock back to centrally managed approaches that seek to control access and local activities? PMID:20964818

Structural Engineering Managers - Innovation Challenges for their Skills

NASA Astrophysics Data System (ADS)

Linkeschová, D.; Tichá, A.

2015-11-01

The profession of a structural engineer is highly responsible, because the consequences of a structural engineer's errors result not only in economic damage to the property and often irreversible damage to the environment, they can also lead to direct loss of lives. In the current turbulent, dynamically developing society the managerial methods of structural engineers should not stagnate at the level of the last century applications. This paper deals with the challenges which the ongoing century poses to structural engineers and managers. It compares the results of research regarding the current state of managerial skills of structural engineers in Czech building companies to the defined skills of the 21st century's managers according to the global research programme ITL Research and according to the Vision for the Future of Structural Engineering, drawn up by Structural Engineering Institute - SEI ASCE.

General RMP Guidance - Chapter 7: Prevention Program (Program 3)

EPA Pesticide Factsheets

Many Program 3 processes are already addressed by the OSHA Process Safety Management Program, which covers on-site consequences. So for compliance with the risk management program, process hazard analysis teams must consider potential offsite consequences.

Modeling wildfire incident complexity dynamics.

PubMed

Thompson, Matthew P

2013-01-01

Wildfire management in the United States and elsewhere is challenged by substantial uncertainty regarding the location and timing of fire events, the socioeconomic and ecological consequences of these events, and the costs of suppression. Escalating U.S. Forest Service suppression expenditures is of particular concern at a time of fiscal austerity as swelling fire management budgets lead to decreases for non-fire programs, and as the likelihood of disruptive within-season borrowing potentially increases. Thus there is a strong interest in better understanding factors influencing suppression decisions and in turn their influence on suppression costs. As a step in that direction, this paper presents a probabilistic analysis of geographic and temporal variation in incident management team response to wildfires. The specific focus is incident complexity dynamics through time for fires managed by the U.S. Forest Service. The modeling framework is based on the recognition that large wildfire management entails recurrent decisions across time in response to changing conditions, which can be represented as a stochastic dynamic system. Daily incident complexity dynamics are modeled according to a first-order Markov chain, with containment represented as an absorbing state. A statistically significant difference in complexity dynamics between Forest Service Regions is demonstrated. Incident complexity probability transition matrices and expected times until containment are presented at national and regional levels. Results of this analysis can help improve understanding of geographic variation in incident management and associated cost structures, and can be incorporated into future analyses examining the economic efficiency of wildfire management.

Revolutionary land use change in the 21st century: Is (rangeland) science relevant?

USGS Publications Warehouse

Herrick, J.E.; Brown, J.R.; Bestelmeyer, B.T.; Andrews, S.S.; Baldi, G.; Davies, J.; Duniway, M.; Havstad, K.M.; Karl, J.W.; Karlen, D.L.; Peters, Debra P.C.; Quinton, J.N.; Riginos, C.; Shaver, P.L.; Steinaker, D.; Twomlow, S.

2012-01-01

Rapidly increasing demand for food, fiber, and fuel together with new technologies and the mobility of global capital are driving revolutionary changes in land use throughout the world. Efforts to increase land productivity include conversion of millions of hectares of rangelands to crop production, including many marginal lands with low resistance and resilience to degradation. Sustaining the productivity of these lands requires careful land use planning and innovative management systems. Historically, this responsibility has been left to agronomists and others with expertise in crop production. In this article, we argue that the revolutionary land use changes necessary to support national and global food security potentially make rangeland science more relevant now than ever. Maintaining and increasing relevance will require a revolutionary change in range science from a discipline that focuses on a particular land use or land cover to one that addresses the challenge of managing all lands that, at one time, were considered to be marginal for crop production. We propose four strategies to increase the relevance of rangeland science to global land management: 1) expand our awareness and understanding of local to global economic, social, and technological trends in order to anticipate and identify drivers and patterns of conversion; 2) emphasize empirical studies and modeling that anticipate the biophysical (ecosystem services) and societal consequences of large-scale changes in land cover and use; 3) significantly increase communication and collaboration with the disciplines and sectors of society currently responsible for managing the new land uses; and 4) develop and adopt a dynamic and flexible resilience-based land classification system and data-supported conceptual models (e.g., state-and-transition models) that represent all lands, regardless of use and the consequences of land conversion to various uses instead of changes in state or condition that are focused on a single land use.

Consequence Maps: A Novel Behavior Management Tool for Educators

ERIC Educational Resources Information Center

Tobin, Catherine E.; Simpson, Richard

2012-01-01

Behavior management remains one of the most significant challenges faced by classroom personnel. One relatively novel and promising management approach involves the use of "Consequence Maps". In this article we discuss the use of this method, including its application and evaluation. A case study of a six-year-old boy in a self-contained special…

A Methodology for Forecasting Damage & Economic Consequences to Floods: Building on the National Flood Interoperability Experiment (NFIE)

NASA Astrophysics Data System (ADS)

Tootle, G. A.; Gutenson, J. L.; Zhu, L.; Ernest, A. N. S.; Oubeidillah, A.; Zhang, X.

2015-12-01

The National Flood Interoperability Experiment (NFIE) held June 3-July 17, 2015 at the National Water Center (NWC) in Tuscaloosa, Alabama sought to demonstrate an increase in flood predictive capacity for the coterminous United States (CONUS). Accordingly, NFIE-derived technologies and workflows offer the ability to forecast flood damage and economic consequence estimates that coincide with the hydrologic and hydraulic estimations these physics-based models generate. A model providing an accurate prediction of damage and economic consequences is a valuable asset when allocating funding for disaster response, recovery, and relief. Damage prediction and economic consequence assessment also offer an adaptation planning mechanism for defending particularly valuable or vulnerable structures. The NFIE, held at the NWC on The University of Alabama (UA) campus led to the development of this large scale flow and inundation forecasting framework. Currently, the system can produce 15-hour lead-time forecasts for the entire coterminous United States (CONUS). A concept which is anticipated to become operational as of May 2016 within the NWC. The processing of such a large-scale, fine resolution model is accomplished in a parallel computing environment using large supercomputing clusters. Traditionally, flood damage and economic consequence assessment is calculated in a desktop computing environment with a ménage of meteorology, hydrology, hydraulic, and damage assessment tools. In the United States, there are a range of these flood damage/ economic consequence assessment software's available to local, state, and federal emergency management agencies. Among the more commonly used and freely accessible models are the Hydrologic Engineering Center's Flood Damage Reduction Analysis (HEC-FDA), Flood Impact Assessment (HEC-FIA), and Federal Emergency Management Agency's (FEMA's) United States Multi-Hazard (Hazus-MH). All of which exist only in a desktop environment. With this, authors submit an initial framework for estimating damage and economic consequences to floods using flow and inundation products from the NFIE framework. This adaptive system utilizes existing nationwide datasets describing location and use of structures and can take assimilate a range of data resolutions.

A Strategy of Dialogue for Communicating Hazard and Risk Information Between the Science and Emergency Management Sectors

NASA Astrophysics Data System (ADS)

Eisner, R. K.

2015-12-01

This presentation will describe a collaborative dialogue process between earth scientists and emergency management officials that focused on translation of science into policy, building long term trust based relationships between sectors and unified presentation of hazards, risks and consequence management to public officials and the general public. The author will describe the structure and process of the California Earthquake Prediction Evaluation Council (CEPEC) in assessing the credibility of long and short term earthquake predictions, assessment of risk, and the formulation of public communication strategies and preparatory actions by government agencies. For nearly 4 decades, earth scientists, politically appointed state officials and emergency managers have engaged in ongoing discussions of the policy implications of research on potential seismic risk. Some discussions were scheduled and occurred over months, and others were ad hoc and occurred in the minutes between potential precursory incidents and possible large events. The effectiveness of this process was dependent on building respect for ones counterparts expertise, bias and responsibilities, clear communication of data, uncertainty and knowledge of the physical models assumed, history and probabilities; and the physical and political consequences of possible events; and the costs and economic and social disruption of alternative preparedness actions. But, the dialogue included political and social scientists, representatives of the print and broadcast media, political and management officials from federal, state and local governments. The presentation will provide an assessment of the effectiveness of the collaborative dialogue process and lessons on sustaining a long term partnership among the participating federal, state and local officials.

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

USGS Publications Warehouse

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

2009-01-01

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

University management nurse: a grounded theory.

PubMed

Cunha, Kamylla Santos da; Andrade, Selma Regina de; Erdmann, Alacoque Lorenzini

2018-03-08

to understand the meaning of the university management performed by nurses managers of the nursing undergraduate course of a public university. this is a qualitative research, based on the grounded theory. Data collection took place between May and September 2016, with open interviews, in the scenario of a federal public university. The technique of constant comparative analysis of the data was followed, obtaining a theoretical sample with 19 nurses, in two sample groups. there were three categories emerged that shaped the phenomenon: Articulating complex collectives through university management for the qualified training of new nurses. The categories included: a) conditions, defined by perceiving the commitment to the collective, previous experiences, and training for health management, as motivations to be a teacher manager; b) actions/interactions, delimited by Knowing and recognizing, in practice, the university management process, limits and possibilities in the coordination of complex collective subjects; and, c) consequences, such as Improving teaching work and taking responsibility for university education. the nurses teaching managers to explain university management as a set of individual and collective actions that, articulated in a complex social environment, promote conditions for the training of critical and reflexive nurses with the demands of society.

Will it rise or will it fall? Managing the complex effects of urbanization on base flow

USGS Publications Warehouse

Bhaskar, Aditi; Beesley, Leah; Burns, Matthew J.; Fletcher, T. D.; Hamel, Perrine; Oldham, Carolyn; Roy, Allison

2016-01-01

Sustaining natural levels of base flow is critical to maintaining ecological function as stream catchments are urbanized. Research shows a variable response of stream base flow to urbanization, with base flow or water tables rising in some locations, falling in others, or elsewhere remaining constant. The variable baseflow response is due to the array of natural (e.g., physiographic setting and climate) and anthropogenic (e.g., urban development and infrastructure) factors that influence hydrology. Perhaps as a consequence of this complexity, few simple tools exist to assist managers to predict baseflow change in their local urban area. This paper addresses this management need by presenting a decision support tool. The tool considers the natural vulnerability of the landscape, together with aspects of urban development in predicting the likelihood and direction of baseflow change. Where the tool identifies a likely increase or decrease it guides managers toward strategies that can reduce or increase groundwater recharge, respectively. Where the tool finds an equivocal result, it suggests a detailed water balance be performed. The decision support tool is embedded within an adaptive-management framework that encourages managers to define their ecological objectives, assess the vulnerability of their ecological objectives to changes in water table height, and monitor baseflow responses to urbanization. We trial our framework using two very different case studies: Perth, Western Australia, and Baltimore, Maryland, USA. Together, these studies show how pre-development water table height, climate and geology together with aspects of urban infrastructure (e.g., stormwater practices, leaky pipes) interact such that urbanization has overall led to rising base flow (Perth) and falling base flow (Baltimore). Greater consideration of subsurface components of the water cycle will help to protect and restore the ecology of urban freshwaters.

Survey of food safety practices on small to medium-sized farms and in farmers markets.

PubMed

Harrison, Judy A; Gaskin, Julia W; Harrison, Mark A; Cannon, Jennifer L; Boyer, Renee R; Zehnder, Geoffrey W

2013-11-01

As produce consumption has increased, so have foodborne disease outbreaks associated with fresh produce. Little research has addressed food safety practices used on small to medium-sized farms selling locally or in farmers markets. This study evaluated current food safety practices used by farmers on small to medium-sized farms and managers of farmers markets in Georgia, Virginia, and South Carolina based on responses to surveys. Surveys were developed, pretested, and revised before implementation with target audiences and were implemented via mail and the Web to maximize participation, with reminders sent to nonrespondents. Data were collected from 226 farmers and 45 market managers. Frequencies and percentages were calculated for all response variables. Responses from farmers indicated that more than 56% of them use manures. Of those who use manures, 34% use raw or mixtures of raw and composted manure, and over 26% wait fewer than 90 days between application of raw manure and harvest. Over 27% use water sources that have not been tested for safety for irrigation, and 16% use such water sources for washing produce. Over 43% do not sanitize surfaces that touch produce at the farm. Only 33% of farmers always clean transport containers between uses. Responses from market managers indicated that over 42% have no food safety standards in place for the market. Only 2 to 11% ask farmers specific questions about conditions on the farm that could affect product safety. Less than 25% of managers sanitize market surfaces. Only 11% always clean market containers between uses. Over 75% of markets offer no sanitation training to workers or vendors. While farmers and market managers are using many good practices, the results indicate that some practices being used may put consumers at risk of foodborne illness. Consequently, there is a need for training for both farmers and market managers.

A typology of time-scale mismatches and behavioral interventions to diagnose and solve conservation problems

USGS Publications Warehouse

Wilson, Robyn S.; Hardisty, David J.; Epanchin-Niell, Rebecca S.; Runge, Michael C.; Cottingham, Kathryn L.; Urban, Dean L.; Maguire, Lynn A.; Hastings, Alan; Mumby, Peter J.; Peters, Debra P.C.

2016-01-01

Ecological systems often operate on time scales significantly longer or shorter than the time scales typical of human decision making, which causes substantial difficulty for conservation and management in socioecological systems. For example, invasive species may move faster than humans can diagnose problems and initiate solutions, and climate systems may exhibit long-term inertia and short-term fluctuations that obscure learning about the efficacy of management efforts in many ecological systems. We adopted a management-decision framework that distinguishes decision makers within public institutions from individual actors within the social system, calls attention to the ways socioecological systems respond to decision makers’ actions, and notes institutional learning that accrues from observing these responses. We used this framework, along with insights from bedeviling conservation problems, to create a typology that identifies problematic time-scale mismatches occurring between individual decision makers in public institutions and between individual actors in the social or ecological system. We also considered solutions that involve modifying human perception and behavior at the individual level as a means of resolving these problematic mismatches. The potential solutions are derived from the behavioral economics and psychology literature on temporal challenges in decision making, such as the human tendency to discount future outcomes at irrationally high rates. These solutions range from framing environmental decisions to enhance the salience of long-term consequences, to using structured decision processes that make time scales of actions and consequences more explicit, to structural solutions aimed at altering the consequences of short-sighted behavior to make it less appealing. Additional application of these tools and long-term evaluation measures that assess not just behavioral changes but also associated changes in ecological systems are needed.

A typology of time-scale mismatches and behavioral interventions to diagnose and solve conservation problems.

PubMed

Wilson, Robyn S; Hardisty, David J; Epanchin-Niell, Rebecca S; Runge, Michael C; Cottingham, Kathryn L; Urban, Dean L; Maguire, Lynn A; Hastings, Alan; Mumby, Peter J; Peters, Debra P C

2016-02-01

Ecological systems often operate on time scales significantly longer or shorter than the time scales typical of human decision making, which causes substantial difficulty for conservation and management in socioecological systems. For example, invasive species may move faster than humans can diagnose problems and initiate solutions, and climate systems may exhibit long-term inertia and short-term fluctuations that obscure learning about the efficacy of management efforts in many ecological systems. We adopted a management-decision framework that distinguishes decision makers within public institutions from individual actors within the social system, calls attention to the ways socioecological systems respond to decision makers' actions, and notes institutional learning that accrues from observing these responses. We used this framework, along with insights from bedeviling conservation problems, to create a typology that identifies problematic time-scale mismatches occurring between individual decision makers in public institutions and between individual actors in the social or ecological system. We also considered solutions that involve modifying human perception and behavior at the individual level as a means of resolving these problematic mismatches. The potential solutions are derived from the behavioral economics and psychology literature on temporal challenges in decision making, such as the human tendency to discount future outcomes at irrationally high rates. These solutions range from framing environmental decisions to enhance the salience of long-term consequences, to using structured decision processes that make time scales of actions and consequences more explicit, to structural solutions aimed at altering the consequences of short-sighted behavior to make it less appealing. Additional application of these tools and long-term evaluation measures that assess not just behavioral changes but also associated changes in ecological systems are needed. © 2015 Society for Conservation Biology.

Enhancing response coordination through the assessment of response network structural dynamics

PubMed Central

Jalili, Mahdi; Choi, Soo-Mi

2018-01-01

Preparing for intensifying threats of emergencies in unexpected, dangerous, and serious natural or man-made events, and consequent management of the situation, is highly demanding in terms of coordinating the personnel and resources to support human lives and the environment. This necessitates prompt action to manage the uncertainties and risks imposed by such extreme events, which requires collaborative operation among different stakeholders (i.e., the personnel from both the state and local communities). This research aims to find a way to enhance the coordination of multi-organizational response operations. To do so, this manuscript investigates the role of participants in the formed coordination response network and also the emergence and temporal dynamics of the network. By analyzing an inter-personal response coordination operation to an extreme bushfire event, the networks’ and participants’ structural change is evaluated during the evolution of the operation network over four time durations. The results reveal that the coordination response network becomes more decentralized over time due to the high volume of communication required to exchange information. New emerging communication structures often do not fit the developed plans, which stress the need for coordination by feedback in addition to by plan. In addition, we find that the participant’s brokering role in the response operation network identifies a formal and informal coordination role. This is useful for comparison of network structures to examine whether what really happens during response operations complies with the initial policy. PMID:29447192

Enhancing response coordination through the assessment of response network structural dynamics.

PubMed

Abbasi, Alireza; Sadeghi-Niaraki, Abolghasem; Jalili, Mahdi; Choi, Soo-Mi

2018-01-01

Preparing for intensifying threats of emergencies in unexpected, dangerous, and serious natural or man-made events, and consequent management of the situation, is highly demanding in terms of coordinating the personnel and resources to support human lives and the environment. This necessitates prompt action to manage the uncertainties and risks imposed by such extreme events, which requires collaborative operation among different stakeholders (i.e., the personnel from both the state and local communities). This research aims to find a way to enhance the coordination of multi-organizational response operations. To do so, this manuscript investigates the role of participants in the formed coordination response network and also the emergence and temporal dynamics of the network. By analyzing an inter-personal response coordination operation to an extreme bushfire event, the networks' and participants' structural change is evaluated during the evolution of the operation network over four time durations. The results reveal that the coordination response network becomes more decentralized over time due to the high volume of communication required to exchange information. New emerging communication structures often do not fit the developed plans, which stress the need for coordination by feedback in addition to by plan. In addition, we find that the participant's brokering role in the response operation network identifies a formal and informal coordination role. This is useful for comparison of network structures to examine whether what really happens during response operations complies with the initial policy.

A psychosocial risk assessment and management framework to enhance response to CBRN terrorism threats and attacks.

PubMed

Lemyre, Louise; Clément, Mélanie; Corneil, Wayne; Craig, Lorraine; Boutette, Paul; Tyshenko, Michael; Karyakina, Nataliya; Clarke, Robert; Krewski, Daniel

2005-01-01

Evidence in the disaster mental health literature indicates that psychosocial consequences of terrorism are a critical component of chemical, biological, radiological, and nuclear (CBRN) events, both at the clinical level and the normal behavioral and emotional levels. Planning for such psychosocial aspects should be an integral part of emergency preparedness. As Canada and other countries build the capacity to prevent, mitigate, and manage CBRN threats and events, it is important to recognize the range of social, psychological, emotional, spiritual, behavioral, and cognitive factors that may affect victims and their families, communities, children, the elderly, responders, decision makers, and others at all phases of terrorism, from threat to post-impact recovery. A structured process to assist CBRN emergency planners, decision makers, and responders in identifying psychosocial risks, vulnerable populations, resources, and interventions at various phases of a CBRN event to limit negative psychosocial impacts and promote resilience and adaptive responses is the essence of our psychosocial risk assessment and management (P-RAM) framework. This article presents the evidence base and conceptual underpinnings of the framework, the principles underlying its design, its key elements, and its use in the development of decision tools for responders, planners, decision makers, and the general public to better assess and manage psychosocial aspects of CBRN threats or attacks.

Consequences of prescribed fire and grazing on grassland ant communities.

PubMed

Underwood, Emma C; Christian, Caroline E

2009-04-01

Prescribed fire and livestock grazing are used for the management and restoration of native grasslands the world over; however, the effects of these management techniques on ant communities are unclear. We examined the response of ants to these disturbances in grasslands in northern California. Twenty-four 30 by 30 m plots were established across two sites that received one of four treatments: grazing, fire, grazing and fire, or no treatment. Ants were censused using 240 pitfall traps with one preburn and two postburn samples (14 d and 1 yr after burning). We analyzed ant abundance using broadly defined groups based on feeding habit and/or habitat use and detected no grazing effect but a significant fire effect that differed by group. Immediate postfire sampling showed an increase in cryptic species (particularly Brachymyrmex depilis). One year after the fire, no response was detected for cryptic species, but burned plots had greater abundance of seed harvesters. Analysis of vegetation showed burned plots had significantly greater forb cover, which might have provided greater food resources, and also lower biomass, which might have facilitated foraging. Understanding the effects of these management tools on ant abundance complements our understanding of their effect on vegetation and assists conservation practitioners effectively manage grassland ecosystems both in California and beyond.

Models to compare management options for a protogynous fish.

PubMed

Heppell, Selina S; Heppell, Scott A; Coleman, Felicia C; Koenig, Christopher C

2006-02-01

Populations of gag (Mycteroperca microlepis), a hermaphroditic grouper, have experienced a dramatic shift in sex ratio over the past 25 years due to a decline in older age classes. The highly female-skewed sex ratio can be predicted as a consequence of increased fishing mortality that truncates the age distribution, and raises some concern about the overall fitness of the population. Management efforts may need to be directed toward maintenance of sex ratio as well as stock size, with evaluations of recruitment based on sex ratio or male stock size in addition to the traditional female-based stock-recruitment relationship. We used two stochastic, age-structured models to heuristically compare the effects of reducing fishing mortality on different life history stages and the relative impact of reductions in fertilization rates that may occur with highly skewed sex ratios. Our response variables included population size, sex ratio, lost egg fertility, and female spawning stock biomass. Population growth rates were highest for scenarios that reduced mortality for female gag (nearshore closure), while improved sex ratios were obtained most quickly with spawning reserves. The effect of reduced fertility through sex ratio bias was generally low but depended on the management scenario employed. Our results demonstrate the utility of evaluation of fishery management scenarios through model analysis and simulation, the synergistic interaction of life history and response to changes in mortality rates, and the importance of defining management goals.

Nutritional Strategies in the Management of Adult Patients with Inflammatory Bowel Disease: Dietary Considerations from Active Disease to Disease Remission.

PubMed

Nguyen, Douglas L; Limketkai, Berkeley; Medici, Valentina; Saire Mendoza, Mardeli; Palmer, Lena; Bechtold, Matthew

2016-10-01

Inflammatory bowel disease (IBD) is a group of chronic, lifelong, and relapsing illnesses, such as ulcerative colitis and Crohn's disease, which involve the gastrointestinal tract. There is no cure for these diseases, but combined pharmacological and nutritional therapy can induce remission and maintain clinical remission. Malnutrition and nutritional deficiencies among IBD patients result in poor clinical outcomes such as growth failure, reduced response to pharmacotherapy, increased risk for sepsis, and mortality. The aim of this review is to highlight the consequences of malnutrition in the management of IBD and describe nutritional interventions to facilitate induction of remission as well as maintenance; we will also discuss alternative delivery methods to improve nutritional status preoperatively.

Consensus statement: appropriate consumer education and communication programs for weight- loss agents in Asia.

PubMed

Chan, Siew Pheng; Chui, William C; Lo, Kwok Wing; Huang, Kuo-Chin; Leyesa, Normita D; Lin, Wen-Yuan; Mirasol, Roberto C; Robles, Yolanda R; Tey, Beng Hea; Paraidathathu, Thomas

2012-07-01

The increasing prevalence of overweight and obesity worldwide demands increased efforts in the prevention and management of obesity. This article aims to present consensus statements promoting appropriate consumer education and communication programs for weight-loss agents in Asia. Panel members from various disciplines developed consensus statements based on an expert meeting on the benefits of consumer education and communication programs for over-the-counter weight-loss agents. Key opinion leaders discussed relevant data that served as the basis of the recommendations. Obesity is a growing epidemic in Asia, turning the region into a potential market for weight-loss products and services. Current trends in direct-to-consumer advertising demonstrate the pervasiveness of false representations lacking adequate substantiation. Relevant issues and recommendations were established. Public education on weight management is a shared responsibility; there is a need to raise public awareness of obesity and its health-related consequences. Advertising guidelines should ensure responsible direct-to-consumer advertising of weight-loss agents.

Loss of sagebrush ecosystems and declining bird populations in the Intermountain West: Priority research issues and information needs

USGS Publications Warehouse

,

2002-01-01

Sagebrush lands in the Intermountain West are declining rapidly in quality and extent. Consequently, populations of many bird species dependent on these ecosystems also are declining. The greater sage-grouse has been petitioned for listing as a threatened and endangered species, and other species of sagebrush-obligate birds have special conservation status in most states. We identified the primary issues and information needs during a multi-agency workshop, conducted in response to concerns by management agencies related to declining bird population trends in sagebrush habitats. Priority needs were to (1) obtain a better understanding of bird response to habitat and landscape features, (2) develop monitoring designs to sample habitats and bird populations, (3) determine the effects of land use on sagebrush habitats and dependent bird species, and (4) identify linkages between breeding and wintering ranges. This agenda will identify causes and mechanisms of population declines in birds dependent on sagebrush ecosystems and will lead to better management of the ecosystems upon which they depend.

Achieving enhanced organisational resilience by improved management of risk: Summary of research into the principles of resilience and the practices of resilient organisations.

PubMed

Hopkin, Paul

There have been many high-profile incidents in recent times that have affected both individual organisations and large parts of society. In response to these disasters and their consequences, there has been increasing focus on the concept of 'resilience'. Airmic worked with Cranfield School of Management to investigate the features of resilient organisations and whether common characteristics could be identified. The research summarised in this paper discovered five principles that increase an organisation's level of resilence. The paper also reports on the actions taken by organisations to embed these resilience principles into four main business enablers. These business enablers in combination represent the business model of the organisation. The overall conclusion of the research was that, in order to achieve a state of enhanced resilience, organisations need to be aware of risks and threats they face and then combine the actions required to be 'risk compliant' with the ability to be 'risk responsive'.

Lessons learned from U.S. Department of Defense 911-Bio Advanced Concept Technology Demonstrations.

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

Baldwin, T.; Gasper, W.; Lacher, L.

1999-07-06

The US Department of Defense (DoD), in cooperation with other federal agencies, has taken many initiatives to improve its ability to support civilian response to a domestic biological terrorism incident. This paper discusses one initiative, the 911-Bio Advanced Concept Technology Demonstrations (ACTDs), conducted by the Office of the Secretary of Defense during 1997 to better understand: (1) the capability of newly developed chemical and biological collection and identification technologies in a field environment; (2) the ability of specialized DoD response teams to use these new technologies within the structure of cooperating DoD and civilian consequence management organizations; and (3) themore » adequacy of current modeling tools for predicting the dispersal of biological hazards. This paper discusses the experience of the ACTDs from the civilian community support perspective. The 911-Bio ACTD project provided a valuable opportunity for DoD and civilian officials to learn how they should use their combined capabilities to manage the aftermath of a domestic biological terrorism incident.« less

Assessing Wildlife Habitat And Range Utilization in Arizona Using Satellite Data

NASA Astrophysics Data System (ADS)

Hutchinson, C. F.; Marsh, S. E.; Krausman, P. R.; Enns, R. M.; Howery, L. D.; Trobia, E.; Wallace, C. S.; Walker, J. J.; Mauz, K.; Boyd, H.; Salazar, H.

2001-05-01

Since their reintroduction in 1914, elk (Cervus elaphus) have grown to be a major issue in the western United States. Most land is controlled by federal or state agencies, but individual ranchers have agreements that permit them to graze cattle on much of this land. Elk often compete with cattle for forage, and damage infrastructure (i.e. fences, watering points, and crops). Conversely, environmentalists and hunters also have an interest in the management of elk populations. As a result, consequence of these conflicting interests, there is little agreement about the size of the elk population or the nature, location, and timing of conflicts that elk might cause. This study was intended to provide information that might help managers understand the distribution of elk in Arizona as a consequence of seasonal variation and in response to extreme climatic events (i.e. El Niño and La Niña). The first task involved modeling elk populations over time. There are no long term or large-scale studies of elk movements through continuous observation (i.e. radiocollars). A technique for modeling elk population has been developed that is based on harvest data, gender ratios, and estimates of male mortality. This provided estimates of elk populations for individual game management units (areas for which harvest is reported and within which elk are managed by the Arizona Game and Fish Department). The second task involved the use of satellite data to characterize vegetation responses to seasonal and interannual climate variation among vegetation associations within game management units. This involved the use of NOAA Advanced Very High Resolution Radiometer (AVHRR) time series data to describe temporal vegetation behavior, Landsat and Ikonos data to describe spatial vegetation distribution in conjunction with U.S. Forest Service vegetation maps. Elk population estimates were correlated with satellite-derived vegetation measures by vegetation association through time. The patterns of elk distribution that this revealed were complex. Not surprisingly, animals appear to respond to differences in vegetation availability - both seasonally and interannually - as portrayed by satellite data.

ARE MACRO AND MICRO ENVIRONMENT AFFECTING MANAGEMENT OF FRESH WATER RESOURCES? A CASE FROM IRAN WITH PESTLE ANALYSIS.

PubMed

Atighechian, Golrokh; Maleki, Mohammadreza; Aryankhesal, Aidin; Jahangiri, Katayoun

2016-07-24

Oil spill in fresh water can affect ecological processes and accordingly it can influence human health. Iran, due to having 58.8 % of the world oil reserves, is highly vulnerable to water contamination by oil products. The aim of this study was to determine environmental factors affecting the management of the oil spill into one of the river in Iran using the PESTLE analysis. This was a qualitative case study conducted in 2015 on an oil spill incident in Iran and its roots from a disaster management approach. Semi-structured interviews were conducted for data collection. Seventy managers and staffs with those responsible or involved in oil spill incident management were recruited to the study. Qualitative content analysis approach was employed for the data analysis. Document analysis was used to collect additional information. Findings of the present study indicated that different factors affected the management of the event of oil spill onto one of the central river and consequently the management of drink water resources. Using this analysis, managers can plan for such events and develop scenarios for them to have better performance for the future events.

ARE MACRO AND MICRO ENVIRONMENT AFFECTING MANAGEMENT OF FRESH WATER RESOURCES? A CASE FROM IRAN WITH PESTLE ANALYSIS

PubMed Central

Atighechian, Golrokh; Maleki, Mohammadreza; Aryankhesal, Aidin; Jahangiri, Katayoun

2016-01-01

Introduction: Oil spill in fresh water can affect ecological processes and accordingly it can influence human health. Iran, due to having 58.8 % of the world oil reserves, is highly vulnerable to water contamination by oil products. Aim: The aim of this study was to determine environmental factors affecting the management of the oil spill into one of the river in Iran using the PESTLE analysis. Material and methods: This was a qualitative case study conducted in 2015 on an oil spill incident in Iran and its roots from a disaster management approach. Semi-structured interviews were conducted for data collection. Seventy managers and staffs with those responsible or involved in oil spill incident management were recruited to the study. Qualitative content analysis approach was employed for the data analysis. Document analysis was used to collect additional information. Results: Findings of the present study indicated that different factors affected the management of the event of oil spill onto one of the central river and consequently the management of drink water resources. Using this analysis, managers can plan for such events and develop scenarios for them to have better performance for the future events. PMID:27698608

Crisis management during anaesthesia: obstruction of the natural airway.

PubMed

Visvanathan, T; Kluger, M T; Webb, R K; Westhorpe, R N

2005-06-01

Obstruction of the natural airway, while usually easily recognised and managed, may present simply as desaturation, have an unexpected cause, be very difficult to manage, and have serious consequences for the patient. To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for obstruction of the natural airway, in the management of acute airway obstruction occurring in association with anaesthesia. The potential performance for this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 62 relevant incidents among the first 4000 reports to the AIMS. It was considered that the correct use of the structured approach would have led to earlier recognition of the problem and/or better management in 11% of cases. Airway management is a fundamental anaesthetic responsibility and skill. Airway obstruction demands a rapid and organised approach to its diagnosis and management and undue delay usually results in desaturation and a potential threat to life. An uncomplicated pre-learned sequence of airway rescue instructions is an essential part of every anaesthetist's clinical practice requirements.

Could controlling mammalian carnivores lead to mesopredator release of carnivorous reptiles?

PubMed Central

Sutherland, Duncan R.; Glen, Alistair S.; de Tores, Paul J.

2011-01-01

Emerging evidence increasingly illustrates the importance of a holistic, rather than taxon-specific, approach to the study of ecological communities. Considerable resources are expended to manage both introduced and native mammalian carnivores to improve conservation outcomes; however, management can result in unforeseen and sometimes catastrophic outcomes. Varanid lizards are likely to be apex- or mesopredators, but being reptiles are rarely considered by managers and researchers when investigating the impacts of mammalian carnivore management. Instances of mesopredator release have been described for Varanus gouldii as a result of fox and cat management in Australia, with cascading effects on faunal community structure. A meta-analysis showing extensive dietary niche overlap between varanids, foxes and cats plus a review of experimental and circumstantial evidence suggests mesopredator release of V. gouldii and about five other medium to large species of varanid lizard is likely in other regions. This highlights the need for managers to adopt a whole-of-community approach when attempting to manage predators for sustained fauna conservation, and that additional research is required to elucidate whether mesopredator release of varanids is a widespread consequence of carnivore management, altering the intended faunal responses. PMID:21123272

EVALUATION OF METEOROLOGICAL ALERT CHAIN IN CASTILLA Y LEÓN (SPAIN): How can the meteorological risk managers help researchers?

NASA Astrophysics Data System (ADS)

López, Laura; Guerrero-Higueras, Ángel Manuel; Sánchez, José Luis; Matía, Pedro; Ortiz de Galisteo, José Pablo; Rodríguez, Vicente; Lorente, José Manuel; Merino, Andrés; Hermida, Lucía; García-Ortega, Eduardo; Fernández-Manso, Oscar

2013-04-01

Evaluating the meteorological alert chain, or, how information is transmitted from the meteorological forecasters to the final users, passing through risk managers, is a useful tool that benefits all the links of the chain, especially the meteorology researchers and forecasters. In fact, the risk managers can help significantly to improve meteorological forecasts in different ways. Firstly, by pointing out the most appropriate type of meteorological format, and its characteristics when representing the meteorological information, consequently improving the interpretation of the already-existing forecasts. Secondly, by pointing out the specific predictive needs in their workplaces related to the type of significant meteorological parameters, temporal or spatial range necessary, meteorological products "custom-made" for each type of risk manager, etc. In order to carry out an evaluation of the alert chain in Castilla y León, we opted for the creation of a Panel of Experts made up of personnel specialized in risk management (Responsible for Protection Civil, Responsible for Alert Services and Hydrological Planning of Hydrographical Confederations, Responsible for highway maintenance, and management of fires, fundamentally). In creating this panel, a total of twenty online questions were evaluated, and the majority of the questions were multiple choice or open-ended. Some of the results show how the risk managers think that it would be interesting, or very interesting, to carry out environmental educational campaigns about the meteorological risks in Castilla y León. Another result is the elevated importance that the risk managers provide to the observation data in real-time (real-time of wind, lightning, relative humidity, combined indices of risk of avalanches, snowslides, index of fires due to convective activity, etc.) Acknowledgements The authors would like to thank the Junta de Castilla y León for its financial support through the project LE220A11-2.

Anticipated Guilt for Not Helping and Anticipated Warm Glow for Helping Are Differently Impacted by Personal Responsibility to Help

PubMed Central

Erlandsson, Arvid; Jungstrand, Amanda Å.; Västfjäll, Daniel

2016-01-01

One important motivation for people behaving prosocially is that they want to avoid negative and obtain positive emotions. In the prosocial behavior literature however, the motivations to avoid negative emotions (e.g., guilt) and to approach positive emotions (e.g., warm glow) are rarely separated, and sometimes even aggregated into a single mood-management construct. The aim of this study was to investigate whether anticipated guilt if not helping and anticipated warm glow if helping are influenced similarly or differently when varying situational factors related to personal responsibility to help. Helping scenarios were created and pilot tests established that each helping scenario could be formulated both in a high-responsibility version and in a low-responsibility version. In Study 1 participants read high-responsibility and low-responsibility helping scenarios, and rated either their anticipated guilt if not helping or their anticipated warm glow if helping (i.e., separate evaluation). Study 2 was similar but here participants rated both their anticipated guilt if not helping and their anticipated warm glow if helping (i.e., joint evaluation). Anticipated guilt was clearly higher in the high-responsibility versions, but anticipated warm glow was unaffected (in Studies 1a and 1b), or even higher in the low-responsibility versions (Study 2). In Studies 3 (where anticipated guilt and warm glow were evaluated separately) and 4 (where they were evaluated jointly), personal responsibility to help was manipulated within-subjects. Anticipated guilt was again constantly higher in the high-responsibility versions but for many types of responsibility-manipulations, anticipated warm glow was higher in the low-responsibility versions. The results suggest that we anticipate guilt if not fulfilling our responsibility but that we anticipate warm glow primarily when doing over and beyond our responsibility. We argue that future studies investigating motivations for helping should measure both anticipated negative consequences for oneself if not helping, and anticipated positive consequences for oneself if helping. PMID:27733840

Anticipated Guilt for Not Helping and Anticipated Warm Glow for Helping Are Differently Impacted by Personal Responsibility to Help.

PubMed

Erlandsson, Arvid; Jungstrand, Amanda Å; Västfjäll, Daniel

2016-01-01

One important motivation for people behaving prosocially is that they want to avoid negative and obtain positive emotions. In the prosocial behavior literature however, the motivations to avoid negative emotions (e.g., guilt) and to approach positive emotions (e.g., warm glow) are rarely separated, and sometimes even aggregated into a single mood-management construct. The aim of this study was to investigate whether anticipated guilt if not helping and anticipated warm glow if helping are influenced similarly or differently when varying situational factors related to personal responsibility to help. Helping scenarios were created and pilot tests established that each helping scenario could be formulated both in a high-responsibility version and in a low-responsibility version. In Study 1 participants read high-responsibility and low-responsibility helping scenarios, and rated either their anticipated guilt if not helping or their anticipated warm glow if helping (i.e., separate evaluation). Study 2 was similar but here participants rated both their anticipated guilt if not helping and their anticipated warm glow if helping (i.e., joint evaluation). Anticipated guilt was clearly higher in the high-responsibility versions, but anticipated warm glow was unaffected (in Studies 1a and 1b), or even higher in the low-responsibility versions (Study 2). In Studies 3 (where anticipated guilt and warm glow were evaluated separately) and 4 (where they were evaluated jointly), personal responsibility to help was manipulated within-subjects. Anticipated guilt was again constantly higher in the high-responsibility versions but for many types of responsibility-manipulations, anticipated warm glow was higher in the low-responsibility versions. The results suggest that we anticipate guilt if not fulfilling our responsibility but that we anticipate warm glow primarily when doing over and beyond our responsibility. We argue that future studies investigating motivations for helping should measure both anticipated negative consequences for oneself if not helping, and anticipated positive consequences for oneself if helping.

Exploration Systems Development (ESD) Approach to Enterprise Risk Management

NASA Technical Reports Server (NTRS)

Bauder, Stephen P.

2014-01-01

The National Aeronautics and Space Administration (NASA) Exploration Systems Development (ESD) Division has implemented an innovative approach to Enterprise Risk Management under a unique governance structure and streamlined integration model. ESD's mission is to design and build the capability to extend human existence to deep space. The Enterprise consists of three Programs: Space Launch System (SLS), Orion, and Ground Systems Development and Operations (GSDO). The SLS is a rocket and launch system that will be capable of powering humans, habitats, and support systems to deep space. Orion will be the first spacecraft in history capable of taking humans to multiple destinations within deep space. GSDO is modernizing Kennedy's spaceport to launch spacecraft built and designed by both NASA and private industry. ESD's approach to Enterprise Risk Management is commensurate with affordability and a streamlined management philosophy. ESD Enterprise Risk Management leverages off of the primary mechanisms for integration within the Enterprise. The Enterprise integration approach emphasizes delegation of authority to manage and execute the majority of cross-program activities and products to the individual Programs, while maintaining the overall responsibility for all cross-program activities at the Division. The intent of the ESD Enterprise Risk Management approach is to improve risk communication, to avoid replication and/or contradictory strategies, and to minimize overhead process burden. This is accomplished by the facilitation and integration of risk information within ESD. The ESD Division risks, Orion risks, SLS risks, and GSDO risks are owned and managed by the applicable Program. When the Programs have shared risks with multiple consequences, they are jointly owned and managed. When a risk is associated with the integrated system that involves more than one Program in condition, consequence, or mitigation plan, it is considered an Exploration Systems Integration (ESI) Risk. An ESI risk may require visibility and risk handling by multiple organizations. The Integrated Risk Working Group (IRWG) is a small team of Risk experts that are responsible for collaborating and communicating best practices. In addition, the forum facilitates proper integration of risks across the Enterprise. The IRWG uses a Continuous Risk Management approach for facilitating the identification, analysis, planning, tracking, and controlling of ESI Risks. The ESD Division, Programs, and Integrated Task Teams identify ESI Risks. The IRWG maintains a set of metrics for understanding Enterprise Risk process and the overall Risk Posture. The team is also actively involved in the modeling of risk for Enterprise Performance Management. With the Enterprise being constrained in Schedule and Budget, and with significant technical complexity, the appropriate use of Risk Management techniques is crucial to the success of the Enterprise. The IRWG achieves this through the modified approach, providing a forum for collaboration on risks that cross boundaries between the separate entities.

Simulation of the consequences of different fire regimes to support wildland fire use decisions

Treesearch

Carol Miller

2007-01-01

The strategy known as wildland fire use, in which lightning-ignited fires are allowed to burn, is rapidly gaining momentum in the fire management community. Managers need to know the consequences of an increase in area burned that might result from an increase in wildland fire use. One concern of land managers as they consider implementing wildland fire use is whether...

5 CFR 250.103 - Consequences of improper agency actions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Consequences of improper agency actions. 250.103 Section 250.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT IN AGENCIES Authority for Personnel Actions in Agencies § 250.103...

Wound management for the 21st century: combining effectiveness and efficiency.

PubMed

Lindholm, Christina; Searle, Richard

2016-07-01

Treatment of wounds of different aetiologies constitutes a major part of the total health care budget. It is estimated that 1·5-2 million people in Europe suffer from acute or chronic wounds. These wounds are managed both in hospitals and in community care. The patients suffering from these wounds report physical, mental and social consequences of their wounds and the care of them. It is often believed that the use of wound dressings per se is the major cost driver in wound management, whereas in fact, nursing time and hospital costs are together responsible for around 80-85% of the total cost. Healing time, frequency of dressing change and complications are three important cost drivers. However, with the use of modern, advanced technology for more rapid wound healing, all these cost drivers can be substantially reduced. A basic understanding of the terminology and principles of Health Economics in relation to wound management might therefore be of interest. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Time Overrun in Construction Project

NASA Astrophysics Data System (ADS)

Othman, I.; Shafiq, Nasir; Nuruddin, M. F.

2017-12-01

Timely completion is the key criteria to achieve success in any project despite the industry. Unfortunately construction industry in Malaysia has been labelled as industry facing poor performance leading to failure in achieving effective time management. As the consequence most of the project face huge amount of time overrun. This study assesses the causes of construction projects time overrun in Malaysia using structured questionnaire survey. Each respondent is asked to assign a one-to-five rating for each of the 18 time factors identified from literature review. Out of the 50 questionnaires sent out, 33 were received back representing 68% of the response rate. Data received from the questionnaires were analysed and processed using the descriptive statistics procedures. Findings from the study revealed that design and documentation issues, project management and contract administration, ineffective project planning and scheduling, contractor’s site management, financial resource management were the major factors that cause the time overrun. This study is hoped to help the practitioners to implement the mitigation measure at planning stage in order to achieve successful construction projects.

Operation of emergency operating centers during mass casualty incidents in taiwan: a disaster management perspective.

PubMed

Wen, Jet-Chau; Tsai, Chia-Chou; Chen, Mei-Hsuan; Chang, Wei-Ta

2014-10-01

On April 27, 2011, a train derailed and crashed in Taiwan, causing a mass casualty incident (MCI) that was similar to a previous event and with similar consequences. In both disasters, the emergency operating centers (EOCs) could not effectively integrate associated agencies to deal with the incident. The coordination and utilization of resources were inefficient, which caused difficulty in command structure operation and casualty evacuation. This study was designed to create a survey questionnaire with problem items using disaster management phases mandated by Taiwan's Emergency Medical Care Law (EMCL), use statistical methods (t test) to analyze the results and issues the EOCs encountered during the operation, and propose solutions for those problems. Findings showed that EOCs lacked authority to intervene or coordinate with associated agencies. Also, placing emphasis on the recovery phase should improve future prevention and response mechanisms. To improve the response to MCIs, the EMCL needs to be amended to give EOCs the lead during disasters; use feedback from the recovery phase to improve future disaster management and operation coordination; and establish an information-sharing platform across agencies to address all aspects of relief work.(Disaster Med Public Health Preparedness. 2014;0:1-6).

Optimal Shift Duration and Sequence: Recommended Approach for Short-Term Emergency Response Activations for Public Health and Emergency Management

PubMed Central

Burgess, Paula A.

2007-01-01

Since September 11, 2001, and the consequent restructuring of the US preparedness and response activities, public health workers are increasingly called on to activate a temporary round-the-clock staffing schedule. These workers may have to make key decisions that could significantly impact the health and safety of the public. The unique physiological demands of rotational shift work and night shift work have the potential to negatively impact decisionmaking ability. A responsible, evidence-based approach to scheduling applies the principles of circadian physiology, as well as unique individual physiologies and preferences. Optimal scheduling would use a clockwise (morning-afternoon-night) rotational schedule: limiting night shifts to blocks of 3, limiting shift duration to 8 hours, and allowing 3 days of recuperation after night shifts. PMID:17413074

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

40 CFR 1400.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... OFF-SITE CONSEQUENCE ANALYSIS INFORMATION DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS INFORMATION... analysis (OCA) information means sections 2 through 5 of a risk management plan (consisting of an... consequence analysis (OCA) data elements means the results of the off-site consequence analysis conducted by a...

Systematic review of prevention and management strategies for the consequences of gender-based violence in refugee settings.

PubMed

Asgary, Ramin; Emery, Eleanor; Wong, Marcia

2013-06-01

Uncertainties continue regarding effective strategies to prevent and address the consequences of gender-based violence (GBV) among refugees. The databases of PubMed, Cochrane Library, Scopus, PsycINFO, Web of Science, Anthropology Plus, EMBASE, DARE, Google Scholar, MSF Field Research, UNHCR and the regional and global indices of the WHO Global Health Library were searched twice within a 6-month period (April and September 2011) for English-language clinical, public health, basic and social science studies evaluating strategies to prevent and manage health sequelae of GBV among refugees before September 2011. Studies not primarily about prevention and treatment, and not describing population, health outcome and interventions, were excluded. The literature search for the prevention and management arms produced 1212 and 1106 results, respectively. After reviewing the titles and abstracts, 29 and 27 articles were selected for review in their entirety, none of which met the inclusion criteria. Multiple panels of expert recommendations and guidelines were not supported by primary data on actual displaced populations. There is a dire need for research that evaluates the efficacy and effectiveness of various responses to GBV to ultimately allow a transition from largely theoretical and expertise driven to a more evidence-based field. We recommend strategies to improve data collection and to overcome barriers in primary data driven research.

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

DTIC Science & Technology

2008-06-01

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

Prediction of response to PPI therapy and factors influencing treatment outcome in patients with GORD: a prospective pragmatic trial using pantoprazole

PubMed Central

2011-01-01

Background Management of patients with gastro-oesophageal reflux disease (GORD) can be assisted by information predicting the likely response to proton pump inhibitor (PPI) treatment. The aim was to undertake a study of GORD patients designed to approximate ordinary clinical practice that would identify patient characteristics predicting symptomatic response to pantoprazole treatment. Methods 1888 patients with symptoms of GORD were enrolled in a multicentre, multinational, prospective, open study of 8 weeks pantoprazole treatment, 40 mg daily. Response was assessed by using the ReQuest™ questionnaire, by the investigator making conventional clinical enquiry and by asking patients about their satisfaction with symptom control. Factors including pre-treatment oesophagitis, gender, age, body mass index (BMI), Helicobacter pylori status, anxiety and depression, and concurrent IBS symptoms were examined using logistic regression to determine if they were related to response, judged from the ReQuest™-GI score. Results Poorer treatment responses were associated with non-erosive reflux disease, female gender, lower BMI, anxiety and concurrent irritable bowel syndrome symptoms before treatment. No association was found with age, Helicobacter pylori status or oesophagitis grade. Some reflux-related symptoms were still present in 14% of patients who declared themselves 'well-satisfied' with their symptom control. Conclusions Some readily identifiable features help to predict symptomatic responses to a PPI and consequently may help in managing patient expectation. ClinicalTrial.gov identifier: NCT00312806. PMID:21569313

Mediterranean Storms: An Integrated Approach of Risk Management

NASA Astrophysics Data System (ADS)

Karageorgou, H.; Riza, E.; Linos, A.; Papanikolaou, D.

2010-09-01

Disaster by UN definition is "a serious disruption of the functioning of a community or a society, involving widespread human, material, economic, or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using only its own resources". Mediterranean storms induce flash floods caused by excessive amounts of rainfall within a short lasting period of time. The intensity and duration of precipitation, region geomorphology, urbanization and different governmental emergency management structures trigger different consequences between Mediterranean countries. The integrated approach in management of storm risk represents a holistic perspective including interactions between government, science and technology institutions, developing agencies, private sector, NGOs and public. Local authorities and national government are responsible for the design, preparation and decision on storm risk management policies and strategies considering scientific risk identifying, assessing and understanding. Efficient governance management requires satisfied response to early warning systems, functionality of the affected systems upon which society depends and appropriate focus on variable interest, beliefs, values and ideologies between social groups. Also an appropriate balancing of benefits and costs in an efficient and equitable manner is important for the governance risk management. Natural sciences in corporation with the engineering science have developed effective early prediction, warning and monitoring systems on storm and flood risk. The health sciences use prediction systems for health related hazards and consequences and the social sciences research estimates the human resilience during disasters and the factors which affect and determine the human behavior. Also social sciences survey the response of public to early warning messages, the appropriate communicative methods to distributing messages and mechanisms to improve public response. The available and applied science and technology in prediction and early warning systems rely on the close collaboration between scientists and policy makers to achieve effective disaster prevention of human life and mitigation of damages. Developing agencies approach risk management as an integral part of development and encourage activities and measures to reduce the exposure and vulnerability to natural hazards through early warning systems, building codes, land use plans and disaster sensitive development plans. The human settlement and investment in high risk floodplains place greater numbers of people and economic assets in danger of being affected by storms and floods. Disasters and development are highly inter-related. Recurrent disasters and frequent localized disasters erode development and conversely the development processes can reduce disaster risk, or create new risks. The private sector participation in risk reduction efforts can help local communities mitigate disasters and increases the benefits of the businesses. The private insurance sector is highly involved in the prevention of disaster caused by natural hazards especially storms and floods. The collaboration between academic community and the insurance sector indicates the linkages between the mutual insurance actions and risk culture. Also tourism industry and private critical infrastructure sector get involved in prevention measures and activities against storm and flood risks to build sustainable functionality and keep public trust. NGOs focus on social, cultural, environmental, educational, or health issues in disaster management and their members are educated and experienced on their area of operations. The staff of local and national NGOs is familiar with culture, languages, governance structures, social networks, climate and geography of the affected area and holds a unique understanding of the specific problems of the affected population. Additionally, NGO’s operations do not suffer from bureaucracy and therefore are able to deploy on very short notice. The public awareness, behavior and response to disasters depend on the knowledge about the risk, the understanding of the information and the translation of what it means in their own particular circumstances. The majority of people judges the information to be credible and discusses the meaning of information with trusted family members, friends and colleagues to decide the next action. Well educated people, efficient management of previous experiences, successful communication methods and trust on government and authorities contribute towards efficient public response on disasters.

Patients' Attitudes and Approaches to the Self-Management of Hypertension: Perspectives from an Australian Qualitative Study in Community Pharmacy.

PubMed

Bajorek, Beata; Lemay, Kate; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol

2017-06-01

In the management of hypertension, blood pressure (BP) monitoring and medication use are key strategies, but they are dependent on patients' motivation to practice self-care. To gauge patients' approaches to monitoring their blood pressure, as well as explore their attitudes toward, and actions relating to, high blood pressure readings, as the key components of their self-management of hypertension. This qualitative study, comprising individual telephone interviews, involved patients attending community pharmacies in Sydney (Australia). Patients' perspectives were elicited using a purpose-designed, semi-structured interview guide. The verbal responses were audio-recorded, transcribed verbatim, and thematically analysed. Three key themes arose: (1) approaches to monitoring blood pressure, (2) attitudes to variability in BP, (3) responses to high BP readings. Many patients self-regulated the frequency of monitoring based on perceived need and/or opportunity. Most were indifferent toward their readings, regarding BP fluctuations as 'normal'. When a high BP was detected, the action taken was highly variable, with no clear action plans in place. Several patients recognised a high BP to be a consequence of not taking their antihypertensive medication, triggering the resumption of short-term adherence to their preferred management strategy, i.e., self-medication with antihypertensives (i.e., restarting their medication) and/or self-management via lifestyle strategies. This study highlights patients' inappropriate self-management of hypertension. Misperceptions about hypertension, e.g., accepting BP fluctuations as normal, can produce indifferent attitudes as well as influence patients' self-management actions. This lack of insight undermines long-term adherence to antihypertensive therapy.

Consequence Management: A Disconnect Between National Security Policy and Force Structure?

DTIC Science & Technology

2001-03-15

effects or the consequences of a detonated and/or released weapon(s) has only recently been given much attention. Despite several warnings of the...with the exposure ? Second, the time required to establish and field a regional JTF would prevent the force from having a strong positive effect on the... outcome of the situation. One of the critical missions of a successful consequence management force is its ability to provide a strong deterrent

Exploring the Use of Molecular Biomarkers for Precision Medicine in Age-Related Macular Degeneration.

PubMed

Lorés-Motta, Laura; de Jong, Eiko K; den Hollander, Anneke I

2018-06-01

Precision medicine aims to improve patient care by adjusting medication to each patient's individual needs. Age-related macular degeneration (AMD) is a heterogeneous eye disease in which several pathways are involved, and the risk factors driving the disease differ per patient. As a consequence, precision medicine holds promise for improved management of this disease, which is nowadays a main cause of vision loss in the elderly. In this review, we provide an overview of the studies that have evaluated the use of molecular biomarkers to predict response to treatment in AMD. We predominantly focus on genetic biomarkers, but also include studies that examined circulating or eye fluid biomarkers in treatment response. This involves studies on treatment response to dietary supplements, response to anti-vascular endothelial growth factor, and response to complement inhibitors. In addition, we highlight promising new therapies that have been or are currently being tested in clinical trials and discuss the molecular studies that can help identify the most suitable patients for these upcoming therapeutic approaches.

Diabetic Hyperglycemia: Link to Impaired Glucose Transport in Pancreatic β Cells

NASA Astrophysics Data System (ADS)

Unger, Roger H.

1991-03-01

Glucose uptake into pancreatic β cells by means of the glucose transporter GLUT-2, which has a high Michaelis constant, is essential for the normal insulin secretory response to hyperglycemia. In both autoimmune and nonautoimmune diabetes, this glucose transport is reduced as a consequence of down-regulation of the normal β-cell transporter. In autoimmune diabetes, circulating immunoglobulins can further impair this glucose transport by inhibiting functionally intact transporters. Insights into mechanisms of the unresponsiveness of β cells to hyperglycemia may improve the management and prevention of diabetes.

The renal concentrating mechanism and the clinical consequences of its loss

PubMed Central

Agaba, Emmanuel I.; Rohrscheib, Mark; Tzamaloukas, Antonios H.

2012-01-01

The integrity of the renal concentrating mechanism is maintained by the anatomical and functional arrangements of the renal transport mechanisms for solute (sodium, potassium, urea, etc) and water and by the function of the regulatory hormone for renal concentration, vasopressin. The discovery of aquaporins (water channels) in the cell membranes of the renal tubular epithelial cells has elucidated the mechanisms of renal actions of vasopressin. Loss of the concentrating mechanism results in uncontrolled polyuria with low urine osmolality and, if the patient is unable to consume (appropriately) large volumes of water, hypernatremia with dire neurological consequences. Loss of concentrating mechanism can be the consequence of defective secretion of vasopressin from the posterior pituitary gland (congenital or acquired central diabetes insipidus) or poor response of the target organ to vasopressin (congenital or nephrogenic diabetes insipidus). The differentiation between the three major states producing polyuria with low urine osmolality (central diabetes insipidus, nephrogenic diabetes insipidus and primary polydipsia) is done by a standardized water deprivation test. Proper diagnosis is essential for the management, which differs between these three conditions. PMID:23293407

Pharmacy practice department chairs' perspectives on part-time faculty members.

PubMed

Fjortoft, Nancy; Winkler, Susan R; Mai, Thy

2012-05-10

To identify the benefits and consequences of having part-time faculty members in departments of pharmacy practice from the department chair's perspective. A stratified purposive sample of 12 pharmacy practice department chairs was selected. Eleven telephone interviews were conducted. Two investigators independently read interview notes and categorized and enumerated responses to determine major themes using content analysis. The investigators jointly reviewed the data and came to consensus on major themes. Benefits of allowing full-time faculty members to reduce their position to part-time included faculty retention and improved individual faculty work/life balance. Consequences of allowing part-time faculty positions included the challenges of managing individual and departmental workloads, the risk of marginalizing part-time faculty members, and the challenges of promotion and tenure issues. All requests to switch to part-time status were faculty-driven and most were approved. There are a variety of benefits and consequences of having part-time faculty in pharmacy practice departments from the chair's perspective. Clear faculty and departmental expectations of part-time faculty members need to be established to ensure optimal success of this working arrangement.

Ethical dilemmas and human rights considerations arising from the evaluation of a smoking policy in a health promoting setting.

PubMed

Harvey, Harold D; Fleming, Paul; Patterson, Michael

2002-09-01

One of the key challenges in managing the Health Promoting Workplace is the development of an effective policy for the control of environmental tobacco smoke (ETS). This paper explores the ethical consequences raised when the implementation of such a policy was evaluated in a large multi-campus university. In a three-stage evaluation, the first stage involved a qualitative enquiry with the Health and Safety Committee to obtain the management perspective on the working of the policy. A survey of the perception of the ETS policy and smoking behaviours with a representative sample of staff and students constituted the second stage. In the final stage the Health and Safety Committee was engaged with the findings of stages 1 and 2 to develop a response to the evaluation. The ethical implications which arise from this evaluation centre, firstly, on the underlying reasons for undertaking an evaluation. Secondly, consideration is given to the consequences of applying utilitarian principles to smoking policy for the minority who smoke and thus find their work or study patterns affected by a smoking ban. Such a ban limits their autonomy and while it may be helpful (beneficent) in terms of their longer-term physical health, it may have harmful (maleficent) effects on their psychological wellbeing and the potential for negative consequences if they choose to contravene the ban on smoking. The implications of addressing this situation are explored.

The relationship between burnout and mobbing among hospital managers.

PubMed

Karsavuran, Seda; Kaya, Sıdıka

2017-05-01

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

[Non-commercial clinical trials--who will be the legal sponsor? Sponsorship of investigator-initiated clinical trials according to the German Drug Law].

PubMed

Benninger-Döring, G; Boos, J

2006-07-01

Non-commercial clinical trials may be of great benefit to the patients concerned. The 12th amendment to the German Drug Law (AMG) changed legal liability of the initiators of investigator-initiated clinical trials with extensive consequences for traditional project leaders. The central point under discussion is the sponsor's responsibility according to the AMG. Presently leading management divisions of university hospitals and universities are developing proceedings to assume sponsor responsibility by institutions (institutional sponsorship), which should enable investigator-initiated clinical trials to be conducted according to legal requirements in the future. Detailed problems and special questions can only be resolved in a single-minded fashion, and if necessary political processes should be catalyzed.

[Moral responsibility of hospital management].

PubMed

Schmidt-Wilcke, Heinrich Alyosius

2009-03-15

The self-concept of hospitals today includes the role of service providers, and so they act accordingly. This attitude is chiefly held by hospital administrators. It means that at management level there is a shift of values toward business ethics. However, hospital management is responsible not only for the business aspects of the hospital but also for the provision of adequate medical care to patients. Therefore, hospitals as service providers must be governed by the principles of medical as well as of business ethics. These principles, although from different areas, can be made to largely coincide, but can also lead to divergent positions within a hospital. The result is what within the scope of medical ethics, too, is experienced as a conflict of principles, e.g., the principle of beneficence versus the principle of autonomy. A reconciliation of such divergent moral positions can often be effected by analyzing the actual conflict situation and thus reaching consensus. The conflict between the principles of medical ethics and business ethics takes place chiefly within the sphere of activity of those providing medical and nursing care. As a consequence, a necessary business decision taken by the management to improve the productivity of medical and nursing activities can lead to serious deficits on the staff side. In terms of business ethics, this is a lack of beneficence toward individual staff members that are perhaps overtaxed, and at the same time, in terms of medical ethics, a potential lack of beneficence toward hospital patients is implicitly accepted. In general, management has the responsibility for bringing about, in the day-to-day operation of a hospital, a plausible reconciliation of the ethical principles of two spheres of activity that are only apparently independent of each other.

When managers and their teams disagree: a longitudinal look at the consequences of differences in perceptions of organizational support.

PubMed

Bashshur, Michael R; Hernández, Ana; González-Romá, Vicente

2011-05-01

The authors argue that over time the difference between team members' perception of the organizational support received by the team (or team climate for organizational support) and their manager's perception of the organizational support received by the team has an effect on important outcomes and emergent states, such as team performance and team positive and negative affect above and beyond the main effects of climate perceptions themselves. With a longitudinal sample of 179 teams at Time 1 and 154 teams at Time 2, the authors tested their predictions using a combined polynomial regression and response surface analyses approach. The results supported the authors' predictions. When team managers and team members' perceptions of organizational support were high and in agreement, outcomes were maximized. When team managers and team members disagreed, team negative affect increased and team performance and team positive affect decreased. The negative effects of disagreement were most amplified when managers perceived that the team received higher levels of support than did the team itself.

[Risk management in health care systems: the new legislative orientations in medical civil responsibility].

PubMed

Tomassini, A; Signorelli, C; Colzani, E

2004-01-01

The recent radical change in the relationships between physicians and patients has increased the frequency of malpractice. Consequently, on one hand, many physicians got used to avoiding any possible risk of denunciation by applying the so called "defensive medicine", while on the other hand, the insurance companies raised the prices of their premiums for policies concerning civil responsibility of health operators. In order to avoid this "vicious circle", some health structures created Units for the Risk Management related to malpractice, while others took advantage of the collaboration of Associations for Patients' Rights to create database about the most frequent medical mistakes. The need for a legislative change has been accepted by the Parliament which expects with the proposal n.108 (approved in spring 2002 by the Commission for Hygiene and Health of the Senate) to attribute the civil responsibility of the physicians to the hospitals (both private and public) for which they work, to constitute a Register of experts and to accelerate the legal disputes. The problem is complex and still to be solved, but it seems that time for a strong intervention in order to improve the situation has to come.

The interplay between habitat structure and chemical contaminants on biotic responses of benthic organisms

PubMed Central

Matias, Miguel G.; Coleman, Ross A.

2016-01-01

Habitat structure influences the diversity and distribution of organisms, potentially affecting their response to disturbances by either affecting their ‘susceptibility’ or through the provision of resources that can mitigate impacts of disturbances. Chemical disturbances due to contamination are associated with decreases in diversity and functioning of systems and are also likely to increase due to coastal urbanisation. Understanding how habitat structure interacts with contaminants is essential to predict and therefore manage such effects, minimising their consequences to marine systems. Here, we manipulated two structurally different habitats and exposed them to different types of contaminants. The effects of contamination and habitat structure interacted, affecting species richness. More complex experimental habitats were colonized by a greater diversity of organisms than the less complex habitats. These differences disappeared, however, when habitats were exposed to contaminants, suggesting that contaminants can override effects of habitats structure at small spatial scales. These results provide insight into the complex ways that habitat structure and contamination interact and the need to incorporate evidence of biotic responses from individual disturbances to multiple stressors. Such effects need to be taken into account when designing and planning management and conservation strategies to natural systems. PMID:27168991

Behavior Management: Examining the Functions of Behavior

ERIC Educational Resources Information Center

Alstot, Andrew E.; Alstot, Crystal D.

2015-01-01

Appropriate student behavior is essential for the success of a physical education lesson. Despite using effective proactive management strategies, teachers may need to also use reactive techniques to reduce problem behaviors by applying suitable consequences. For these consequences to be effective, they must be aligned with the function, or cause,…

Cyber-Victimization and Its Psychosocial Consequences: Relationships with Behavior Management and Traditional Bullying

ERIC Educational Resources Information Center

Mindrila, Diana; Moore, Lori; Davis, Pamela

2015-01-01

The current study investigated the relationship between behavior management, traditional bullying, cyber-victimization, and several psychosocial consequences of cyber-victimization. Findings from previous research were used to specify a complex path model, which allowed the simultaneous estimation of multiple direct and indirect effects. Data were…

The Systematic Use of Positive and Negative Consequences in Managing Classroom Encopresis

ERIC Educational Resources Information Center

George, Thomas W.; And Others

1977-01-01

This study reports a successful classroom intervention program which was designed to curb encopresis. It used positive consequences in combination with negative consequences, rather than negative consequences alone. Also it utilized a reversal strategy to evalulate the efficacy of the treatment variables. (Author)

Directive and incentive functions of affective action consequences: an ideomotor approach.

PubMed

Eder, Andreas B; Rothermund, Klaus; De Houwer, Jan; Hommel, Bernhard

2015-07-01

Five experiments examined whether affective consequences become associated with the responses producing them and whether anticipations of positive and negative action outcomes influence action control differently. In a learning phase, one response produced pleasant and another response unpleasant visual effects. In a subsequent test phase, the same actions were carried out in response to a neutral feature of affective stimuli. Results showed that responses were faster when the irrelevant valence of the response cue matched the valence of the response outcome, but only when the responses still produced outcomes. These results suggest that affective action consequences have a directive function in that they facilitate the selection of the associated response over other responses, even when the response outcome is unpleasant (Experiment 4A). Results of another experiment showed that affective action consequences can also have an incentive function in that responses with pleasant outcomes are generally facilitated relative to responses with unpleasant outcomes. However, this motivational effect was seen only in a free-choice test (Experiment 5). The results suggest that behavioral impulses induced by ideomotor processes are constrained by the motivational evaluation of the anticipated action outcome. A model that integrates motivational factors into ideomotor theory is presented.

Taking out violence.

PubMed

Loafmann, B

2001-01-01

An analysis of how consequences impact your company from inside or outside will enable you to prevent the situations that can build up until they explode into violence. Specific skill enhancement on the use of feedback and consequences will broaden the base of involvement and foster early intervention opportunities before things get out of control. Understanding how consequences influence behavior also can improve self-management efforts. When these strategies are coupled with security hardware and appropriate policies, we can once again help our managers and employees work without fear of violence.

Accidental awareness during general anaesthesia - a narrative review.

PubMed

Tasbihgou, S R; Vogels, M F; Absalom, A R

2018-01-01

Unintended accidental awareness during general anaesthesia represents failure of successful anaesthesia, and so has been the subject of numerous studies during the past decades. As return to consciousness is both difficult to describe and identify, the reported incidence rates vary widely. Similarly, a wide range of techniques have been employed to identify cases of accidental awareness. Studies which have used the isolated forearm technique to identify responsiveness to command during intended anaesthesia have shown remarkably high incidences of awareness. For example, the ConsCIOUS-1 study showed an incidence of responsiveness around the time of laryngoscopy of 1:25. On the other hand, the 5th Royal College of Anaesthetists National Audit Project, which reported the largest ever cohort of patients who had experienced accidental awareness, used a system to identify patients who spontaneously self-reported accidental awareness. In this latter study, the incidence of accidental awareness was 1:19,600. In the recently published SNAP-1 observational study, in which structured postoperative interviews were performed, the incidence was 1:800. In almost all reported cases of intra-operative responsiveness, there was no subsequent explicit recall of intra-operative events. To date, there is no evidence that this occurrence has any psychological consequences. Among patients who experience accidental awareness and can later remember details of their experience, the consequences are better known. In particular, when awareness occurs in a patient who has been given neuromuscular blocking agents, it may result in serious sequelae such as symptoms of post-traumatic stress disorder and a permanent aversion to surgery and anaesthesia, and is feared by patients and anaesthetists. In this article, the published literature on the incidence, consequences and management of accidental awareness under general anaesthesia with subsequent recall will be reviewed. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Adapt to more wildfire in western North American forests as climate changes.

PubMed

Schoennagel, Tania; Balch, Jennifer K; Brenkert-Smith, Hannah; Dennison, Philip E; Harvey, Brian J; Krawchuk, Meg A; Mietkiewicz, Nathan; Morgan, Penelope; Moritz, Max A; Rasker, Ray; Turner, Monica G; Whitlock, Cathy

2017-05-02

Wildfires across western North America have increased in number and size over the past three decades, and this trend will continue in response to further warming. As a consequence, the wildland-urban interface is projected to experience substantially higher risk of climate-driven fires in the coming decades. Although many plants, animals, and ecosystem services benefit from fire, it is unknown how ecosystems will respond to increased burning and warming. Policy and management have focused primarily on specified resilience approaches aimed at resistance to wildfire and restoration of areas burned by wildfire through fire suppression and fuels management. These strategies are inadequate to address a new era of western wildfires. In contrast, policies that promote adaptive resilience to wildfire, by which people and ecosystems adjust and reorganize in response to changing fire regimes to reduce future vulnerability, are needed. Key aspects of an adaptive resilience approach are ( i ) recognizing that fuels reduction cannot alter regional wildfire trends; ( ii ) targeting fuels reduction to increase adaptation by some ecosystems and residential communities to more frequent fire; ( iii ) actively managing more wild and prescribed fires with a range of severities; and ( iv ) incentivizing and planning residential development to withstand inevitable wildfire. These strategies represent a shift in policy and management from restoring ecosystems based on historical baselines to adapting to changing fire regimes and from unsustainable defense of the wildland-urban interface to developing fire-adapted communities. We propose an approach that accepts wildfire as an inevitable catalyst of change and that promotes adaptive responses by ecosystems and residential communities to more warming and wildfire.

Adapt to more wildfire in western North American forests as climate changes

PubMed Central

Schoennagel, Tania; Balch, Jennifer K.; Brenkert-Smith, Hannah; Harvey, Brian J.; Mietkiewicz, Nathan; Morgan, Penelope; Moritz, Max A.; Rasker, Ray; Turner, Monica G.; Whitlock, Cathy

2017-01-01

Wildfires across western North America have increased in number and size over the past three decades, and this trend will continue in response to further warming. As a consequence, the wildland–urban interface is projected to experience substantially higher risk of climate-driven fires in the coming decades. Although many plants, animals, and ecosystem services benefit from fire, it is unknown how ecosystems will respond to increased burning and warming. Policy and management have focused primarily on specified resilience approaches aimed at resistance to wildfire and restoration of areas burned by wildfire through fire suppression and fuels management. These strategies are inadequate to address a new era of western wildfires. In contrast, policies that promote adaptive resilience to wildfire, by which people and ecosystems adjust and reorganize in response to changing fire regimes to reduce future vulnerability, are needed. Key aspects of an adaptive resilience approach are (i) recognizing that fuels reduction cannot alter regional wildfire trends; (ii) targeting fuels reduction to increase adaptation by some ecosystems and residential communities to more frequent fire; (iii) actively managing more wild and prescribed fires with a range of severities; and (iv) incentivizing and planning residential development to withstand inevitable wildfire. These strategies represent a shift in policy and management from restoring ecosystems based on historical baselines to adapting to changing fire regimes and from unsustainable defense of the wildland–urban interface to developing fire-adapted communities. We propose an approach that accepts wildfire as an inevitable catalyst of change and that promotes adaptive responses by ecosystems and residential communities to more warming and wildfire. PMID:28416662

Paediatric physician-researchers: coping with tensions in dual accountability.

PubMed

Boydell, Katherine; Shaul, Randi Zlotnik; D'Agincourt-Canning, Lori; Da Silva, Michael; Simpson, Christy; Czoli, Christine D; Rashkovan, Natalie; Kim, Celine C; Levin, Alex V; Schneider, Rayfel

2012-01-01

Potential conflicts between the roles of physicians and researchers have been described at the theoretical level in the bioethics literature (Czoli, et al., 2011). Physicians and researchers are generally in mutually distinct roles, responsible for patients and participants respectively. With increasing emphasis on integration of research into clinical settings, however, the role divide is sometimes unclear. Consequently, physician-researchers must consider and negotiate salient ethical differences between clinical- and research-based obligations (Miller et al, 1998). This paper explores the subjective experiences and perspectives of 30 physician-researchers working in three Canadian paediatric settings. Drawing on qualitative interviews, it identifies ethical challenges and strategies used by physician-researchers in managing dual roles. It considers whether competing obligations could have both positive and adverse consequences for both physician-researchers and patients. Finally, we discuss how empirical work, which explores the perspectives of those engaged in research and clinical practice, can lead the way to understanding and promoting best practice.

Changing Donor Funding and the Challenges of Integrated HIV Treatment.

PubMed

Nattrass, Nicoli; Hodes, Rebecca; Cluver, Lucie

2016-07-01

Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

Community-level consequences of cannibalism.

PubMed

Ohlberger, Jan; Langangen, Oystein; Stenseth, Nils C; Vøllestad, L Asbjørn

2012-12-01

Ecological interactions determine the structure and dynamics of communities and their responses to the environment. Understanding the community-level effects of ecological interactions, such as intra- and interspecifc competition, predation, and cannibalism, is therefore central to ecological theory and ecosystem management. Here, we investigate the community-level consequences of cannibalism in populations with density-dependent maturation and reproduction. We model a stage-structured consumer population with an ontogenetic diet shift to analyze how cannibalism alters the conditions for the invasion and persistence of stage-specific predators and competitors. Our results demonstrate that cannibalistic interactions can facilitate coexistence with other species at both trophic levels. This effect of cannibalism critically depends on the food dependence of the demographic processes. The underlying mechanism is a cannibalism-induced shift in the biomass distribution between the consumer life stages. These findings suggest that cannibalism may alter the structure of ecological communities through its effects on species coexistence.

Evaluation of stroke volume variation obtained by arterial pulse contour analysis to predict fluid responsiveness intraoperatively.

PubMed

Lahner, D; Kabon, B; Marschalek, C; Chiari, A; Pestel, G; Kaider, A; Fleischmann, E; Hetz, H

2009-09-01

Fluid management guided by oesophageal Doppler monitor has been reported to improve perioperative outcome. Stroke volume variation (SVV) is considered a reliable clinical predictor of fluid responsiveness. Consequently, the aim of the present trial was to evaluate the accuracy of SVV determined by arterial pulse contour (APCO) analysis, using the FloTrac/Vigileo system, to predict fluid responsiveness as measured by the oesophageal Doppler. Patients undergoing major abdominal surgery received intraoperative fluid management guided by oesophageal Doppler monitoring. Fluid boluses of 250 ml each were administered in case of a decrease in corrected flow time (FTc) to <350 ms. Patients were connected to a monitoring device, obtaining SVV by APCO. Haemodynamic variables were recorded before and after fluid bolus application. Fluid responsiveness was defined as an increase in stroke volume index >10%. The ability of SVV to predict fluid responsiveness was assessed by calculation of the area under the receiver operating characteristic (ROC) curve. Twenty patients received 67 fluid boluses. Fifty-two of the 67 fluid boluses administered resulted in fluid responsiveness. SVV achieved an area under the ROC curve of 0.512 [confidence interval (CI) 0.32-0.70]. A cut-off point for fluid responsiveness was found for SVV > or =8.5% (sensitivity: 77%; specificity: 43%; positive predictive value: 84%; and negative predictive value: 33%). This prospective, interventional observer-blinded study demonstrates that SVV obtained by APCO, using the FloTrac/Vigileo system, is not a reliable predictor of fluid responsiveness in the setting of major abdominal surgery.

Strengths, altered investment, risk management, and other elaborations on the behavioural constellation of deprivation.

PubMed

Pepper, Gillian V; Nettle, Daniel

2017-01-01

We are grateful to have received so many insightful commentaries from interested colleagues regarding our proposed behavioural constellation of deprivation (BCD) and our thoughts on its causes and consequences. In this response article, we offer some clarifications regarding our perspective and tackle some common misperceptions, including, for example, assumptions that the BCD is adaptive and that it should include all behaviours that vary with socioeconomic status. We then welcome some excellent proposals for extensions and modifications of our ideas, such as the conceptualisation of the BCD as a risk-management strategy and the calls for a greater focus on strengths and differential investment rather than deficits and disinvestment. Finally, we highlight some insightful explorations of the implications of our ideas for ethics, policy, and practice.

The potential benefits of a new poliovirus vaccine for long-term poliovirus risk management.

PubMed

Duintjer Tebbens, Radboud J; Thompson, Kimberly M

2016-12-01

To estimate the incremental net benefits (INBs) of a hypothetical ideal vaccine with all of the advantages and no disadvantages of existing oral and inactivated poliovirus vaccines compared with current vaccines available for future outbreak response. INB estimates based on expected costs and polio cases from an existing global model of long-term poliovirus risk management. Excluding the development costs, an ideal poliovirus vaccine could offer expected INBs of US$1.6 billion. The ideal vaccine yields small benefits in most realizations of long-term risks, but great benefits in low-probability-high-consequence realizations. New poliovirus vaccines may offer valuable insurance against long-term poliovirus risks and new vaccine development efforts should continue as the world gathers more evidence about polio endgame risks.

"And DPSIR begat DAPSI(W)R(M)!" - A unifying framework for marine environmental management.

PubMed

Elliott, M; Burdon, D; Atkins, J P; Borja, A; Cormier, R; de Jonge, V N; Turner, R K

2017-05-15

The marine environment is a complex system formed by interactions between ecological structure and functioning, physico-chemical processes and socio-economic systems. An increase in competing marine uses and users requires a holistic approach to marine management which considers the environmental, economic and societal impacts of all activities. If managed sustainably, the marine environment will deliver a range of ecosystem services which lead to benefits for society. In order to understand the complexity of the system, the DPSIR (Driver-Pressure-State-Impact-Response) approach has long been a valuable problem-structuring framework used to assess the causes, consequences and responses to change in a holistic way. Despite DPSIR being used for a long time, there is still confusion over the definition of its terms and so to be appropriate for current marine management, we contend that this confusion needs to be addressed. Our viewpoint advocates that DPSIR should be extended to DAPSI(W)R(M) (pronounced dap-see-worm) in which Drivers of basic human needs require Activities which lead to Pressures. The Pressures are the mechanisms of State change on the natural system which then leads to Impacts (on human Welfare). Those then require Responses (as Measures). Furthermore, because of the complexity of any managed sea area in terms of multiple Activities, there is the need for a linked-DAPSI(W)R(M) framework, and then the connectivity between marine ecosystems and ecosystems in the catchment and further at sea, requires an interlinked, nested-DAPSI(W)R(M) framework to reflect the continuum between adjacent ecosystems. Finally, the unifying framework for integrated marine management is completed by encompassing ecosystem structure and functioning, ecosystem services and societal benefits. Hence, DAPSI(W)R(M) links the socio-ecological system of the effects of changes to the natural system on the human uses and benefits of the marine system. However, to deliver these sustainably in the light of human activities requires a Risk Assessment and Risk Management framework; the ISO-compliant Bow-Tie method is used here as an example. Finally, to secure ecosystem health and economic benefits such as Blue Growth, successful, adaptive and sustainable marine management Responses (as Measures) are delivered using the 10-tenets, a set of facets covering all management disciplines and approaches. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

California Earthquake Clearinghouse: Advocating for, and Advancing, Collaboration and Technology Interoperability, Between the Scientific and Emergency Response Communities, to Produce Actionable Intelligence for Situational Awareness, and Decision Support

NASA Astrophysics Data System (ADS)

Rosinski, A.; Beilin, P.; Colwell, J.; Hornick, M.; Glasscoe, M. T.; Morentz, J.; Smorodinsky, S.; Millington, A.; Hudnut, K. W.; Penn, P.; Ortiz, M.; Kennedy, M.; Long, K.; Miller, K.; Stromberg, M.

2015-12-01

The Clearinghouse provides emergency management and response professionals, scientific and engineering communities with prompt information on ground failure, structural damage, and other consequences from significant seismic events such as earthquakes or tsunamis. Clearinghouse activations include participation from Federal, State and local government, law enforcement, fire, EMS, emergency management, public health, environmental protection, the military, public and non-governmental organizations, and private sector. For the August 24, 2014 S. Napa earthquake, over 100 people from 40 different organizations participated during the 3-day Clearinghouse activation. Every organization has its own role and responsibility in disaster response; however all require authoritative data about the disaster for rapid hazard assessment and situational awareness. The Clearinghouse has been proactive in fostering collaboration and sharing Essential Elements of Information across disciplines. The Clearinghouse-led collaborative promotes the use of standard formats and protocols to allow existing technology to transform data into meaningful incident-related content and to enable data to be used by the largest number of participating Clearinghouse partners, thus providing responding personnel with enhanced real-time situational awareness, rapid hazard assessment, and more informed decision-making in support of response and recovery. The Clearinghouse efforts address national priorities outlined in USGS Circular 1242, Plan to Coordinate NEHRP post-earthquake investigations and S. 740-Geospatial Data Act of 2015, Sen. Orrin Hatch (R-UT), to streamline and coordinate geospatial data infrastructure, maximizing geospatial data in support of the Robert T. Stafford Act. Finally, the US Dept. of Homeland Security, Geospatial Management Office, recognized Clearinghouse's data sharing efforts as a Best Practice to be included in the forthcoming 2015 HLS Geospatial Concept of Operations.

Consequence Management Symposium

DTIC Science & Technology

2001-09-01

AND SUBTITLE Consequence Management Symposium 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e...log i cal agents and their effects was deemed essen tial for “first respond ers,” includ ing emer gency medi cal and hospi tal prac ti tio ners

A modeling approach to assess coastal management effects on benthic habitat quality: A case study on coastal defense and navigability

NASA Astrophysics Data System (ADS)

Cozzoli, Francesco; Smolders, Sven; Eelkema, Menno; Ysebaert, Tom; Escaravage, Vincent; Temmerman, Stijn; Meire, Patrick; Herman, Peter M. J.; Bouma, Tjeerd J.

2017-01-01

The natural coastal hydrodynamics and morphology worldwide is altered by human interventions such as embankments, shipping and dredging, which may have consequences for ecosystem functionality. To ensure long-term ecological sustainability, requires capability to predict long-term large-scale ecological effects of altered hydromorphology. As empirical data sets at relevant scales are missing, there is need for integrating ecological modeling with physical modeling. This paper presents a case study showing the long-term, large-scale macrozoobenthic community response to two contrasting human alterations of the hydromorphological habitat: deepening of estuarine channels to enhance navigability (Westerschelde) vs. realization of a storm surge barrier to enhance coastal safety (Oosterschelde). A multidisciplinary integration of empirical data and modeling of estuarine morphology, hydrodynamics and benthic ecology was used to reconstruct the hydrological evolution and resulting long-term (50 years) large-scale ecological trends for both estuaries over the last. Our model indicated that hydrodynamic alterations following the deepening of the Westerschelde had negative implications for benthic life, while the realization of the Oosterschelde storm surge barriers had mixed and habitat-dependent responses, that also include unexpected improvement of environmental quality. Our analysis illustrates long-term trends in the natural community caused by opposing management strategies. The divergent human pressures on the Oosterschelde and Westerschelde are examples of what could happen in a near future for many global coastal ecosystems. The comparative analysis of the two basins is a valuable source of information to understand (and communicate) the future ecological consequences of human coastal development.

Application of biochemical and physiological indicators for assessing recovery of fish populations in a disturbed stream.

PubMed

Adams, S Marshall; Ham, Kenneth D

2011-06-01

Recovery dynamics in a previously disturbed stream were investigated to determine the influence of a series of remedial actions on stream recovery and to evaluate the potential application of bioindicators as an environmental management tool. A suite of bioindicators, representing five different functional response groups, were measured annually for a sentinel fish species over a 15 year period during which a variety of remedial and pollution abatement actions were implemented. Trends in biochemical, physiological, condition, growth, bioenergetic, and nutritional responses demonstrated that the health status of a sentinel fish species in the disturbed stream approached that of fish in the reference stream by the end of the study. Two major remedial actions, dechlorination and water flow management, had large effects on stream recovery resulting in an improvement in the bioenergetic, disease, nutritional, and organ condition status of the sentinel fish species. A subset of bioindicators responded rather dramatically to temporal trends affecting all sites, but some indicators showed little response to disturbance or to restoration activities. In assessing recovery of aquatic systems, application of appropriate integrative structural indices along with a variety of sensitive functional bioindicators should be used to understand the mechanistic basis of stress and recovery and to reduce the risk of false positives. Understanding the mechanistic processes involved between stressors, stress responses of biota, and the recovery dynamics of aquatic systems reduces the uncertainty involved in environmental management and regulatory decisions resulting in an increased ability to predict the consequences of restoration and remedial actions for aquatic systems.

Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices.

PubMed

Kirby, Catherine N; Segal, Ahuva Y; Hinds, Rupert; Jones, Kay M; Piterman, Leon

2016-01-01

The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management. A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire. In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments. Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Predator diversity reduces habitat colonization by mosquitoes and midges.

PubMed

Staats, Ethan G; Agosta, Salvatore J; Vonesh, James R

2016-12-01

Changes in predator diversity via extinction and invasion are increasingly widespread and can have important ecological and socio-economic consequences. Anticipating and managing these consequences requires understanding how predators shape ecological communities. Previous predator biodiversity research has focused on post-colonization processes. However, predators can also shape communities by altering patterns of prey habitat selection during colonization. The sensitivity of this non-consumptive top down mechanism to changes in predator diversity is largely unexamined. To address this gap, we examined patterns of dipteran oviposition habitat selection in experimental aquatic habitats in response to varied predator species richness while holding predator abundance constant. Caged predators were used in order to disentangle behavioural oviposition responses to predator cues from potential post-oviposition consumption of eggs and larvae. We hypothesized that because increases in predator richness often result in greater prey mortality than would be predicted from independent effects of predators, prey should avoid predator-rich habitats during colonization. Consistent with this hypothesis, predator-rich habitats received 48% fewer dipteran eggs than predicted, including 60% fewer mosquito eggs and 38% fewer midge eggs. Our findings highlight the potentially important links between predator biodiversity, prey habitat selection and the ecosystem service of pest regulation. © 2016 The Author(s).

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

PubMed

Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

2017-09-07

In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and constraints. Managers at the organizational level should be vigilant with regard to unintended consequences that a WTMS in one area can have for other areas of care. A more systemic approach to sustainability can help avoid or mitigate undesirable unintended consequences.

Current trends in pharmacy benefit designs: a threat to disease management in chronic complex diseases.

PubMed

Owens, Gary; Emons, Matthew F; Christian-Herman, Jennifer; Lawless, Grant

2007-04-01

With a focus on those patients who are candidates for treatment with biologic agents, we review the impact that current pharmacy benefit trends have on patients with chronic complex diseases and how they affect opportunities for disease management in this unique patient population. Dramatic increases in health care costs have led to a variety of strategies to manage cost. Many of these strategies either limit access to care or increase the patient's responsibility for choosing and paying for care, especially for medications. These strategies have a disproportionate impact on patients with chronic complex diseases, particularly those who require the use of biologic medications. A fundamental prerequisite of disease management has been coverage of disease-modifying therapies. If current pharmacy benefit trends continue, unintended consequences will likely occur including lost opportunities for disease management. Current pharmacy benefit trends could adversely impact disease management, particularly for patients requiring the use of biologic agents. Health plans should consider innovative benefit designs that reflect an appropriate level of cost sharing across all key stake-holders, ensuring appropriate access to needed therapies. Additional research is needed to clarify the value of newer approaches to therapies or benefit design changes.

Science preparedness and science response: perspectives on the dynamics of preparedness conference.

PubMed

Lant, Timothy; Lurie, Nicole

2013-01-01

The ability of the scientific modeling community to meaningfully contribute to postevent response activities during public health emergencies was the direct result of a discrete set of preparedness activities as well as advances in theory and technology. Scientists and decision-makers have recognized the value of developing scientific tools (e.g. models, data sets, communities of practice) to prepare them to be able to respond quickly--in a manner similar to preparedness activities by first-responders and emergency managers. Computational models have matured in their ability to better inform response plans by modeling human behaviors and complex systems. We advocate for further development of science preparedness activities as deliberate actions taken in advance of an unpredicted event (or an event with unknown consequences) to increase the scientific tools and evidence-base available to decision makers and the whole-of-community to limit adverse outcomes.

Mortality salience and morality: thinking about death makes people less utilitarian.

PubMed

Trémolière, Bastien; Neys, Wim De; Bonnefon, Jean-François

2012-09-01

According to the dual-process model of moral judgment, utilitarian responses to moral conflict draw on limited cognitive resources. Terror Management Theory, in parallel, postulates that mortality salience mobilizes these resources to suppress thoughts of death out of focal attention. Consequently, we predicted that individuals under mortality salience would be less likely to give utilitarian responses to moral conflicts. Two experiments corroborated this hypothesis. Experiment 1 showed that utilitarian responses to non-lethal harm conflicts were less frequent when participants were reminded of their mortality. Experiment 2 showed that the detrimental effect of mortality salience on utilitarian conflict judgments was comparable to that of an extreme concurrent cognitive load. These findings raise the question of whether private judgment and public debate about controversial moral issues might be shaped by mortality salience effects, since these issues (e.g., assisted suicide) often involve matters of life and death. Copyright © 2012 Elsevier B.V. All rights reserved.

Quantifying Phishing Susceptibility for Detection and Behavior Decisions.

PubMed

Canfield, Casey Inez; Fischhoff, Baruch; Davis, Alex

2016-12-01

We use signal detection theory to measure vulnerability to phishing attacks, including variation in performance across task conditions. Phishing attacks are difficult to prevent with technology alone, as long as technology is operated by people. Those responsible for managing security risks must understand user decision making in order to create and evaluate potential solutions. Using a scenario-based online task, we performed two experiments comparing performance on two tasks: detection, deciding whether an e-mail is phishing, and behavior, deciding what to do with an e-mail. In Experiment 1, we manipulated the order of the tasks and notification of the phishing base rate. In Experiment 2, we varied which task participants performed. In both experiments, despite exhibiting cautious behavior, participants' limited detection ability left them vulnerable to phishing attacks. Greater sensitivity was positively correlated with confidence. Greater willingness to treat e-mails as legitimate was negatively correlated with perceived consequences from their actions and positively correlated with confidence. These patterns were robust across experimental conditions. Phishing-related decisions are sensitive to individuals' detection ability, response bias, confidence, and perception of consequences. Performance differs when people evaluate messages or respond to them but not when their task varies in other ways. Based on these results, potential interventions include providing users with feedback on their abilities and information about the consequences of phishing, perhaps targeting those with the worst performance. Signal detection methods offer system operators quantitative assessments of the impacts of interventions and their residual vulnerability. © 2016, Human Factors and Ergonomics Society.

Hospital CEOs, CFOs, and nurse executives: opportunities for a new alliance.

PubMed

Dwore, R B; Murray, B P; Fosbinder, D; Parsons, R P; Smith, P; Dalley, K; Vorderer, L; Gustafson, G

1998-01-01

This article examines the involvement of Utah acute care hospital nurse executives (NEs) in financial management roles. The authors surveyed NEs and their career supporters and hinderers. Findings suggest that NFs: 1. lack financial management skills, support, involvement, and satisfaction; 2. recognize financial management's importance and desire to improve performance; and 3. consider chief executive officers (CEOs) as their major supporters and chief financial officers (CFOs) their major hinderers in financial management. These "supporters" and "hinderers" of NEs showed consensus regarding the primacy of NEs' leadership and patient advocacy roles. These findings contrast with major professional association policy directives and expert opinions that advocate expanded financial management roles for NEs that will enable them to fully realize their executive potential. CEOs are positioned to establish norms that balance the traditional leadership-patient advocacy roles of NEs with newer financial management roles. CEOs can offer NEs and CFOs opportunities to improve NEs' financial management participation and performance. CEOs can provide empowerment and encourage CFOs to offer NEs "power tools" (for example, information, expertise, resources, and support). The three groups, however, must negotiate reasonable expectations for NEs in financial management and adequate preparation for these consequent responsibilities. Together, CEOs, CFOs, and NEs can successfully take hospitals into the future by leading them in ongoing learning and change.

A risk-based approach to sanitary sewer pipe asset management.

PubMed

Baah, Kelly; Dubey, Brajesh; Harvey, Richard; McBean, Edward

2015-02-01

Wastewater collection systems are an important component of proper management of wastewater to prevent environmental and human health implications from mismanagement of anthropogenic waste. Due to aging and inadequate asset management practices, the wastewater collection assets of many cities around the globe are in a state of rapid decline and in need of urgent attention. Risk management is a tool which can help prioritize resources to better manage and rehabilitate wastewater collection systems. In this study, a risk matrix and a weighted sum multi-criteria decision-matrix are used to assess the consequence and risk of sewer pipe failure for a mid-sized city, using ArcGIS. The methodology shows that six percent of the uninspected sewer pipe assets of the case study have a high consequence of failure while four percent of the assets have a high risk of failure and hence provide priorities for inspection. A map incorporating risk of sewer pipe failure and consequence is developed to facilitate future planning, rehabilitation and maintenance programs. The consequence of failure assessment also includes a novel failure impact factor which captures the effect of structurally defective stormwater pipes on the failure assessment. The methodology recommended in this study can serve as a basis for future planning and decision making and has the potential to be universally applied by municipal sewer pipe asset managers globally to effectively manage the sanitary sewer pipe infrastructure within their jurisdiction. Copyright © 2014 Elsevier B.V. All rights reserved.

41 CFR 105-55.024 - Consideration of tax consequences to the Government.

Code of Federal Regulations, 2010 CFR

2010-07-01

... consequences to the Government. 105-55.024 Section 105-55.024 Public Contracts and Property Management Federal... consequences to the Government. In negotiating a compromise, the General Services Administration (GSA) may consider the tax consequences to the Government. In particular, GSA may consider requiring a waiver of tax...

National Labs and Nuclear Emergency Response

NASA Astrophysics Data System (ADS)

Budil, Kimberly

2015-04-01

The DOE national laboratories, and in particular the three NNSA national security laboratories, have long supported a broad suite of national nuclear security missions for the U.S. government. The capabilities, infrastructure and base of expertise developed to support the U.S. nuclear weapons stockpile have been applied to such challenges as stemming nuclear proliferation, understanding the nuclear capabilities of adversaries, and assessing and countering nuclear threats including essential support to nuclear emergency response. This talk will discuss the programs that are underway at the laboratories and the essential role that science and technology plays therein. Nuclear scientists provide expertise, fundamental understanding of nuclear materials, processes and signatures, and tools and technologies to aid in the identification and mitigation of nuclear threats as well as consequence management. This talk will also discuss the importance of direct engagement with the response community, which helps to shape research priorities and to enable development of useful tools and techniques for responders working in the field. National Labs and Nuclear Emergency Response.

The Lung Immune Response to Nontypeable Haemophilus influenzae (Lung Immunity to NTHi)

PubMed Central

King, Paul T.; Sharma, Roleen

2015-01-01

Haemophilus influenzae is divided into typeable or nontypeable strains based on the presence or absence of a polysaccharide capsule. The typeable strains (such as type b) are an important cause of systemic infection, whilst the nontypeable strains (designated as NTHi) are predominantly respiratory mucosal pathogens. NTHi is present as part of the normal microbiome in the nasopharynx, from where it may spread down to the lower respiratory tract. In this context it is no longer a commensal and becomes an important respiratory pathogen associated with a range of common conditions including bronchitis, bronchiectasis, pneumonia, and particularly chronic obstructive pulmonary disease. NTHi induces a strong inflammatory response in the respiratory tract with activation of immune responses, which often fail to clear the bacteria from the lung. This results in recurrent/persistent infection and chronic inflammation with consequent lung pathology. This review will summarise the current literature about the lung immune response to nontypeable Haemophilus influenzae, a topic that has important implications for patient management. PMID:26114124

41 CFR 302-14.7 - Are there tax consequences when I receive a home marketing incentive payment?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false Are there tax consequences when I receive a home marketing incentive payment? 302-14.7 Section 302-14.7 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES...

Action errors, error management, and learning in organizations.

PubMed

Frese, Michael; Keith, Nina

2015-01-03

Every organization is confronted with errors. Most errors are corrected easily, but some may lead to negative consequences. Organizations often focus on error prevention as a single strategy for dealing with errors. Our review suggests that error prevention needs to be supplemented by error management--an approach directed at effectively dealing with errors after they have occurred, with the goal of minimizing negative and maximizing positive error consequences (examples of the latter are learning and innovations). After defining errors and related concepts, we review research on error-related processes affected by error management (error detection, damage control). Empirical evidence on positive effects of error management in individuals and organizations is then discussed, along with emotional, motivational, cognitive, and behavioral pathways of these effects. Learning from errors is central, but like other positive consequences, learning occurs under certain circumstances--one being the development of a mind-set of acceptance of human error.

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Offsite consequence analysis. 68.165 Section 68.165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence...

Mass Fatality Management following the South Asian Tsunami Disaster: Case Studies in Thailand, Indonesia, and Sri Lanka

PubMed Central

Morgan, Oliver W; Sribanditmongkol, Pongruk; Perera, Clifford; Sulasmi, Yeddi; Van Alphen, Dana; Sondorp, Egbert

2006-01-01

Background Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. Methods and Findings After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24–48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. Conclusions Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies. PMID:16737348

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

PubMed

Morgan, Oliver W; Sribanditmongkol, Pongruk; Perera, Clifford; Sulasmi, Yeddi; Van Alphen, Dana; Sondorp, Egbert

2006-06-01

Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

[Waste water management in a health area: environmental hygiene in primary care].

PubMed

García Cuadrado, J; Contessotto Spadetto, C; Pereñiguez Barranco, J E; Fuster Quiñonero, D; Paricio Núñez, P

1992-01-01

Within the scope of the programmes to be developed by the primary health care parties, we consider it interesting to investigate the sewage management in our health area because of its impact on the population health and welfare and the main socioeconomic local activities: agriculture and tourism. We carry out an epidemiological descriptive study: we review the most important structural and functional characteristics of the sewage depuration and collection in the municipality of S. Javier (Murcia). The evaluation of the collected data made it obvious that deficiencies exist in the collection system as well as in the sewage processing; both deficiencies were shown in some places of the locality and in particular periods of the year, with a consequent risk of environmental contamination and enteric diseases transmission among population and summer holidaymakers. A positive corrective action on the installations by the organisms responsible for the local sanitation as a response to these conclusions, which we informed due time, constitutes a good stimulant to go on investigating this question of such a great sanitary and general interest, which is almost unknown in medical literature.

Changing Arctic ecosystems: resilience of caribou to climatic shifts in the Arctic

USGS Publications Warehouse

Gustine, David D.; Adams, Layne G.; Whalen, Mary E.; Pearce, John M.

2014-01-01

The U.S. Geological Survey (USGS) Changing Arctic Ecosystems (CAE) initiative strives to inform key resource management decisions for Arctic Alaska by providing scientific information and forecasts for current and future ecosystem response to a warming climate. Over the past 5 years, a focal area for the USGS CAE initiative has been the North Slope of Alaska. This region has experienced a warming trend over the past 60 years, yet the rate of change has been varied across the North Slope, leading scientists to question the future response and resilience of wildlife populations, such as caribou (Rangifer tarandus), that rely on tundra habitats for forage. Future changes in temperature and precipitation to coastal wet sedge and upland low shrub tundra are expected, with unknown consequences for caribou that rely on these plant communities for food. Understanding how future environmental change may affect caribou migration, nutrition, and reproduction is a focal question being addressed by the USGS CAE research. Results will inform management agencies in Alaska and people that rely on caribou for food.

An economic evaluation of solar radiation management.

PubMed

Aaheim, Asbjørn; Romstad, Bård; Wei, Taoyuan; Kristjánsson, Jón Egill; Muri, Helene; Niemeier, Ulrike; Schmidt, Hauke

2015-11-01

Economic evaluations of solar radiation management (SRM) usually assume that the temperature will be stabilized, with no economic impacts of climate change, but with possible side-effects. We know from experiments with climate models, however, that unlike emission control the spatial and temporal distributions of temperature, precipitation and wind conditions will change. Hence, SRM may have economic consequences under a stabilization of global mean temperature even if side-effects other than those related to the climatic responses are disregarded. This paper addresses the economic impacts of implementing two SRM technologies; stratospheric sulfur injection and marine cloud brightening. By the use of a computable general equilibrium model, we estimate the economic impacts of climatic responses based on the results from two earth system models, MPI-ESM and NorESM. We find that under a moderately increasing greenhouse-gas concentration path, RCP4.5, the economic benefits of implementing climate engineering are small, and may become negative. Global GDP increases in three of the four experiments and all experiments include regions where the benefits from climate engineering are negative. Copyright © 2015 Elsevier B.V. All rights reserved.

Stress and workload of men and women in high-ranking positions.

PubMed

Lundberg, U; Frankenhaeuser, M

1999-04-01

Psychological and physiological stress responses related to work and family were investigated in 21 female and 21 male managers and professional specialists in high-ranking positions. The main result was that both women and men experienced their jobs as challenging and stimulating, although almost all data indicated a more favorable situation for men than for women. In addition, women were more stressed by their greater unpaid workload and by a greater responsibility for duties related to home and family. Women had higher norepinephrine levels than men did, both during and after work, which reflected their greater workload. Women with children at home had significantly higher norepinephrine levels after work than did the other participants. The possible long-term health consequences of women's higher stress levels are discussed.

Postoperative management of dogs with gastric dilatation and volvulus.

PubMed

Bruchim, Yaron; Kelmer, Efrat

2014-09-01

The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. Intensive postoperative management of the patients with GDV is essential for survival. Therapy in the postoperative period is focused on maintaining tissue perfusion along with intensive monitoring for prevention and early identification of ischemia-reperfusion injury (IRI) and consequent potential complications such as hypotension, cardiac arrhythmias, acute kidney injury (AKI), gastric ulceration, electrolyte imbalances, and pain. In addition, early identification of patients in need for re-exploration owing to gastric necrosis, abdominal sepsis, or splenic thrombosis is crucial. Therapy with intravenous lidocaine may play a central role in combating IRI and cardiac arrhythmias. The most serious complications of GDV are associated with IRI and consequent systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Other reported complications include hypotension, AKI, disseminated intravascular coagulation, gastric ulceration, and cardiac arrhythmias. Despite appropriate medical and surgical treatment, the reported mortality rate in dogs with GDV is high (10%-28%). Dogs with GDV that are affected with gastric necrosis or develop AKI have higher mortality rates. Copyright © 2014 Elsevier Inc. All rights reserved.

District nurses' perceptions of osteoporosis management: a qualitative study.

PubMed

Claesson, A; Toth-Pal, E; Piispanen, P; Salminen, H

2015-07-01

Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention. Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system. Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis. The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture. Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.

Near-Surface Geophysical Mapping of the Hydrological Response to an Intense Rainfall Event at the Field Scale

NASA Astrophysics Data System (ADS)

Martínez, G.; Vanderlinden, K.; Giraldez, J. V.; Espejo, A. J.; Muriel, J. L.

2009-12-01

Soil moisture plays an important role in a wide variety of biogeochemical fluxes in the soil-plant-atmosphere system and governs the (eco)hydrological response of a catchment to an external forcing such as rainfall. Near-surface electromagnetic induction (EMI) sensors that measure the soil apparent electrical conductivity (ECa) provide a fast and non-invasive means for characterizing this response at the field or catchment scale through high-resolution time-lapse mapping. Here we show how ECa maps, obtained before and after an intense rainfall event of 125 mm h-1, elucidate differences in soil moisture patterns and hydrologic response of an experimental field as a consequence of differed soil management. The dryland field (Vertisol) was located in SW Spain and cropped with a typical wheat-sunflower-legume rotation. Both, near-surface and subsurface ECa (ECas and ECad, respectively), were measured using the EM38-DD EMI sensor in a mobile configuration. Raw ECa measurements and Mean Relative Differences (MRD) provided information on soil moisture patterns while time-lapse maps were used to evaluate the hydrologic response of the field. ECa maps of the field, measured before and after the rainfall event showed similar patterns. The field depressions where most of water and sediments accumulated had the highest ECa and MRD values. The SE-oriented soil, which was deeper and more exposed to sun and wind, showed the lowest ECa and MRD. The largest differences raised in the central part of the field where a high ECa and MRD area appeared after the rainfall event as a consequence of the smaller soil depth and a possible subsurface flux concentration. Time-lapse maps of both ECa and MRD were also similar. The direct drill plots showed higher increments of ECa and MRD as a result of the smaller runoff production. Time-lapse ECa increments showed a bimodal distribution differentiating clearly the direct drill from the conventional and minimum tillage plots. However this kind of distribution could not be shown using MRD differences since they come from standardized distributions. Field-extend time-lapse ECa maps can provide useful images of the hydrological response of agricultural fields which can be used to evaluate different soil management strategies or to aid the assessment of biogeochemical fluxes at the field scale.

Management of Hepatic Encephalopathy Not Responsive to First-Line Treatments.

PubMed

Nardelli, Silvia; Ridola, Lorenzo; Gioia, Stefania; Riggio, Oliviero

2018-06-01

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that occurs in up to 30% of patients with cirrhosis. HE may be a consequence of pure liver failure, as in patients with fulminant hepatitis, or of the combination of liver failure and portal-systemic shunting, as in patients with liver cirrhosis. Episodes of HE are usually related to precipitating events, such as infections or gastrointestinal bleeding; a minority of cirrhotic patients experienced a chronic HE, refractory to standard medical treatment. The prevention of HE recurrence, after the first episode of HE, could be obtained by the administration of prophylactic therapy with lactulose, rifaximin or a combination of both. The aim of this review is to clarify some key points in the management of cirrhotic patients with HE, not responsive to first line treatment. Recent studies investigated the role of fecal microbiota transplantation in the treatment of HE with promising results, but further investigations are needed. In a cirrhotic patient with acute cognitive impairment, the correct diagnosis of HE, after excluding other causes of neurological diseases, is mandatory for the correct management of the precipitating factors and for the treatment. In patients not responsive to standard treatment, the probable precipitating factors have not been correctly identified, multiple precipitating events are coexisting or a new precipitating event is superimposed. In some patients with recurrent HE, characterized by persistent alterations in neurological symptoms, without specific precipitants events, the presence of spontaneous or iatrogenic shunts should be investigated.

Use of after action reports (AARs) to promote organizational and systems learning in emergency preparedness.

PubMed

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D

2012-08-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The "lessons-learned" approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the "Lessons Learned Information Sharing (LLIS.gov)" system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strove to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed.

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

Barnes, B.K.; Rothkopf, M.H.

Energy emergency preparedness is the special responsibility of the Deputy Assistant Secretary of Energy Emergencies within the Office of the Assistant Secretary for International Affairs and Energy Emergencies; though other Department of Energy (DOE) offices manage some aspects and DOE also coordinates emergency management with other federal departments. There are two basic objectives for energy emergency preparedness. The first of these, the economic stabilization objective, seeks to ease the impact of an energy supply disruption by facilitating a quick recovery and minimizing the disruption's economic consequences. The second is the mobilization support objective to ensure that there is adequate energymore » and fuel to support defense, defense industrial and critical civilian needs for energy and fuel. While all energy systems are vulnerable they vary in the degree of seriousness and the probability of a disruption. Oil is the most vulnerable, and will become increasingly so in the 1990's, as domestic and reliable foreign sources diminish and the United States relies more on imports from volatile Persian Gulf countries. Electric power is the next most vulnerable system, being open particularly to multi-site terrorist attack. This overview examines two highly connected organizations: the Office of Energy Emergencies (OEE) itself and the actual response organization, centering on the Energy Emergency Management System (EEMS). 38 refs., 10 figs.« less

How understanding immunology contributes to managing CMV disease in immunosuppressed patients: now and in future.

PubMed

Sissons, J G Patrick; Wills, Mark R

2015-06-01

Several decades of research on human cytomegalovirus (HCMV) and the principal mammalian cytomegaloviruses which to varying degrees act as models of HCMV infection, particularly murine, guinea pig and rhesus CMV, have led to the recognition of the CMVs as interesting models of persistent infection with a large and complex DNA virus, which have been highly informative of the immunology and molecular pathogenesis of the virus-host relationship in the normal host. However, it is appropriate to ask how this relative wealth of knowledge has influenced the understanding and management of clinical disease due to HCMV. This article considers the immunology of cytomegalovirus in the normal human host, and the interrelated issue of the sites of HCMV latency and mechanisms of reactivation in the myeloid cell lineage, and in related in vitro model systems. The way in which this site of latency conditions the immune response, and emerging information on the special features of the adaptive immune response to HCMV during latency are also considered. Examples of HCMV disease associated with acquired immunosuppression, principally in the context of transplantation, but also as a consequence of HIV/AIDS and immune reconstitution inflammatory syndrome, are then discussed, with a particular emphasis on how understanding the immunology of persistent infection may contribute to managing CMV disease now and in future.

Natural-technological risk assessment and management

NASA Astrophysics Data System (ADS)

Burova, Valentina; Frolova, Nina

2016-04-01

EM-DAT statistical data on human impact and economic damages in the 1st semester 2015 are the highest since 2011: 41% of disasters were floods, responsible for 39% of economic damage and 7% of events were earthquakes responsible for 59% of total death toll. This suggests that disaster risk assessment and management still need to be improved and stay the principle issue in national and international related programs. The paper investigates the risk assessment and management practice in the Russian Federation at different levels. The method is proposed to identify the territories characterized by integrated natural-technological hazard. The maps of the Russian Federation zoning according to the integrated natural-technological hazard level are presented, as well as the procedure of updating the integrated hazard level taking into account the activity of separate processes. Special attention is paid to data bases on past natural and technological processes consequences, which are used for verification of current hazard estimation. The examples of natural-technological risk zoning for the country and some regions territory are presented. Different output risk indexes: both social and economic, are estimated taking into account requirements of end-users. In order to increase the safety of population of the Russian Federation the trans-boundaries hazards are also taken into account.

Use of After Action Reports (AARs) to Promote Organizational and Systems Learning in Emergency Preparedness

PubMed Central

Savoia, Elena; Agboola, Foluso; Biddinger, Paul D.

2012-01-01

Many public health and healthcare organizations use formal knowledge management practices to identify and disseminate the experiences gained over time. The “lessons-learned” approach is one such example of knowledge management practice applied to the wider concept of organizational learning. In the field of emergency preparedness, the lessons-learned approach stands on the assumption that learning from experience improves practice and minimizes avoidable deaths and negative economic and social consequences of disasters. In this project, we performed a structured review of AARs to analyze how lessons learned from the response to real-incidents may be used to maximize knowledge management and quality improvement practices such as the design of public health emergency preparedness (PHEP) exercises. We chose as a source of data the “Lessons Learned Information Sharing (LLIS.gov)” system, a joined program of the U.S. Department of Homeland Security DHS and FEMA that serves as the national, online repository of lessons learned, best practices, and innovative ideas. We identified recurring challenges reported by various states and local public health agencies in the response to different types of incidents. We also strived to identify the limitations of systematic learning that can be achieved due to existing weaknesses in the way AARs are developed. PMID:23066408

Stress--where are we now? Does immunity play an intrinsic role?

PubMed

Jedryka-Góral, Anna; Maślinski, Włodzimierz; Ziółkowska, Maria; Konarska, Maria; Zołnierczyk-Zreda, Dorota

2002-11-01

The whole world experiences progress and development, however it is the human being who pays the price in stress--an inevitable part of modern life. When encountering stress, an individual reacts at the level of both the micro- and macroenvironment. Nowadays, stress is defined as a real or interpreted threat to the physiological or psychological integrity of an individual, which results in a physiological and/or behavioral response. In the article a review of the stress conceptualization, health consequences of stress (its neurophysiology and relation to autoimmune disease) as well as ways of management (exercises and psychotherapeutic intervention) is given.

[The 'Osteoporosis' guideline of the Dutch College of General Practitioners. The response from internal medicine].

PubMed

Duursma, S A

1999-07-31

The Dutch College of General Practitioners published well documented guidelines for the management of osteoporosis. It is however incorrect to use the Z-score for the elderly and the T-score for other age groups. The guidelines balance the patient's and the physician's interests and the financial consequences of osteoporosis. They demand certainty about recommending the GP's interventions and accept less certainty where the influence on the GP's activities is limited. The guidelines contain weighed judgements by and for GP's; it is questionable whether they are adequate regarding the interaction with the increasingly well informed patient.

Locating ethics in data science: responsibility and accountability in global and distributed knowledge production systems

PubMed Central

2016-01-01

The distributed and global nature of data science creates challenges for evaluating the quality, import and potential impact of the data and knowledge claims being produced. This has significant consequences for the management and oversight of responsibilities and accountabilities in data science. In particular, it makes it difficult to determine who is responsible for what output, and how such responsibilities relate to each other; what ‘participation’ means and which accountabilities it involves, with regard to data ownership, donation and sharing as well as data analysis, re-use and authorship; and whether the trust placed on automated tools for data mining and interpretation is warranted (especially as data processing strategies and tools are often developed separately from the situations of data use where ethical concerns typically emerge). To address these challenges, this paper advocates a participative, reflexive management of data practices. Regulatory structures should encourage data scientists to examine the historical lineages and ethical implications of their work at regular intervals. They should also foster awareness of the multitude of skills and perspectives involved in data science, highlighting how each perspective is partial and in need of confrontation with others. This approach has the potential to improve not only the ethical oversight for data science initiatives, but also the quality and reliability of research outputs. This article is part of the themed issue ‘The ethical impact of data science’. PMID:28336799

Locating ethics in data science: responsibility and accountability in global and distributed knowledge production systems.

PubMed

Leonelli, Sabina

2016-12-28

The distributed and global nature of data science creates challenges for evaluating the quality, import and potential impact of the data and knowledge claims being produced. This has significant consequences for the management and oversight of responsibilities and accountabilities in data science. In particular, it makes it difficult to determine who is responsible for what output, and how such responsibilities relate to each other; what 'participation' means and which accountabilities it involves, with regard to data ownership, donation and sharing as well as data analysis, re-use and authorship; and whether the trust placed on automated tools for data mining and interpretation is warranted (especially as data processing strategies and tools are often developed separately from the situations of data use where ethical concerns typically emerge). To address these challenges, this paper advocates a participative, reflexive management of data practices. Regulatory structures should encourage data scientists to examine the historical lineages and ethical implications of their work at regular intervals. They should also foster awareness of the multitude of skills and perspectives involved in data science, highlighting how each perspective is partial and in need of confrontation with others. This approach has the potential to improve not only the ethical oversight for data science initiatives, but also the quality and reliability of research outputs.This article is part of the themed issue 'The ethical impact of data science'. © 2015 The Authors.

Duties and functions of veterinary public health for the management of food safety: present needs and evaluation of efficiency.

PubMed

Trevisani, M; Rosmini, R

2008-09-01

Functions of veterinarians in the context of food safety assurance have changed very much in the last ten years as a consequence of new legislation. The aim of this review is to evaluate the management tools in veterinary public health that shall be used in response to the actual need and consider some possible key performance indicators. This review involved an examination of the legislation, guidelines and literature, which was then discussed to analyse the actual need, the strategies and the procedures with which the public veterinary service shall comply. The management of information gathered at different stages of the food chain, from both food production operators and veterinary inspectors operating in primary production, food processing and feed production should be exchanged and integrated in a database, not only to produce annual reports and plan national sampling plans, but also to verify and validate the effectiveness of procedures and strategies implemented by food safety operators to control risks. Further, the surveillance data from environmental agencies and human epidemiological units should be used for assessing risks and addressing management options.

Adolescents' and parents' experiences of managing the psychosocial impact of appearance change during cancer treatment.

PubMed

Williamson, Heidi; Harcourt, Diana; Halliwell, Emma; Frith, Hannah; Wallace, Melissa

2010-01-01

Using combined qualitative data from multiple case study interviews and an online survey, this study explored the impact of appearance change on 22 adolescents receiving cancer treatment aged 13 to 18 years and six of their parents. Data were analyzed using template analysis. Appearance changes were a major concern. Adolescents typically struggled to adapt to new experiences and concerns related to this highly sensitive issue. Many felt anxious and self-conscious and were reluctant to reveal appearance changes in public. These feelings were compounded by the negative reactions of others (e.g., staring, teasing, and inappropriate questioning), which sometimes lead to avoidance of social activity and threats of noncompliance. Parents of these children felt ill-prepared to manage appearance-related anxieties. Adolescents wanted support to develop the practical and social skills necessary to maintain a "normal" appearance and manage the negative responses of others. However, some adolescents showed resilience and, with support from friends and family, developed strategies to manage their altered appearance and its social consequences. These strategies are explored, which can inform interventions to support adolescents and parents.

Tap water isotopes reveal the San Francisco Bay Area's plumbing and responses to a major drought

NASA Astrophysics Data System (ADS)

Tipple, B. J.; Jameel, M. Y.; Chau, T. H.; Mancuso, C. J.; Bowen, G. J.; Dufour, A.; Chesson, L. A.; Ehleringer, J. R.

2016-12-01

Water availability and sustainability in the Western United States is a major flashpoint among expanding communities, growing industries, and productive agricultural lands. This issue came to a head in 2015 in the State of California, when the State mandated a 25% reduction in urban water use following a multi-year drought that significantly depleted water resources. The demands for and challenges in supplying water are only expected to intensify as climate perturbations, such as the 2012-2015 California Drought, become more common. As a consequence, there is an increased need to understand linkages between population centers, water transport and usage, and the impacts of climate change on water resources and infrastructure. To better understand these relationships within a megalopolis in the Western United States, we collected and analyzed 723 tap waters from the San Francisco Bay Area during seven collection campaigns across 21 months during 2013-2015. San Francisco Bay Area was selected as it has well-known water management strategies and its water resources were dramatically affected by the 2012-2105 drought. Consistent with known water management strategies and previous reports of tap water isotope values, we found large spatiotemporal variations in the δ2H and δ18O values of tap waters, indicative of complex water transport systems and municipality-scale management decisions. We observed δ2H and δ18O values of tap water consistent with waters originating from snowmelt from the Sierra Nevada Mountains, local precipitation, ground water, and partially evaporated reservoir sources. A cluster analysis of measured tap water data grouped waters from 43 static sampling sites that were associated with specific water utility providers within the San Francisco Bay Area and known management practices. Water management responses to the drought, such as source switching, bringing in new sources, and conservation, could be observed within the isotope data from each of collection campaigns. Finally, we used a modified Craig-Gordon model of evaporative loss from one utility's reservoir system during the 2015 water year to estimate the consequences of the drought on this resource. Using these isotope methods, we estimated that approximately 10% of the water in this reservoir system was lost to evaporation.

[Sickness absence certification from the medical perspective].

PubMed

Echevarría-Zuno, Santiago; Mar-Obeso, Alvaro Julián; Borja-Aburto, Víctor Hugo; Méndez-Bueno, Francisco Javier; Aguilar-Sánchez, Leticia; Rascón-Pacheco, Ramón Alberto

2009-01-01

Sickness absence certification is a medical task with important clinical, social, occupational and ethical implications, in addition to economic consequences for the worker, the employers and social security institutions. In 2007, IMSS affiliated workers received certifications for 65,384,690 days of absence, with cash benefits for 8.1 billion pesos. The duration of return to work depends on the efficiency of health care team as well as factors associated to the worker and the occupational environment. The correct management of sickness absence certification requires adequate disease diagnosis, regulatory knowledge and adequate communication with the patient. The purpose of control and auditing is to make sure that the certification is adequate in the indication and the optimal length, in order to warrant a responsible and sustainable management of this resource of social protection. If expenditure reduction is not possible, the objective is to avoid inefficient or irrational management. Treating physicians, with proper information, can contribute to optimize the provision of this benefit to those who need it.

PHEOCHROMOCYTOMA: IMPLICATIONS IN TUMORIGENESIS AND THE ACTUAL MANAGEMENT

PubMed Central

Shah, Urvi; Giubellino, Alessio; Pacak, Karel

2012-01-01

Pheochromocytomas and paragangliomas are rare neuroendocrine catecholamine producing tumors with varied clinical presentations, biochemistries and genetic makeup. These features outline the complexity and the difficulties in studying and understanding the oncogenesis of these tumors. The study of families with genetically inherited mutations in pheochromocytoma susceptibility genes has greatly enhanced our understanding of the pathophysiology and mechanisms of oncogenesis of the disease, and consequently changed our clinical approach. Several molecular pathways and mutations in their important regulatory proteins have been identified. Such mutations are responsible for the dysregulation of metabolic pathways involved in oxygen and nutrient sensing, apoptosis regulation, cell proliferation, migration and invasion. The knowledge derived from the study of these pathways will be fundamental in the future clinical management of these patients. As a rare disease that often masks its clinical presentation, the diagnosis is frequently missed and a high level of suspicion is required. Management of this disease requires a multidisciplinary team approach and has been discussed along with advances in its treatment. PMID:22691888

Sexuality in the workplace: where do we stand?

PubMed

Perez, Bianca; Liberman, Aaron

2010-01-01

Increasingly, organizational leaders must face the perplexing problem of dealing with sexual relationships in the workplace. Given recent changes in the composition of our workforce, there is a critical need for leaders to manage sexual workplace relationships and to do so in a way that acknowledges both individual and organizational needs. As a result, organizations must distinguish between appropriate and inappropriate sexual behaviors. For organizations to set effective and realistic behavioral guidelines, it is imperative that leaders gain a clearer understanding of the issues that surround sexuality in the workplace. In response to this need, this article discusses the characteristics of sexual workplace relationships, explain the individual and organizational factors that encourage these relationships to form, and outline the individual and organizational consequences that are likely to ensue. Lastly, this article evaluates some contemporary approaches to managing sexual workplace behaviors so that organizational leaders can gain some insight on how to manage interpersonal attractions among employees in a positive, productive, and nonthreatening manner.

Relevance of the land use changes related to a megacity development in a Colombian river basin

NASA Astrophysics Data System (ADS)

García-Arias, Alicia; Romero Hernández, Claudia Patricia; Francés, Félix

2017-04-01

A megacity development is a main driving force for land uses changes. Population in these megacities usually rise depending on some or all of the natural resources related to the occupied area and, among them, water is a pivotal requirement. On the other hand, land use changes determine the catchment hydrology and, in consequence, its management. The better knowledge on land uses cover distribution and characteristics, the higher capabilities to increase the accuracy of hydrological predictions and the efficiency of water management. This study aims to describe the land uses changes occurred during the recent expansion of the megacity of Bogotá (Colombia) and to understand the expected changes. In addition, we propose the base for the consideration of this land use changes in the TETIS distributed hydrological modelling approach. The discussion focus on the necessity of considering this kind of scenarios in hydrological modelling for a responsible management of the water resources.

Vesicant extravasation part I: Mechanisms, pathogenesis, and nursing care to reduce risk.

PubMed

Sauerland, Carmel; Engelking, Constance; Wickham, Rita; Corbi, Dominick

2006-11-27

To review the literature regarding the incidence, current practice, guideline recommendations, nursing management, and knowledge gaps relevant to vesicant extravasation. Published research articles, books, case reports, and national guidelines. Vesicant extravasation is a relatively rare but significant complication of chemotherapy administration. Extravasation may have a range of consequences that can cause serious physical and quality-of-life effects. Knowledge of risk factors and preventive measures can reduce patient risk. Data-based and empirical management strategies such as immediate local measures (agent withdrawal, comfort measures, and medical interventions) may minimize risk for extravasation, as well as lead to timely recognition and management and decreased morbidity should extravasation occur. Vesicant extravasation and sequelae constitute a complex patient problem that clinicians should strive to prevent or to minimize injury should it occur. To this end, clinicians must demonstrate awareness of risks and use specialized knowledge while administering vesicant agents. Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.

Pheochromocytoma: implications in tumorigenesis and the actual management.

PubMed

Shah, U; Giubellino, A; Pacak, K

2012-06-01

Pheochromocytomas and paragangliomas are rare neuroendocrine catecholamine producing tumors with varied clinical presentations, biochemistries and genetic makeup. These features outline the complexity and the difficulties in studying and understanding the oncogenesis of these tumors. The study of families with genetically inherited mutations in pheochromocytoma susceptibility genes has greatly enhanced our understanding of the pathophysiology and mechanisms of oncogenesis of the disease, and consequently changed our clinical approach. Several molecular pathways and mutations in their important regulatory proteins have been identified. Such mutations are responsible for the dysregulation of metabolic pathways involved in oxygen and nutrient sensing, apoptosis regulation, cell proliferation, migration and invasion. The knowledge derived from the study of these pathways will be fundamental in the future clinical management of these patients. As a rare disease that often masks its clinical presentation, the diagnosis is frequently missed and a high level of suspicion is required. Management of this disease requires a multidisciplinary team approach and will be discussed along with advances in its treatment.

Occupational Stress in Secondary Education in Cyprus: Causes, Symptoms, Consequences and Stress Management

ERIC Educational Resources Information Center

Hadjisymeou, Georgia

2010-01-01

The survey attempted to look into the causes, symptoms and consequences that occupational stress has on teachers in Secondary Education in Cyprus and find ways to manage it. Thirty eight schools with 553 teachers participated in the survey. The sample chosen is a result of a simple random sampling and it is representative of the country's…

Current practices and future opportunities for policy on climate change and invasive species.

PubMed

Pyke, Christopher R; Thomas, Roxanne; Porter, Read D; Hellmann, Jessica J; Dukes, Jeffrey S; Lodge, David M; Chavarria, Gabriela

2008-06-01

Climate change and invasive species are often treated as important, but independent, issues. Nevertheless, they have strong connections: changes in climate and societal responses to climate change may exacerbate the impacts of invasive species, whereas invasive species may affect the magnitude, rate, and impact of climate change. We argue that the design and implementation of climate-change policy in the United States should specifically consider the implications for invasive species; conversely, invasive-species policy should address consequences for climate change. The development of such policies should be based on (1) characterization of interactions between invasive species and climate change, (2) identification of areas where climate-change policies could negatively affect invasive-species management, and (3) identification of areas where policies could benefit from synergies between climate change and invasive-species management.

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience.

PubMed

Knapp, Martin; Beecham, Jennifer; McDaid, David; Matosevic, Tihana; Smith, Monique

2011-03-01

Many European mental health systems are undergoing change as community-centred care replaces large-scale institutions. We review empirical evidence from three countries (UK, Germany, Italy) that have made good progress with this rebalancing of care. We focus particularly on the economic consequences of deinstitutionalisation. A systematic literature review was conducted using a broad search strategy in accordance with established guidelines. We searched the International Bibliography of the Social Sciences, Health Management Information Consortium, British Nursing Index and PUBMED/Medline to 2008. The on-line search was supplemented by advice and assistance from contacts with government departments, European Commission, professional networks and known local experts. Community-based models of care are not inherently more costly than institutions, once account is taken of individuals' needs and the quality of care. New community-based care arrangements could be more expensive than long-stay hospital care but may still be seen as more cost-effective because, when properly set up and managed, they deliver better outcomes. Understanding the economic consequences of deinstitutionalisation is fundamental to success. Local stakeholders and budget controllers need to be aware of the underlying policy and operational plan. Joint planning and commissioning or devolving certain powers and responsibilities to care managers may aid development of effective and cost-effective care. People's needs, preferences and circumstances vary, and so their service requirements and support costs also vary, opening up the possibility for purposive targeting of services on needs to improve the ability of a care system to improve well-being from constrained resources. As the institutional/community balance shifts, strategic planning should also ensure that the new care arrangements address the specific contexts of different patient groups. Decision-makers have to plan a dynamic community-based system to match the needs of people moving from institutions, and must take the long view. © 2010 Blackwell Publishing Ltd.

[Framework of work stress for the evaluation and management of risk].

PubMed

Costa, G

2009-01-01

Occupational stress is the negative consequence of a distorted relation between the worker and the work environment (mental/physical load, work organisation, social relationships), where both components, that is work demands and human resources, are strictly interacting in causing more or less severe mal-adjustment and health impairment. This is mediated by several intervening factors, related not only to high cognitive and emotional stress, but also to scarce coping strategies, that are strongly influenced by personal characteristics, lack of control on working conditions, and social support. Hence high costs for the individual, the company and the whole society, not only in terms of workers' health and well-being, but also as regards work ability and performance efficiency, as well as social consequences and compensative interventions. The Occupational Health Physician has to deal with these multidimensional and multifaceted aspects of work stress by different and concurrent approaches, at both group and individual levels, with epidemiological and clinical perspectives, enacting preventive and therapeutic strategies. Both "external" work load and individual "responses" have to be properly considered and addressed not only for the evaluation of at fitness to work, but also to plan corrective actions. Hence, the OHP has to act in closer collaboration with work psychologists, sociologists, human resources managers and work organisation experts.

Shortcomings in Dealing with Psychological Effects of Natural Disasters in Iran

PubMed Central

RABIEI, Ali; NAKHAEE, Nouzar; POURHOSSEINI, Samira Sadat

2014-01-01

Abstract Background Natural disasters result in numerous economic, social, psychological and cultural consequences. Of them, psychological consequences of disasters will affect the lives of people long after the critical conditions finish. Thus, concerning the importance of psychological support in disasters, this study has identified problems and weaknesses in dealing with the psychological effects of the disasters occurred in Iran. Methods This qualitative study was carried out using semi-structured in-depth interviews and focus groups. Sample volume consisted of 26 experts in the field of disaster management. Content analysis was used to analyze data. Results Nine major problems were identified as weaknesses in handling the psychological effects of the disaster. These weaknesses include: rescuers’ unfamiliarity with the basic principles of psychosocial support, shortage of relevant experts and inadequate training, paying no attention to the needs of specific groups, weaknesses in organizational communications, discontinuation of psychological support after disaster, unfamiliarity with native language and culture of the disaster area, little attention paid by media to psychological principles in broadcasting news, people’s long-term dependence on governmental aid. Conclusions Disaster management has various aspects; in Iran, less attention has been paid to psychological support in disasters. Increasing education at all levels, establishing responsible structures and programming seem necessary in dealing with the psychological effects of disasters. PMID:25927043

Seagrass meadows in a globally changing environment.

PubMed

Unsworth, Richard K F; van Keulen, Mike; Coles, Rob G

2014-06-30

Seagrass meadows are valuable ecosystem service providers that are now being lost globally at an unprecedented rate, with water quality and other localised stressors putting their future viability in doubt. It is therefore critical that we learn more about the interactions between seagrass meadows and future environmental change in the anthropocene. This needs to be with particular reference to the consequences of poor water quality on ecosystem resilience and the effects of change on trophic interactions within the food web. Understanding and predicting the response of seagrass meadows to future environmental change requires an understanding of the natural long-term drivers of change and how these are currently influenced by anthropogenic stress. Conservation management of coastal and marine ecosystems now and in the future requires increased knowledge of how seagrass meadows respond to environmental change, and how they can be managed to be resilient to these changes. Finding solutions to such issues also requires recognising people as part of the social-ecological system. This special issue aims to further enhance this knowledge by bringing together global expertise across this field. The special issues considers issues such as ecosystem service delivery of seagrass meadows, the drivers of long-term seagrass change and the socio-economic consequences of environmental change to seagrass. Copyright © 2014 Elsevier Ltd. All rights reserved.

The SAFRR (Science Application for Risk Reduction) Tsunami Scenario

USGS Publications Warehouse

Ross, Stephanie L.; Jones, Lucile M.

2013-01-01

The Science Application for Risk Reduction (SAFRR) tsunami scenario depicts a hypothetical but plausible tsunami created by an earthquake offshore from the Alaska Peninsula and its impacts on the California coast. The tsunami scenario is a collaboration between the U.S. Geological Survey (USGS), the California Geological Survey (CGS), the California Governor’s Office of Emergency Services (Cal OES), the National Oceanic and Atmospheric Administration (NOAA), other Federal, State, County, and local agencies, private companies, and academic and other institutions. This document presents evidence for past tsunamis, the scientific basis for the source, likely inundation areas, current velocities in key ports and harbors, physical damage and repair costs, economic consequences, environmental and ecological impacts, social vulnerability, emergency management and evacuation challenges, and policy implications for California associated with this hypothetical tsunami. We also discuss ongoing mitigation efforts by the State of California and new communication products. The intended users are those who need to make mitigation decisions before future tsunamis, and those who will need to make rapid decisions during tsunami events. The results of the tsunami scenario will help managers understand the context and consequences of their decisions and how they may improve preparedness and response. An evaluation component will assess the effectiveness of the scenario process for target stakeholders in a separate report to improve similar efforts in the future.

The Development of Improved Risk Assessment Methods for Use in Industrial Environmental Management Systems

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

Manners, T.K.

2006-07-01

Industrial sites that store or use chemicals are controlled in the UK under the COMAH (Control Of Major Accident Hazards) Regulations 1999 [1] based on their holdings of 'Dangerous Substances'. The COMAH Regulations [1] came into force in 1999 and are the UK's response to the European Union's Seveso II Directive. The purpose of these Regulations [1] is to: - Identify Major Accident Hazards (MAH); - Ensure that control measures are in place to prevent a MAH; - Ensure that mitigatory measures are in place to limit effects if MAH do occur. The UK's Health and Safety Executive (HSE), andmore » the Environment Agency (EA) jointly enforce the Regulations [1]. The fundamental requirement is given in the statement below, which is taken directly from the Regulations [1]. 'Every operator shall take all measures necessary to prevent major accidents and limit their consequences to persons and the environment'. This paper describes the development of a six-step screening methodology designed to identify Major Accidents To The Environment (MATTE) and improved consequence definitions that can be used in risk matrices to define the severity of an environmental fault. The method has been designed to be compatible with existing Environmental Management Systems (EMS) used in the chemical and nuclear industry. (authors)« less

Performance-based contracting in home-care work in The Netherlands: professionalism under pressure?

PubMed

Oomkens, Rosanne; Hoogenboom, Marcel; Knijn, Trudie

2016-07-01

Our aim was to improve the understanding of the relationships between performance-based contracting, management supportiveness and professionalism in home care. Using path analysis, this article explores the relationships between home-care workers' perceptions of management support, implementation of performance-based contracting (i.e. use of strict time registration rules and cost-efficiency measures) and autonomy and intrinsic job satisfaction. We hypothesised that: use of strict time registration rules and cost-efficiency measures relates to lower levels of autonomy and intrinsic job satisfaction (H1); there is an indirect relationship between use of strict time registration rules and use of cost-efficiency measures and intrinsic job satisfaction via autonomy (H2); higher levels of management support relate to the use of looser time registration rules and less use of cost-efficiency measures (H3); and higher levels of management support relate to higher levels of autonomy and intrinsic job satisfaction (H4). We used data from a cross-sectional survey conducted in 2010 of a sample of Dutch home-care workers (N = 156, response rate = 34%). Overall, our study suggests that the consequences of performance-based contracting for professionalism are ambiguous. More specifically, using strict time registration rules is related to lower levels of autonomy, whereas using cost-efficiency measures does not seem to affect autonomy (H1). Performance-based contracting has no consequences for the level of fulfilment home-care workers find in their job, as neither of the two contracting dimensions measured was directly or indirectly related to intrinsic job satisfaction (H1, H2). The role of managers must be taken into account when studying performance-based contracting, because perceived higher management support is related to managers' less frequent use of both strict time registration rules and of cost-efficiency measures (H3). The insight we gained into the importance of supportive managers for both autonomy and job satisfaction (H4) can help home-care organisations improve the attractiveness of home-care work. © 2015 John Wiley & Sons Ltd.

Pharmacy Practice Department Chairs’ Perspectives on Part-Time Faculty Members

PubMed Central

Winkler, Susan R.; Mai, Thy

2012-01-01

Objective. To identify the benefits and consequences of having part-time faculty members in departments of pharmacy practice from the department chair’s perspective. Methods. A stratified purposive sample of 12 pharmacy practice department chairs was selected. Eleven telephone interviews were conducted. Two investigators independently read interview notes and categorized and enumerated responses to determine major themes using content analysis. The investigators jointly reviewed the data and came to consensus on major themes. Results. Benefits of allowing full-time faculty members to reduce their position to part-time included faculty retention and improved individual faculty work/life balance. Consequences of allowing part-time faculty positions included the challenges of managing individual and departmental workloads, the risk of marginalizing part-time faculty members, and the challenges of promotion and tenure issues. All requests to switch to part-time status were faculty-driven and most were approved. Conclusions. There are a variety of benefits and consequences of having part-time faculty in pharmacy practice departments from the chair’s perspective. Clear faculty and departmental expectations of part-time faculty members need to be established to ensure optimal success of this working arrangement. PMID:22611268

The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions.

PubMed

Hors-Fraile, S; Atique, S; Mayer, M A; Denecke, K; Merolli, M; Househ, M

2016-11-10

Social media is increasingly being used in conjunction with health information technology (health IT). The objective of this paper is to identify some of the undesirable outcomes that arise from this integration and to suggest solutions to these problems. After a discussion with experts to elicit the topics that should be included in the survey, we performed a narrative review based on recent literature and interviewed multidisciplinary experts from different areas. In each case, we identified and analyzed the unintended effects of social media in health IT. Each analyzed topic provided a different set of unintended consequences. Most relevant consequences include lack of privacy with ethical and legal issues, patient confusion in disease management, poor information accuracy in crowdsourcing, unclear responsibilities, misleading and biased information in the prevention and detection of epidemics, and demotivation in gamified health solutions with social components. Using social media in healthcare offers several benefits, but it is not exempt of potential problems, and not all of these problems have clear solutions. We recommend careful design of digital systems in order to minimize patient's feelings of demotivation and frustration and we recommend following specific guidelines that should be created by all stakeholders in the healthcare ecosystem.

Healthcare managers in negative media focus: a qualitative study of personification processes and their personal consequences

PubMed Central

2014-01-01

Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach. Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization. PMID:24397306

A Method for Dynamic Risk Assessment and Management of Rockbursts in Drill and Blast Tunnels

NASA Astrophysics Data System (ADS)

Liu, Guo-Feng; Feng, Xia-Ting; Feng, Guang-Liang; Chen, Bing-Rui; Chen, Dong-Fang; Duan, Shu-Qian

2016-08-01

Focusing on the problems caused by rockburst hazards in deep tunnels, such as casualties, damage to construction equipment and facilities, construction schedule delays, and project cost increase, this research attempts to present a methodology for dynamic risk assessment and management of rockbursts in D&B tunnels. The basic idea of dynamic risk assessment and management of rockbursts is determined, and methods associated with each step in the rockburst risk assessment and management process are given, respectively. Among them, the main parts include a microseismic method for early warning the occurrence probability of rockburst risk, an estimation method that aims to assess potential consequences of rockburst risk, an evaluation method that utilizes a new quantitative index considering both occurrence probability and consequences for determining the level of rockburst risk, and the dynamic updating. Specifically, this research briefly describes the referenced microseismic method of warning rockburst, but focuses on the analysis of consequences and associated risk assessment and management of rockburst. Using the proposed method of risk assessment and management of rockburst, the occurrence probability, potential consequences, and the level of rockburst risk can be obtained in real-time during tunnel excavation, which contributes to the dynamic optimisation of risk mitigation measures and their application. The applicability of the proposed method has been verified by those cases from the Jinping II deep headrace and water drainage tunnels at depths of 1900-2525 m (with a length of 11.6 km in total for D&B tunnels).

Particle size of wheat, maize, and oat test meals: effects on plasma glucose and insulin responses and on the rate of starch digestion in vitro.

PubMed

Heaton, K W; Marcus, S N; Emmett, P M; Bolton, C H

1988-04-01

When normal volunteers ate isocaloric wheat-based meals, their plasma insulin responses (peak concentration and area under curve) increased stepwise: whole grains less than cracked grains less than coarse flour less than fine flour. Insulin responses were also greater with fine maizemeal than with whole or cracked maize grains but were similar with whole groats, rolled oats, and fine oatmeal. The peak-to-nadir swing of plasma glucose was greater with wheat flour than with cracked or whole grains. In vitro starch hydrolysis by pancreatic amylase was faster with decreasing particle size with all three cereals. Correlation with the in vivo data was imperfect. Oat-based meals evoked smaller glucose and insulin responses than wheat- or maize-based meals. Particle size influences the digestion rate and consequent metabolic effects of wheat and maize but not oats. The increased insulin response to finely ground flour may be relevant to the etiology of diseases associated with hyperinsulinemia and to the management of diabetes.

The Effects of Recreation Experience, Environmental Attitude, and Biospheric Value on the Environmentally Responsible Behavior of Nature-Based Tourists

NASA Astrophysics Data System (ADS)

Lee, Tsung Hung; Jan, Fen-Hauh

2015-07-01

The scientific understanding of the recreation experience and the environmentally responsible behavior of nature-based tourists is limited. This study examines the relationship among the recreation experience, environmental attitude, biospheric value, and the general and site-specific environmentally responsible behavior of nature-based tourists in Taomi, Liuqiu Island, and Aowanda and Najenshan in Taiwan. A total of 1342 usable questionnaires were collected for this study. The empirical results indicate that the recreation experience influences biospheric value and environmental attitude; subsequently, it then indirectly influences the general and site-specific environmentally responsible behavior of nature-based tourists. Our theoretical behavioral model elucidates previously proposed but unexamined behavioral models among nature-based tourists, and it offers a theoretical framework for researchers, decision makers, managers, and tourists in the field of nature-based tourism. We conclude that when an individual participates in nature-based tourism as described here, these recreation experiences strengthen their environmental attitude and biospheric value, and consequently increase their engagement in both general and site-specific environmentally responsible behaviors.

The effects of recreation experience, environmental attitude, and biospheric value on the environmentally responsible behavior of nature-based tourists.

PubMed

Lee, Tsung Hung; Jan, Fen-Hauh

2015-07-01

The scientific understanding of the recreation experience and the environmentally responsible behavior of nature-based tourists is limited. This study examines the relationship among the recreation experience, environmental attitude, biospheric value, and the general and site-specific environmentally responsible behavior of nature-based tourists in Taomi, Liuqiu Island, and Aowanda and Najenshan in Taiwan. A total of 1342 usable questionnaires were collected for this study. The empirical results indicate that the recreation experience influences biospheric value and environmental attitude; subsequently, it then indirectly influences the general and site-specific environmentally responsible behavior of nature-based tourists. Our theoretical behavioral model elucidates previously proposed but unexamined behavioral models among nature-based tourists, and it offers a theoretical framework for researchers, decision makers, managers, and tourists in the field of nature-based tourism. We conclude that when an individual participates in nature-based tourism as described here, these recreation experiences strengthen their environmental attitude and biospheric value, and consequently increase their engagement in both general and site-specific environmentally responsible behaviors.

[Return on investment for occupational health: review of methods and recommendations].

PubMed

Rydlewska-Liszkowska, Izabela

2010-01-01

The impact of the population health on the national economy, occupational risk factors and economic consequences of workers' behaviors in the workplace are the subject of health economics studies. Conditions and behaviors at work are recognized as one of the major economic factors. These relations are analyzed and evaluated with use of methods that combine economic consequences of working conditions, management and enterprise finances. The methods of assessing this impact are well known but the ability to implement them in practice is still limited. There are two main types of methods: methods for measuring economic relations between the work environment and enterprise management and methods for the economic analysis of investments in the work environment and occupational health. Methods for assessing economic effectiveness of working conditions limited to measurements of costs of absenteeism at work are also used. One of the methodological options in this regard is return on investment (ROI) for occupational health. ROI has been applied in many firms all over the world. Depending on the analytical assumptions and the scope of research, the ROI value ranged between more than 1 and 13. This means that the increase in return on investment for occupational health has been observed. There are examples that the return on invested resources cannot be always obtained. ROI accounting gives employers an opportunity of increasing effectiveness. Evidence of the real value of health investment enables to provide the platform of discussion among managers and other persons responsible for occupational health management. The results of the studies cannot be overestimated as an element of economic incentives system. Based on the review of the methods and results of their implementation some recommendations can be formulated.

Coastal zone - Terra (and aqua) incognita - Integrated Coastal Zone Management in the Black Sea

NASA Astrophysics Data System (ADS)

Kosyan, R. D.; Velikova, V. N.

2016-02-01

In the Black Sea coastal states (Bulgaria, Georgia, Romania, Russian Federation, Turkey, and Ukraine), Integrated Coastal Zone Management (ICZM) has no properly established legal and institutional framework. The term "coastal zone" is undefined in national (reportedly with the exception of Bulgaria) and regional legislative documents. The interface between science and policy within ICZM remains poorly developed. Policies for streamlining efforts have been ill-managed and decisions taken in functional zoning and the balanced use and protection of coastal zones have often been shown to be incorrect. The observed proliferation of consultative committees and councils has not been much helpful, public participation has been widely neglected. Illegal practices are in place, and coastal developments continue being largely unsustainable. These problems are often explained by the low awareness of ICZM benefits, and hence, a shortage of political good will, but also by the lack of appropriate Black Sea scientific research, which would ensure a fundamental knowledge-base. There are hundreds of organizations involved in collection of data and information of relevance for ICZM, although there is a distinct lack of coordination. Consequently, there is a substantial overlap of activities, whilst important scientific and policy questions remain unanswered. We review the status of ICZM or mismanagement (ICZmisM) in the Black Sea region, building links between environmental problems and policy measures in response, and providing appropriate examples. Recommendations are put forward with regard to major gaps in ICZM at levels of its theoretical development and practical implementation within the region. The review is intended to remind of major disastrous consequences of present complacency and laissez-faire in the management of the Black Sea. This paper calls for urgent implementation of ICZM in the Black Sea at national and regional levels.

[Second victim : Critical incident stress management in clinical medicine].

PubMed

Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

2013-09-01

Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

Decision Support System For Management Of Low-Level Radioactive Waste Disposal At The Nevada Test Site

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

Shott, G.; Yucel, V.; Desotell, L.

2006-07-01

The long-term safety of U.S. Department of Energy (DOE) low-level radioactive disposal facilities is assessed by conducting a performance assessment -- a systematic analysis that compares estimated risks to the public and the environment with performance objectives contained in DOE Manual 435.1-1, Radioactive Waste Management Manual. Before site operations, facilities design features such as final inventory, waste form characteristics, and closure cover design may be uncertain. Site operators need a modeling tool that can be used throughout the operational life of the disposal site to guide decisions regarding the acceptance of problematic waste streams, new disposal cell design, environmental monitoringmore » program design, and final site closure. In response to these needs the National Nuclear Security Administration Nevada Site Office (NNSA/NSO) has developed a decision support system for the Area 5 Radioactive Waste Management Site in Frenchman Flat on the Nevada Test Site. The core of the system is a probabilistic inventory and performance assessment model implemented in the GoldSim{sup R} simulation platform. The modeling platform supports multiple graphic capabilities that allow clear documentation of the model data sources, conceptual model, mathematical implementation, and results. The combined models have the capability to estimate disposal site inventory, contaminant concentrations in environmental media, and radiological doses to members of the public engaged in various activities at multiple locations. The model allows rapid assessment and documentation of the consequences of waste management decisions using the most current site characterization information, radionuclide inventory, and conceptual model. The model is routinely used to provide annual updates of site performance, evaluate the consequences of disposal of new waste streams, develop waste concentration limits, optimize the design of new disposal cells, and assess the adequacy of environmental monitoring programs. (authors)« less

A management system for end-of-life tyres: a Portuguese case study.

PubMed

Ferrão, Paulo; Ribeiro, Paulo; Silva, Paulo

2008-01-01

The European Union introduced several policy instruments based in the extended producer responsibility (EPR) in order to improve the environmental performance of products and services through their life cycles. In this context, the Portuguese government decided to apply the EPR concept to tyres, and producers were obliged to constitute an end-of-life management system to promote the collection, recycling and reuse of end-of-life (EOL) tyres. This required producers, distributors, recyclers and retreaders to be identified and characterized, and local processing infrastructures to be analyzed. The information was used to design an economically optimised EOL tyre management system while promoting the activity of all EOL operators in order for the imposed collecting and recovery targets to be fulfilled. This paper discusses the interaction between the different governmental, private and academic institutions for the creation of the integrated management system for EOL tyres, the approach taken, the technical, political and legal aspects underneath them, as well as the environmental consequences induced by the creation of the management system. The results obtained during the first years of operation are reported and show an increase in the collection and recycling of EOL tyres and the consolidation of the collection and processing infrastructures.

Experimental restoration of coppice-with-standards: Response of understorey vegetation from the conservation perspective.

PubMed

Vild, Ondřej; Roleček, Jan; Hédl, Radim; Kopecký, Martin; Utinek, Dušan

2013-12-15

A substantial part of European lowland woodlands was managed as coppices or wood pastures for millennia. However, traditional management forms were almost completely abandoned in Central Europe by the middle of the 20th century. Combined with the effects of nitrogen deposition and herbivore pressure, shifts in management resulted in biodiversity loss affecting particularly light-demanding oligotrophic plant species. Experimental thinning was applied in a former oak coppice-with-standards in an attempt to restore vanishing understorey plant communities. Two levels of thinning intensity and zero management as control were used on 90 plots. Ten years after the treatment, significant changes in species composition and diversity were observed in heavily thinned plots, while moderate thinning had mostly insignificant effects. Light-demanding oligotrophic species significantly increased, indicating positive consequences of restoration. However, heavy thinning also brought about the expansion of native ruderal species. Alien species remained unchanged. We conclude that the restoration of coppice-with-standards can be an efficient tool to support vanishing light-demanding woodland species. Combined with biodiversity benefits, the increasing demand for biofuel may contribute to the renaissance of traditional management forms in forestry.

Practical anesthetic considerations in patients undergoing tracheobronchial surgeries: a clinical review of current literature

PubMed Central

Ahuja, Sanchit; Cohen, Barak; Hinkelbein, Jochen; Diemunsch, Pierre

2016-01-01

Tracheobronchial surgeries require close cooperation and extensive communication between the anesthesia providers and the surgeons. Anesthetic management of tracheal and bronchial pathologies differ basically from regular upper airways management, due access to the patients airway is limited, mostly even practically impossible for the anesthesia providers. As a consequence, the surgeon overtakes responsibility for the airway access from the anesthesia provider in the variety of the cases. Preoperative recognition of a difficult airway, detailed planning and being aware of plan B and plan C are the elementary keys to success. Providers have to be aware, that preoperative airway assessment does not always correlate with the ease of oxygenation and ventilation. Therefore, various methods have been described in the literature and several authors have adopted unique ways to manage the airways in a successful manner. With the advancement of surgical techniques over the years, anesthetic management has also evolved tremendously to match the needs. The commonly encountered conditions requiring surgical interventions include post-intubation stenosis and foreign body aspiration. In this review we will discuss the most common pathologies of tracheobronchial lesions and specific anesthetic management considerations related to them. PMID:28066624

Uncertainty quantification and reliability assessment in operational oil spill forecast modeling system.

PubMed

Hou, Xianlong; Hodges, Ben R; Feng, Dongyu; Liu, Qixiao

2017-03-15

As oil transport increasing in the Texas bays, greater risks of ship collisions will become a challenge, yielding oil spill accidents as a consequence. To minimize the ecological damage and optimize rapid response, emergency managers need to be informed with how fast and where oil will spread as soon as possible after a spill. The state-of-the-art operational oil spill forecast modeling system improves the oil spill response into a new stage. However uncertainty due to predicted data inputs often elicits compromise on the reliability of the forecast result, leading to misdirection in contingency planning. Thus understanding the forecast uncertainty and reliability become significant. In this paper, Monte Carlo simulation is implemented to provide parameters to generate forecast probability maps. The oil spill forecast uncertainty is thus quantified by comparing the forecast probability map and the associated hindcast simulation. A HyosPy-based simple statistic model is developed to assess the reliability of an oil spill forecast in term of belief degree. The technologies developed in this study create a prototype for uncertainty and reliability analysis in numerical oil spill forecast modeling system, providing emergency managers to improve the capability of real time operational oil spill response and impact assessment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Collective response to public health emergencies and large-scale disasters: putting hospitals at the core of community resilience.

PubMed

Paturas, James L; Smith, Deborah; Smith, Stewart; Albanese, Joseph

2010-07-01

Healthcare organisations are a critical part of a community's resilience and play a prominent role as the backbone of medical response to natural and manmade disasters. The importance of healthcare organisations, in particular hospitals, to remain operational extends beyond the necessity to sustain uninterrupted medical services for the community, in the aftermath of a large-scale disaster. Hospitals are viewed as safe havens where affected individuals go for shelter, food, water and psychosocial assistance, as well as to obtain information about missing family members or learn of impending dangers related to the incident. The ability of hospitals to respond effectively to high-consequence incidents producing a massive arrival of patients that disrupt daily operations requires surge capacity and capability. The activation of hospital emergency support functions provides an approach by which hospitals manage a short-term shortfall of hospital personnel through the reallocation of hospital employees, thereby obviating the reliance on external qualified volunteers for surge capacity and capability. Recent revisions to the Joint Commission's hospital emergency preparedness standard have impelled healthcare facilities to participate actively in community-wide planning, rather than confining planning exclusively to a single healthcare facility, in order to harmonise disaster management strategies and effectively coordinate the allocation of community resources and expertise across all local response agencies.

Biophysical Approaches for Oral Wound Healing: Emphasis on Photobiomodulation

PubMed Central

Khan, Imran; Arany, Praveen

2015-01-01

Significance: Oral wounds can lead to significant pain and discomfort as well as affect overall general health due to poor diet and inadequate nutrition. Besides many biological and pharmaceutical methods being investigated, there is growing interest in exploring various biophysical devices that utilize electric, magnetic, ultrasound, pressure, and light energy. Recent Advances: Significant insight into mechanisms of these biophysical devices could provide a clear rationale for their clinical use. Preclinical studies are essential precursors in determining physiological mechanisms and elucidation of causal pathways. This will lead to development of safe and effective therapeutic protocols for clinical wound management. Critical Issues: Identification of precise events initiated by biophysical devices, specifically photobiomodulation—the major focus of this review, offers promising avenues in improving oral wound management. The primary phase responses initiated by the interventions that distinctly contribute to the therapeutic response must be clearly delineated from secondary phase responses. The latter events are a consequence of the wound healing process and must not be confused with causal mechanisms. Future Direction: Clinical adoption of these biophysical devices needs robust and efficacious protocols that can be developed by well-designed preclinical and clinical studies. Elucidation of the precise molecular mechanisms of these biophysical approaches could determine optimization of their applications for predictive oral wound care. PMID:26634185

Aberrant immune response with consequent vascular and connective tissue remodeling - causal to scleroderma and associated syndromes such as Raynaud phenomenon and other fibrosing syndromes?

PubMed

Durmus, Nedim; Park, Sung-Hyun; Reibman, Joan; Grunig, Gabriele

2016-11-01

Scleroderma and other autoimmune-induced connective tissue diseases are characterized by dysfunctions in the immune system, connective tissue and the vasculature. We are focusing on systemic sclerosis (SSc)-associated pulmonary hypertension, which remains a leading cause of death with only a 50-60% of 2-year survival rate. Much research and translational efforts have been directed at understanding the immune response that causes SSc and the networked interactions with the connective tissue and the vasculature. One of the unexpected findings was that in some cases the pathogenic immune response in SSc resembles the immune response to helminth parasites. During coevolution, means of communication were developed which protect the host from over-colonization with parasites and which protect the parasite from excessive host responses. One explanation for the geographically clustered occurrence of SSc is that environmental exposures combined with genetic predisposition turn on triggers of molecular and cellular modules that were once initiated by parasites. Future research is needed to further understand the parasite-derived signals that dampen the host response. Therapeutic helminth infection or treatment with parasite-derived response modifiers could be promising new management tools for autoimmune connective tissue diseases.

The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study.

PubMed

Zambas, Shelaine I; Smythe, Elizabeth A; Koziol-Mclain, Jane

2016-01-01

The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. Appropriate, accurate, and timely assessment by nurses is the cornerstone of maintaining patient safety in hospitals. The inclusion of "advanced" physical assessment skills such as auscultation, palpation, and percussion is thought to better prepare nurses for complex patient presentations within a wide range of clinical situations. This qualitative study used a hermeneutic pragmatic approach. Unstructured interviews were conducted with five experienced medical and surgical nurses to obtain 13 detailed narratives of assessment practice. Narratives were analyzed using Van Manen's six-step approach to identify the consequences of the nurse's use of advanced assessment skills. The consequences of using advanced assessment skills include looking for more, challenging interpretations, and perseverance. The use of advanced assessment skills directs what the nurse looks for, what she sees, interpretation of the findings, and her response. It is the interpretation of what is seen, heard, or felt within the full context of the patient situation, which is the advanced skill. Advanced assessment skill is the means to an accurate interpretation of the clinical situation and contributes to appropriate diagnosis and medical management in complex patient situations. The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting.

Psychosocial consequences of allocation to lung cancer screening: a randomised controlled trial.

PubMed

Aggestrup, Louise Mosborg; Hestbech, Mie Sara; Siersma, Volkert; Pedersen, Jesper Holst; Brodersen, John

2012-01-01

To examine the psychosocial consequences of being allocated to the control group as compared with the screen group in a randomised lung cancer screening trial. The Danish Lung Cancer Screening Trial, a randomised controlled trial, ran from 2004 to 2010 with the purpose of investigating the benefits and harms of lung cancer screening. The participants in Danish Lung Cancer Screening Trial were randomised to either the control group or the screen group and were asked to complete the questionnaires Consequences Of Screening and Consequences Of Screening in Lung Cancer (COS-LC). The Consequences Of Screening and the COS-LC were used to examine the psychosocial consequences of participating in the study, by comparing the control and the screen groups' responses at the prevalence and at the incidence round. There was no statistically significant difference in socio-demographic characteristics or smoking habits between the two groups. Responses to the COS-LC collected before the incidence round were statistically significantly different on the scales 'anxiety', 'behaviour', 'dejection', 'self-blame', 'focus on airway symptoms' and 'introvert', with the control group reporting higher negative psychosocial consequences. Furthermore, the participants in both the control and the screen groups exhibited a mean increase in negative psychosocial consequences when their responses from the prevalence round were compared with their responses from the first incidence round. Participation in a randomised controlled trial on lung cancer screening has negative psychosocial consequences for the apparently healthy participants-both the participants in the screen group and the control group. This negative impact was greatest for the control group.

Assessment of runoff response to landscape changes in the San Pedro subbasin (Nayarit, Mexico) using remote sensing data and GIS.

PubMed

Hernández-Guzmán, Rafael; Ruiz-Luna, Arturo; Berlanga-Robles, César Alejandro

2008-10-01

Results on runoff estimates as a response to land-use and land-cover changes are presented. We used remote sensing and GIS techniques with rainfall time-series data, spatial ancillary information, and the curve-number method (NRCS-CN) to assess the runoff response in the San Pedro subbasin. Thematic maps with eight land-cover classes derived from satellite imagery classification (1973, 1990, and 2000) and hydrologic soil-group maps were used as the input for the runoff calculation. About 20% to 25% of the subbasin landscape has changed since 1973, mainly as consequence of the growth of agriculture. Forest is the main cover, although further analyses indicate that forest is degrading from good to poor conditions when evaluated as a function of the spectral response. Soils with low infiltration rates, classified as the hydrological soil-group "C", were dominant in the area (52%). The overlaying of all the hydrological soil groups with the land-use map produced a total of 43 hydro-group and land-use categories for which runoff was calculated using the curve-number method. Estimates of total runoff volumes (26 x 10(6) m3) were similar for the three dates analyzed in spite of landscape changes, but there were temporal variations among the hydro-group and land-use categories as a consequence. Changes are causing the rise of covers with high runoff potential and the increase of runoff depth is expected, but it can be reversed by different management of subbasin hydro-groups and land-use units.

Practical management of cumulative anthropogenic impacts with working marine examples.

PubMed

Wright, Andrew J; Kyhn, Line A

2015-04-01

Human pressure on the environment is expanding and intensifying, especially in coastal and offshore areas. Major contributors to this are the current push for offshore renewable energy sources, which are thought of as environmentally friendly sources of power, as well as the continued demand for petroleum. Human disturbances, including the noise almost ubiquitously associated with human activity, are likely to increase the incidence, magnitude, and duration of adverse effects on marine life, including stress responses. Stress responses have the potential to induce fitness consequences for individuals, which add to more obvious directed takes (e.g., hunting or fishing) to increase the overall population-level impact. To meet the requirements of marine spatial planning and ecosystem-based management, many efforts are ongoing to quantify the cumulative impacts of all human actions on marine species or populations. Meanwhile, regulators face the challenge of managing these accumulating and interacting impacts with limited scientific guidance. We believe there is scientific support for capping the level of impact for (at a minimum) populations in decline or with unknown statuses. This cap on impact can be facilitated through implementation of regular application cycles for project authorization or improved programmatic and aggregated impact assessments that simultaneously consider multiple projects. Cross-company collaborations and a better incorporation of uncertainty into decision making could also help limit, if not reduce, cumulative impacts of multiple human activities. These simple management steps may also form the basis of a rudimentary form of marine spatial planning and could be used in support of future ecosystem-based management efforts. © 2014 Society for Conservation Biology.

Medical examiners, coroners, and biologic terrorism: a guidebook for surveillance and case management.

PubMed

Nolte, Kurt B; Hanzlick, Randy L; Payne, Daniel C; Kroger, Andrew T; Oliver, William R; Baker, Andrew M; McGowan, Dennis E; DeJong, Joyce L; Bell, Micahel R; Guarner, Jeannette; Shieh, Wun-Ju; Zaki, Sherif R

2004-06-11

Medical examiners and coroners (ME/Cs) are essential public health partners for terrorism preparedness and response. These medicolegal investigators support both public health and public safety functions and investigate deaths that are sudden, suspicious, violent, unattended, and unexplained. Medicolegal autopsies are essential for making organism-specific diagnoses in deaths caused by biologic terrorism. This report has been created to 1) help public health officials understand the role of ME/Cs in biologic terrorism surveillance and response efforts and 2) provide ME/Cs with the detailed information required to build capacity for biologic terrorism preparedness in a public health context. This report provides background information regarding biologic terrorism, possible biologic agents, and the consequent clinicopathologic diseases, autopsy procedures, and diagnostic tests as well as a description of biosafety risks and standards for autopsy precautions. ME/Cs' vital role in terrorism surveillance requires consistent standards for collecting, analyzing, and disseminating data. Familiarity with the operational, jurisdictional, and evidentiary concerns involving biologic terrorism-related death investigation is critical to both ME/Cs and public health authorities. Managing terrorism-associated fatalities can be expensive and can overwhelm the existing capacity of ME/Cs. This report describes federal resources for funding and reimbursement for ME/C preparedness and response activities and the limited support capacity of the federal Disaster Mortuary Operational Response Team. Standards for communication are critical in responding to any emergency situation. This report, which is a joint collaboration between CDC and the National Association of Medical Examiners (NAME), describes the relationship between ME/Cs and public health departments, emergency management agencies, emergency operations centers, and the Incident Command System.

Can compensatory culling offset undesirable evolutionary consequences of trophy hunting?

PubMed

Mysterud, Atle; Bischof, Richard

2010-01-01

1. There is growing concern about the evolutionary consequences of human harvesting on phenotypic trait quality in wild populations. Undesirable consequences are especially likely with trophy hunting because of its strong bias for specific phenotypic trait values, such as large antlers in cervids and horns in bovids. Selective hunting can cause a decline in a trophy trait over time if it is heritable, thereby reducing the long-term sustainability of the activity itself. 2. How can we build a sustainable trophy hunting tradition without the negative trait-altering effects? We used an individual-based model to explore whether selective compensatory culling of 'low quality' individuals at an early life stage can facilitate sustainability, as suggested by information from managed game populations in eastern and central Europe. Our model was rooted in empirical data on red deer, where heritability of sexual ornaments has been confirmed and phenotypic quality can be assessed by antler size in individuals as young as 1 year. 3. Simulations showed that targeted culling of low-quality yearlings could counter the selective effects of trophy hunting on the distribution of the affected trait (e.g. antler or horn size) in prime-aged individuals. Assumptions of trait heritability and young-to-adult correlation were essential for compensation, but the model proved robust to various other assumptions and changes to input parameters. The simulation approach allowed us to verify responses as evolutionary changes in trait values rather than short-term consequences of altered age structure, density and viability selection. 4. We conclude that evolutionarily enlightened management may accommodate trophy hunting. This has far reaching implications as income from trophy hunting is often channelled into local conservation efforts and rural economies. As an essential follow-up, we recommend an analysis of the effects of trophy hunting in conjunction with compensatory culling on the phenotypic and underlying genetic variance of the trophy trait.

Between Securitisation and Neglect: Managing Ebola at the Borders of Global Health

PubMed Central

Honigsbaum, Mark

2017-01-01

In 2014 the World Health Organization (WHO) was widely criticised for failing to anticipate that an outbreak of Ebola in a remote forested region of south-eastern Guinea would trigger a public health emergency of international concern (pheic). In explaining the WHO’s failure, critics have pointed to structural restraints on the United Nations organisation and a leadership ‘vacuum’ in Geneva, among other factors. This paper takes a different approach. Drawing on internal WHO documents and interviews with key actors in the epidemic response, I argue that the WHO’s failure is better understood as a consequence of Ebola’s shifting medical identity and of triage systems for managing emerging infectious disease (EID) risks. Focusing on the discursive and non-discursive practices that produced Ebola as a ‘problem’ for global health security, I argue that by 2014 Ebola was no longer regarded as a paradigmatic EID and potential biothreat so much as a neglected tropical disease. The result was to relegate Ebola to the fringes of biosecurity concerns just at the moment when the virus was crossing international borders in West Africa and triggering large urban outbreaks for the first time. Ebola’s fluctuating medical identity also helps explain the prominence of fear and rumours during the epidemic and social resistance to Ebola control measures. Contrasting the WHO’s delay over declaring a pheic in 2014, with its rapid declaration of pheics in relation to H1N1 swine flu in 2009 and polio in 2014, I conclude that such ‘missed alarms’ may be an inescapable consequence of pandemic preparedness systems that seek to rationalise responses to the emergence of new diseases. PMID:28260567

Interactions of predominant insects and diseases with climate change in Douglas-fir forests of western Oregon and Washington, U.S.A.

PubMed

Agne, Michelle C; Beedlow, Peter A; Shaw, David C; Woodruff, David R; Lee, E Henry; Cline, Steven P; Comeleo, Randy L

2018-02-01

Forest disturbance regimes are beginning to show evidence of climate-mediated changes, such as increasing severity of droughts and insect outbreaks. We review the major insects and pathogens affecting the disturbance regime for coastal Douglas-fir forests in western Oregon and Washington State, USA, and ask how future climate changes may influence their role in disturbance ecology. Although the physiological constraints of light, temperature, and moisture largely control tree growth, episodic and chronic disturbances interacting with biological factors have substantial impacts on the structure and functioning of forest ecosystems in this region. Understanding insect and disease interactions is critical to predicting forest response to climate change and the consequences for ecosystem services, such as timber, clean water, fish and wildlife. We focused on future predictions for warmer wetter winters, hotter drier summers, and elevated atmospheric CO 2 to hypothesize the response of Douglas-fir forests to the major insects and diseases influencing this forest type: Douglas-fir beetle, Swiss needle cast, black stain root disease, and laminated root rot. We hypothesize that 1) Douglas-fir beetle and black stain root disease could become more prevalent with increasing, fire, temperature stress, and moisture stress, 2) future impacts of Swiss needle cast are difficult to predict due to uncertainties in May-July leaf wetness, but warmer winters could contribute to intensification at higher elevations, and 3) laminated root rot will be influenced primarily by forest management, rather than climatic change. Furthermore, these biotic disturbance agents interact in complex ways that are poorly understood. Consequently, to inform management decisions, insect and disease influences on disturbance regimes must be characterized specifically by forest type and region in order to accurately capture these interactions in light of future climate-mediated changes.

Unintended Consequences of Wearable Sensor Use in Healthcare. Contribution of the IMIA Wearable Sensors in Healthcare WG.

PubMed

Schukat, M; McCaldin, D; Wang, K; Schreier, G; Lovell, N H; Marschollek, M; Redmond, S J

2016-11-10

As wearable sensors take the consumer market by storm, and medical device manufacturers move to make their devices wireless and appropriate for ambulatory use, this revolution brings with it some unintended consequences, which we aim to discuss in this paper. We discuss some important unintended consequences, both beneficial and unwanted, which relate to: modifications of behavior; creation and use of big data sets; new security vulnerabilities; and unforeseen challenges faced by regulatory authorities, struggling to keep pace with recent innovations. Where possible, we proposed potential solutions to unwanted consequences. Intelligent and inclusive design processes may mitigate unintended modifications in behavior. For big data, legislating access to and use of these data will be a legal and political challenge in the years ahead, as we trade the health benefits of wearable sensors against the risk to our privacy. The wireless and personal nature of wearable sensors also exposes them to a number of unique security vulnerabilities. Regulation plays an important role in managing these security risks, but also has the dual responsibility of ensuring that wearable devices are fit for purpose. However, the burden of validating the function and security of medical devices is becoming infeasible for regulators, given the many software apps and wearable sensors entering the market each year, which are only a subset of an even larger 'internet of things'. Wearable sensors may serve to improve wellbeing, but we must be vigilant against the occurrence of unintended consequences. With collaboration between device manufacturers, regulators, and end-users, we balance the risk of unintended consequences occurring against the incredible benefit that wearable sensors promise to bring to the world.

Unintended Consequences of Wearable Sensor Use in Healthcare

PubMed Central

McCaldin, D.; Wang, K.; Schreier, G.; Lovell, N. H.; Marschollek, M.; Redmond, S. J.

2016-01-01

Summary Objectives As wearable sensors take the consumer market by storm, and medical device manufacturers move to make their devices wireless and appropriate for ambulatory use, this revolution brings with it some unintended consequences, which we aim to discuss in this paper. Methods We discuss some important unintended consequences, both beneficial and unwanted, which relate to: modifications of behavior; creation and use of big data sets; new security vulnerabilities; and unforeseen challenges faced by regulatory authorities, struggling to keep pace with recent innovations. Where possible, we proposed potential solutions to unwanted consequences. Results Intelligent and inclusive design processes may mitigate unintended modifications in behavior. For big data, legislating access to and use of these data will be a legal and political challenge in the years ahead, as we trade the health benefits of wearable sensors against the risk to our privacy. The wireless and personal nature of wearable sensors also exposes them to a number of unique security vulnerabilities. Regulation plays an important role in managing these security risks, but also has the dual responsibility of ensuring that wearable devices are fit for purpose. However, the burden of validating the function and security of medical devices is becoming infeasible for regulators, given the many software apps and wearable sensors entering the market each year, which are only a subset of an even larger ‘internet of things’. Conclusion Wearable sensors may serve to improve wellbeing, but we must be vigilant against the occurrence of unintended consequences. With collaboration between device manufacturers, regulators, and end-users, we balance the risk of unintended consequences occurring against the incredible benefit that wearable sensors promise to bring to the world. PMID:27830234

Improving the safety of street-vended food.

PubMed

Moy, G; Hazzard, A; Käferstein, F

1997-01-01

An integrated plan of action for improving street food involving health and other regulatory authorities, vendors and consumers should address not only food safety, but also environmental health management, including consideration of inadequate sanitation and waste management, possible environmental pollution, congestion and disturbances to traffic. However, WHO cautions that, in view of their importance in the diets of urban populations, particularly the socially disadvantaged, every effort should be made to preserve the benefits provided by varied, inexpensive and often nutritious street food. Therefore, authorities concerned with street food management must balance efforts aimed at reducing the negative aspects on the environment with the benefits of street food and its important role in the community. Health authorities charged with responsibility for food safety control should match risk management action to the level of assessed risk. The rigorous application of codes and enforcement of regulations more suited to larger and permanent food service establishments is unlikely to be justifiable. Such rigorous application of codes and regulations may result in disappearance of the trade with consequent aggravation of hunger and malnutrition. Moreover, most codes and regulations have not been based on any systematic identification and assessment of health hazards associated with different types of foods and operations as embodied in the HACCP approach which has been recognized by Codex as the most cost-effective means for promoting food safety. WHO encourages the development of regulations that empower vendors to take greater responsibility for the preparation of safe food, and of codes of practice based on the HACCP system.

Management of crizotinib therapy for ALK-rearranged non-small cell lung carcinoma: an expert consensus.

PubMed

Cappuzzo, Federico; Moro-Sibilot, Denis; Gautschi, Oliver; Boleti, Ekaterini; Felip, Enriqueta; Groen, Harry J M; Germonpré, Paul; Meldgaard, Peter; Arriola, Edurne; Steele, Nicola; Fox, Jesme; Schnell, Patrick; Engelsberg, Arne; Wolf, Jürgen

2015-02-01

Within 4 years of the discovery of anaplastic lymphoma kinase (ALK) rearrangements in non-small cell lung cancer (NSCLC), the ALK inhibitor crizotinib gained US and European approval for the treatment of advanced ALK-positive NSCLC. This was due to the striking response data observed with crizotinib in phase I and II trials in patients with ALK-positive NSCLC, as well as the favorable tolerability and safety profile observed. Recently published phase III data established crizotinib as a new standard of care for this NSCLC molecular subset. A consequence of such rapid approval, however, is the limited clinical experience and relative paucity of information concerning optimal therapy management. In this review, we discuss the development of crizotinib and the clinical relevance of its safety profile, examining crizotinib-associated adverse events in detail and making specific management recommendations. Crizotinib-associated adverse events were mostly mild to moderate in severity in clinical studies, and appropriate monitoring and supportive therapies are considered effective in avoiding the need for dose interruption or reduction in most cases. Therapy management of patients following disease progression on crizotinib is also discussed. Based on available clinical data, it is evident that patients may have prolonged benefit from crizotinib after Response Evaluation Criteria in Solid Tumors-defined disease progression, and crizotinib should be continued for as long as the patient derives benefit. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

New insights into managing the risk of hypoglycaemia associated with intermittent high-intensity exercise in individuals with type 1 diabetes mellitus: implications for existing guidelines.

PubMed

Guelfi, Kym J; Jones, Timothy W; Fournier, Paul A

2007-01-01

Exercise is generally recommended for individuals with type 1 diabetes mellitus since it is associated with numerous physiological and psychological benefits. However, participation in exercise can also increase the risk of experiencing severe hypoglycaemia, a potentially life-threatening condition, both during exercise and for up to 31 hours of recovery. Fortunately, this risk of exercise-induced hypoglycaemia can be managed by adjusting the dosage of self-administered exogenous insulin and nutritional intake to maintain blood glucose levels within the normal physiological range. In order to provide evidence-based guidelines to allow individuals with type 1 diabetes to safely participate in a range of physical activities, much previous research has focused on understanding the metabolic and hormonal responses to exercise. Consequently, it is well established that moderate- and high-intensity exercise have a contrasting effect on blood glucose levels and require different management strategies to maintain euglycaemia. On the other hand, the response of blood glucose levels to a combination of moderate- and high-intensity exercise, a pattern of physical activity referred to as intermittent high-intensity exercise (IHE) has received little research attention. This is despite the fact that this type of exercise characterises the activity patterns of most team and field sports as well as spontaneous play in children. The lack of previous research into the glucoregulatory responses to IHE is reflected in existing guidelines, which either do not address IHE, or suggest similar management strategies for blood glucose levels during and after IHE as for moderate- or high-intensity exercise alone. It is important, however, to appreciate that there are fundamental differences in the metabolic responses to intermittent exercise compared with other types of exercise. Recently, a series of investigations into the glucoregulatory responses to IHE that replicates the work-to-recovery ratios observed in team and field sports have been conducted. The findings of these studies do not support the existing recommendations for managing blood glucose levels during IHE. Hence, the purpose of this article is to discuss the results of these recent studies, which provide new insight into the management of blood glucose levels during and after IHE and have implications for current guidelines aimed at minimising the risk of hypoglycaemia. These findings, along with future investigations, should provide valuable information for health professionals and individuals with type 1 diabetes on the management of blood glucose levels during and after exercise to allow for safe participation in intermittent activities along with their peers.

A GIS-based model to estimate flood consequences and the degree of accessibility and operability of strategic emergency response structures in urban areas

NASA Astrophysics Data System (ADS)

Albano, R.; Sole, A.; Adamowski, J.; Mancusi, L.

2014-11-01

Efficient decision-making regarding flood risk reduction has become a priority for authorities and stakeholders in many European countries. Risk analysis methods and techniques are a useful tool for evaluating costs and benefits of possible interventions. Within this context, a methodology to estimate flood consequences was developed in this paper that is based on GIS, and integrated with a model that estimates the degree of accessibility and operability of strategic emergency response structures in an urban area. The majority of the currently available approaches do not properly analyse road network connections and dependencies within systems, and as such a loss of roads could cause significant damages and problems to emergency services in cases of flooding. The proposed model is unique in that it provides a maximum-impact estimation of flood consequences on the basis of the operability of the strategic emergency structures in an urban area, their accessibility, and connection within the urban system of a city (i.e. connection between aid centres and buildings at risk), in the emergency phase. The results of a case study in the Puglia region in southern Italy are described to illustrate the practical applications of this newly proposed approach. The main advantage of the proposed approach is that it allows for defining a hierarchy between different infrastructure in the urban area through the identification of particular components whose operation and efficiency are critical for emergency management. This information can be used by decision-makers to prioritize risk reduction interventions in flood emergencies in urban areas, given limited financial resources.

Using Rapid-Response Scenario-Building Methodology for Climate Change Adaptation Planning

NASA Astrophysics Data System (ADS)

Ludwig, K. A.; Stoepler, T. M.; Schuster, R.

2015-12-01

Rapid-response scenario-building methodology can be modified to develop scenarios for slow-onset disasters associated with climate change such as drought. Results of a collaboration between the Department of the Interior (DOI) Strategic Sciences Group (SSG) and the Southwest Colorado Social-Ecological Climate Resilience Project are presented in which SSG scenario-building methods were revised and applied to climate change adaptation planning in Colorado's Gunnison Basin, United States. The SSG provides the DOI with the capacity to rapidly assemble multidisciplinary teams of experts to develop scenarios of the potential environmental, social, and economic cascading consequences of environmental crises, and to analyze these chains to determine actionable intervention points. By design, the SSG responds to acute events of a relatively defined duration. As a capacity-building exercise, the SSG explored how its scenario-building methodology could be applied to outlining the cascading consequences of slow-onset events related to climate change. SSG staff facilitated two workshops to analyze the impacts of drought, wildfire, and insect outbreak in the sagebrush and spruce-fir ecosystems. Participants included local land managers, natural and social scientists, ranchers, and other stakeholders. Key findings were: 1) scenario framing must be adjusted to accommodate the multiple, synergistic components and longer time frames of slow-onset events; 2) the development of slow-onset event scenarios is likely influenced by participants having had more time to consider potential consequences, relative to acute events; 3) participants who are from the affected area may have a more vested interest in the outcome and/or may be able to directly implement interventions.

Consumer responses to communication about food risk management.

PubMed

van Dijk, Heleen; Houghton, Julie; van Kleef, Ellen; van der Lans, Ivo; Rowe, Gene; Frewer, Lynn

2008-01-01

Recent emphasis within policy circles has been on transparent communication with consumers about food risk management decisions and practices. As a consequence, it is important to develop best practice regarding communication with the public about how food risks are managed. In the current study, the provision of information about regulatory enforcement, proactive risk management, scientific uncertainty and risk variability were manipulated in an experiment designed to examine their impact on consumer perceptions of food risk management quality. In order to compare consumer reactions across different cases, three food hazards were selected (mycotoxins on organically grown food, pesticide residues, and a genetically modified potato). Data were collected from representative samples of consumers in Germany, Greece, Norway and the UK. Scores on the "perceived food risk management quality" scale were subjected to a repeated-measures mixed linear model. Analysis points to a number of important findings, including the existence of cultural variation regarding the impact of risk communication strategies-something which has obvious implications for pan-European risk communication approaches. For example, while communication of uncertainty had a positive impact in Germany, it had a negative impact in the UK and Norway. Results also indicate that food risk managers should inform the public about enforcement of safety laws when communicating scientific uncertainty associated with risks. This has implications for the coordination of risk communication strategies between risk assessment and risk management organizations.

Disaster waste management in Italy: Analysis of recent case studies.

PubMed

Gabrielli, Francesco; Amato, Alessia; Balducci, Susanna; Magi Galluzzi, Lorenzo; Beolchini, Francesca

2018-01-01

The geomorphology of the Italian territory causes the incidence of many disasters like earthquakes and floods, with the consequent production of large volumes of waste. The management of such huge flows, produced in a very short time, may have a high impact on the whole emergency response. Moreover, historical data related to disaster waste management are often not easily accessible; on the other hand, the availability of data concerning previous events could support the emergency managers, that have to take a decision in a very short time. In this context, the present paper analyses four relevant recent case studies in Italy, dealing with disaster waste management after geologic and hydrologic natural events. Significant differences have been observed in the quantity and types of generated wastes, and, also, in the management approach. Such differences are mainly associated with the kind of disaster (i.e. earthquake vs. flood), to the geographical location (i.e. internal vs. coastal area), to the urbanisation level (i.e. industrial vs. urban). The study allowed the identification of both strengths and weaknesses of the applied waste management strategies, that represent "lessons to learn" for future scenarios. Even though it deals with Italian case studies, this manuscript may have a high impact also at international level, making available for the first-time emergency waste management data, that are considered an indispensable support for decision makers. Copyright © 2017 Elsevier Ltd. All rights reserved.

5 CFR 250.103 - Consequences of improper agency actions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Consequences of improper agency actions. 250.103 Section 250.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... Consequences of improper agency actions. If OPM finds that an agency has taken an action contrary to a law...

Theories of lean management: an empirical evaluation.

PubMed

Handel, Michael J

2014-03-01

Debates within organization theory traditionally argued the relative merits of bureaucracy but today there is broad agreement across different perspectives that bureaucratic organization is inefficient and outmoded. Despite their differences, post-bureaucratic and neo-liberal theories argue that organizations with relatively flat hierarchies and low management overhead are better adapted to current market requirements. Post-bureaucratic theory also argues that employees, as well as firms, benefit from leaner management structures. This paper investigates trends in managerial leanness, proposed explanations for such trends, and the consequences of leanness for firms and employees. Although there is a trend toward flatter management hierarchies, there is only weak support for current claims regarding both the causes and consequences of lean management. Copyright © 2013 Elsevier Inc. All rights reserved.

Framework for measuring sustainable development in catchment systems.

PubMed

Walmsley, Jay J

2002-02-01

Integrated catchment management represents an approach to managing the resources of a catchment by integrating environmental, economic, and social issues. It is aimed at deriving sustainable benefits for future generations, while protecting natural resources, particularly water, and minimizing possible adverse social, economic, and environmental consequences. Indicators of sustainable development, which summarize information for use in decision-making, are invaluable when trying to assess the diverse, interacting components of catchment processes and resource management actions. The Driving-Forces--Pressure--State--Impact--Response (DPSIR) indicator framework is useful for identifying and developing indicators of sustainable development for catchment management. Driving forces have been identified as the natural conditions occurring in a catchment and the level of development and economic activity. Pressures include the natural and anthropogenic supply of water, water demand, and water pollution. State indicators can be split into those of quantity and those of quality. Impacts include those that affect the ecosystems directly and those that impact the use value of the resource. It core indicators are identified within each of the categories given in the framework, most major catchment-based management issues can be evaluated. This framework is applied to identify key issues in catchment management in South Africa, and develop a set of indicators for evaluating catchments throughout the country.

Assessment of a Bayesian Belief Network-GIS framework as a practical tool to support marine planning.

PubMed

Stelzenmüller, V; Lee, J; Garnacho, E; Rogers, S I

2010-10-01

For the UK continental shelf we developed a Bayesian Belief Network-GIS framework to visualise relationships between cumulative human pressures, sensitive marine landscapes and landscape vulnerability, to assess the consequences of potential marine planning objectives, and to map uncertainty-related changes in management measures. Results revealed that the spatial assessment of footprints and intensities of human activities had more influence on landscape vulnerabilities than the type of landscape sensitivity measure used. We addressed questions regarding consequences of potential planning targets, and necessary management measures with spatially-explicit assessment of their consequences. We conclude that the BN-GIS framework is a practical tool allowing for the visualisation of relationships, the spatial assessment of uncertainty related to spatial management scenarios, the engagement of different stakeholder views, and enables a quick update of new spatial data and relationships. Ultimately, such BN-GIS based tools can support the decision-making process used in adaptive marine management. Copyright © 2010 Elsevier Ltd. All rights reserved.

Evaluation by employees of employee management on large US dairy farms.

PubMed

Durst, Phillip T; Moore, Stanley J; Ritter, Caroline; Barkema, Herman W

2018-05-23

Employees, many of whom are not native English speakers, perform the majority of work on large US dairy farms. Although management of employees is a critical role of dairy owners and managers, factors that improve employee engagement and retention are not well known. Objectives were to (1) identify key dairy farm employee management issues based on employee perceptions, (2) evaluate strengths and weaknesses of farms based on employee responses, (3) investigate differences between Latino and English-speaking employees, and (4) investigate differences in perception between employers and employees. Employees from 12 US dairy farms (each with a minimum of 10 employees) were interviewed by phone following a questionnaire provided. Employees provided their responses to 21 Likert scale questions and 8 open-ended questions. There was a wide range in employee turnover among farms (<10 to >100%). Latino employees had much shorter tenure and were more often employed in milking and livestock care than English-speaking employees. Employee perceptions differed among farms regarding whether they would recommend their farm as a place to work, teamwork within the dairy, whether rules were fairly applied, availability of tools and equipment, clear lines of supervision, and recognition for good work in the previous 15 d. Latino employees (n = 91) were more positive in many of these measures than their English-speaking counterparts (n = 77) but less often provided ideas to their employer on how to improve the business. Employers, surveyed on how they thought their employees would answer, underestimated employee responses on several questions, particularly the interest of employees in learning about dairy. When asked to cite 3 goals of the operation, there were differences among owners, managers, and employees. Although employees rated their commitment to the farm and their interest in learning as high, based on turnover, there was an obvious disparity between reality and ideal employee management. Consequently, employers should act on identified management shortfalls to improve employee retention. © 2018, The Authors. Published by the Federation of Animal Science Societies and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...

40 CFR 68.165 - Offsite consequence analysis.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) CHEMICAL ACCIDENT PREVENTION PROVISIONS Risk Management Plan § 68.165 Offsite consequence... released in pounds; (7) Release rate; (8) Release duration; (9) Wind speed and atmospheric stability class...

The micropolitics of responsibility vis-à-vis autonomy: parental accounts of childhood genetic testing and (non)disclosure.

PubMed

Arribas-Ayllon, Michael; Sarangi, Srikant; Clarke, Angus

2008-03-01

Genetic testing and (non)disclosure of genetic information present ethical and moral dilemmas for the management of parental responsibility vis-à-vis the child's autonomy. Ethical guidelines aimed at professionals currently seek to defer childhood testing where there is no clear medical or psychosocial benefit. This version of autonomy is derived from a bioethical paradigm which brackets the individual rights and capacities of the child. In this paper we focus on situated parental accounts of responsibility/autonomy to understand the complex forms of relational work -i.e. the micropolitics of balancing rights and responsibilities - involving a range of inherited genetic disorders. Interviews (n= 20) were conducted with parents whose genetic condition may have had consequences for their children. Using rhetorical discourse analysis, we show how parents draw upon a number of rhetorical/discoursal devices to produce accounts where genetic responsibility is actually or potentially transmitted to the child. We identify three kinds of accounting practice: (1) aligned responsibility; (2) deferred responsibility; and (3) misaligned responsibility. Each of these practices demonstrates how parents position themselves responsibly by foregrounding figures and events onto which the child's autonomy is selectively mapped. Rather than simple representations, we regard these accounts as complex moral performances that seek alignment with broader bioethical discourses.

Racial Geography, Economic Growth and Natural Disaster Resilience

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

Li, Huiping; Fernandez, Steven J.; Ganguly, Auroop

Recent development of National Response Plans and National Incident Management Plans has emphasized the need for interoperability of plans, systems, technology, and command structures. However, much less emphasis has been placed on equally important elements such as the at-risk populations’ response to those plans, systems, and directions. The community-wide consequences of Hurricane Katrina demonstrated that the protection of communities should no longer be considered only a function of public organizations. Private organizations, nonprofit organizations and individual households have significant roles to play in these plans (Comfort 2006, Salamon 2002). This study is a first attempt to characterize the effect onmore » the resilience (recovery) of metropolitan areas by the presence (or absence) of separate small communities within a larger jurisdiction. These communities can be based on many different social cleavages (ethnic, racial, economic, social, geographic, linguistic, etc.).« less

Shivering in acutely ill vulnerable populations.

PubMed

Holtzclaw, Barbara J

2004-01-01

The hazards of thermoregulatory shivering in the critically ill are often overlooked by caregivers. Shivering may accompany heat loss from bathing, dressing, transport, and many therapeutic activities. Febrile shivering is common during chills of fever, blood product transfusions, administration of antigenic drugs, and chemotherapy. Many patients are at risk for shivering and its negative consequences that increase oxygen expenditure and cardiorespiratory effort. Learning how underlying thermoregulatory mechanisms are involved in shivering clarifies how temperature gradients and environmental stimuli induce the shivering response. Knowledge of the anatomical progression of shivering equips the nurse to recognize or prevent this energy-consuming response. This article discusses measures to prevent shivering as well as evidence-based interventions to manage shivering during fever, aggressive cooling, and postoperative recovery. Detailed information is presented on assessment and documentation of the extent and severity of shivering.

Bureaucracy Versus Environment: The Environmental Costs of Bureaucratic Governance

NASA Astrophysics Data System (ADS)

Singer, S. Fred

The 15 contributors to this volume have an important message. They are convinced that both environmental and economic costs of bureaucratic management of natural resources are too high, and unnecessarily so. The main reason is an institutional one: Authority is given to those who do not bear responsibility for the consequences o f their actions.A classic case is the set of specific numerical emission standards for automobiles in the Clean Air Act Amendments of 1970. Congress arrived at these standards without a scientific basis, without technical analysis, and certainly without any consideration of costs and benefits. Only 3 years later did Senator Muskie ask the National Academy of Sciences to conduct a cost-benefit analysis. The NAS results were presented in a fashion that seemed to support the action of Congress; yet, the statutory emissions standards yielded marginal costs well beyond their marginal benefits. They had a major impact on Detroit during the 1970's, and very likely damaged, perhaps irreversibly, the competitive standing of the American automobile industry, a major segment of the U.S. economy. But the economic costs of these actions were never considered, least of all by the responsible bureaucrats. They were completely buffered from any consequences flowing from the exercise of their authority.

How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis

PubMed Central

Moran, Valerie; Allen, Pauline; Checkland, Kath; Warwick-Giles, Lynsey; Gore, Oz; Bramwell, Donna; Coleman, Anna

2017-01-01

Objectives From April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services. Design We carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs). Setting/participants We conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning. Results Conflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein. Conclusions Devolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs. PMID:29122801

Reducing the health consequences of opioid addiction in primary care.

PubMed

Bowman, Sarah; Eiserman, Julie; Beletsky, Leo; Stancliff, Sharon; Bruce, R Douglas

2013-07-01

Addiction to prescription opioids is prevalent in primary care settings. Increasing prescription opioid use is largely responsible for a parallel increase in overdose nationally. Many patients most at risk for addiction and overdose come into regular contact with primary care providers. Lack of routine addiction screening results in missed treatment opportunities in this setting. We reviewed the literature on screening and brief interventions for addictive disorders in primary care settings, focusing on opioid addiction. Screening and brief interventions can improve health outcomes for chronic illnesses including diabetes, hypertension, and asthma. Similarly, through the use of screening and brief interventions, patients with addiction can achieve improved health outcome. A spectrum of low-threshold care options can reduce the negative health consequences among individuals with opioid addiction. Screening in primary care coupled with short interventions, including motivational interviewing, syringe distribution, naloxone prescription for overdose prevention, and buprenorphine treatment are effective ways to manage addiction and its associated risks and improve health outcomes for individuals with opioid addiction. Copyright © 2013 Elsevier Inc. All rights reserved.

Ecohydrological consequences of vegetation interactions within the critical zone in the tropical Andes: multi-scale assessment of vegetation change consequences

NASA Astrophysics Data System (ADS)

Villegas, J. C.; Salazar, J. F.; Arias, P. A.; León, J. D.

2017-12-01

Land cover transformation is currently one of the most important challenges in tropical South America. These transformations occur both because of climate-related ecological perturbations, as well as in response to ongoing socio-economic processes. A fundamental difference between those two drivers is the spatial and temporal scale at which they operate. However, when considered in a larger context, both drivers affect the ability of ecosystems to provide fundamental services to society. In this work, we use a multi-scale approach to identify key-mechanisms through which land cover transformation significantly affects ecological, hydrological and ecoclimatological dynamics, potentially leading to loss of societally-critical regulation services. We propose a suite of examples spanning multiple spatial and temporal scales that illustrate the effects of land cover trnasformations in ecological, hydrological, biogeochemical and climatic functions in tropical South America. These examples highlight important global-change-effects management challenges, as well as the need to consider the feedbacks and interactions between multi-scale processes.

Methods for measuring, enhancing, and accounting for medication adherence in clinical trials.

PubMed

Vrijens, B; Urquhart, J

2014-06-01

Adherence to rationally prescribed medications is essential for effective pharmacotherapy. However, widely variable adherence to protocol-specified dosing regimens is prevalent among participants in ambulatory drug trials, mostly manifested in the form of underdosing. Drug actions are inherently dose and time dependent, and as a result, variable underdosing diminishes the actions of trial medications by various degrees. The ensuing combination of increased variability and decreased magnitude of trial drug actions reduces statistical power to discern between-group differences in drug actions. Variable underdosing has many adverse consequences, some of which can be mitigated by the combination of reliable measurements of ambulatory patients' adherence to trial and nontrial medications, measurement-guided management of adherence, statistically and pharmacometrically sound analyses, and modifications in trial design. Although nonadherence is prevalent across all therapeutic areas in which the patients are responsible for treatment administration, the significance of the adverse consequences depends on the characteristics of both the disease and the medications.

Public health decisions: Actions and consequences☆

PubMed Central

Pohl, H.R.; Jones, D.E.; Holler, J.S.; Murray, H.E.

2017-01-01

The goal of public health is to promote the best possible health for the whole population. Public health issues are numerous and can be unbelievably complex in form, scope, and possible consequence. Most public health decisions involve assessing several different options, weighing the respective benefits and risks of those options, and making difficult decisions that hopefully provide the greatest benefit to the affected populations. Many risk management decisions involve a variety of societal factors which modify risk assessment choices. The purpose of this paper is to point out difficulties in making decisions that impact public health. The intent of such decisions is to improve public health, but as illustrated in the paper, there can be unintended adverse consequences. Such unplanned issues require continued attention and efforts for responsible officials in the protection of environmental public health. This article presents examples of such events, when in the past, it was necessary to assess and regulate a number of potentially hazardous chemicals commonly used as insecticides, gasoline additives, and wood preservatives. PMID:25092130

Resilience Metrics for the Electric Power System: A Performance-Based Approach.

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

Vugrin, Eric D.; Castillo, Andrea R; Silva-Monroy, Cesar Augusto

Grid resilience is a concept related to a power system's ability to continue operating and delivering power even in the event that low probability, high-consequence disruptions such as hurricanes, earthquakes, and cyber-attacks occur. Grid resilience objectives focus on managing and, ideally, minimizing potential consequences that occur as a result of these disruptions. Currently, no formal grid resilience definitions, metrics, or analysis methods have been universally accepted. This document describes an effort to develop and describe grid resilience metrics and analysis methods. The metrics and methods described herein extend upon the Resilience Analysis Process (RAP) developed by Watson et al. formore » the 2015 Quadrennial Energy Review. The extension allows for both outputs from system models and for historical data to serve as the basis for creating grid resilience metrics and informing grid resilience planning and response decision-making. This document describes the grid resilience metrics and analysis methods. Demonstration of the metrics and methods is shown through a set of illustrative use cases.« less

Photosynthetic variation and responsiveness to CO2 in a widespread riparian tree

PubMed Central

Quentin, Audrey; Ivković, Milos; Furbank, Robert T.; Pinkard, Elizabeth

2018-01-01

Phenotypic responses to rising CO2 will have consequences for the productivity and management of the world’s forests. This has been demonstrated through extensive free air and controlled environment CO2 enrichment studies. However intraspecific variation in plasticity remains poorly characterised in trees, with the capacity to produce unexpected trends in response to CO2 across a species distribution. Here we examined variation in photosynthesis traits across 43 provenances of a widespread, genetically diverse eucalypt, E. camaldulensis, under ambient and elevated CO2 conditions. Genetic variation suggestive of local adaptation was identified for some traits under ambient conditions. Evidence of genotype by CO2 interaction in responsiveness was limited, however support was identified for quantum yield (φ). In this case local adaptation was invoked to explain trends in provenance variation in response. The results suggest potential for genetic variation to influence a limited set of photosynthetic responses to rising CO2 in seedlings of E. camaldulensis, however further assessment in mature stage plants in linkage with growth and fitness traits is needed to understand whether trends in φ could have broader implications for productivity of red gum forests. PMID:29293528

Photosynthetic variation and responsiveness to CO2 in a widespread riparian tree.

PubMed

Dillon, Shannon; Quentin, Audrey; Ivković, Milos; Furbank, Robert T; Pinkard, Elizabeth

2018-01-01

Phenotypic responses to rising CO2 will have consequences for the productivity and management of the world's forests. This has been demonstrated through extensive free air and controlled environment CO2 enrichment studies. However intraspecific variation in plasticity remains poorly characterised in trees, with the capacity to produce unexpected trends in response to CO2 across a species distribution. Here we examined variation in photosynthesis traits across 43 provenances of a widespread, genetically diverse eucalypt, E. camaldulensis, under ambient and elevated CO2 conditions. Genetic variation suggestive of local adaptation was identified for some traits under ambient conditions. Evidence of genotype by CO2 interaction in responsiveness was limited, however support was identified for quantum yield (φ). In this case local adaptation was invoked to explain trends in provenance variation in response. The results suggest potential for genetic variation to influence a limited set of photosynthetic responses to rising CO2 in seedlings of E. camaldulensis, however further assessment in mature stage plants in linkage with growth and fitness traits is needed to understand whether trends in φ could have broader implications for productivity of red gum forests.

Airport Managers' Perspectives on Security and Safety Management Systems in Aviation Operations: A Multiple Case Study

NASA Astrophysics Data System (ADS)

Brown, Willie L., Jr.

Global terrorism continues to persist despite the great efforts of various countries to protect and safely secure their citizens. As airports form the entry and exit ports of a country, they are one of the most vulnerable locations to terror attacks. Managers of international airports constantly face similar challenges in developing and implementing airport security protocols. Consequently, the technological advances of today have brought both positive and negative impacts on security and terrorism of airports, which are mostly managed by the airport managers. The roles of the managers have greatly increased over the years due to technological advances. The developments in technology have had different roles in security, both in countering terrorism and, at the same time, increasing the communication methods of the terrorists. The purpose of this qualitative multiple case study was to investigate the perspectives of airport managers with regard to societal security and social interactions in the socio-technical systems of the National Terrorism Advisory System (NTAS). Through the data gained regarding managers' perception and experiences, the researcher hoped to enable the development of security measures and policies that are appropriate for airports as socio-technical systems. The researcher conducted interviews with airport managers to gather relevant data to fulfill the rationale of the study. Ten to twelve airport managers based in three commercial aviation airports in Maryland, United States participated in the study. The researcher used a qualitative thematic analysis procedure to analyze the data responses of participants in the interview sessions.

Psychosocial consequences of allocation to lung cancer screening: a randomised controlled trial

PubMed Central

Aggestrup, Louise Mosborg; Hestbech, Mie Sara; Siersma, Volkert; Pedersen, Jesper Holst

2012-01-01

Objective To examine the psychosocial consequences of being allocated to the control group as compared with the screen group in a randomised lung cancer screening trial. Method The Danish Lung Cancer Screening Trial, a randomised controlled trial, ran from 2004 to 2010 with the purpose of investigating the benefits and harms of lung cancer screening. The participants in Danish Lung Cancer Screening Trial were randomised to either the control group or the screen group and were asked to complete the questionnaires Consequences Of Screening and Consequences Of Screening in Lung Cancer (COS-LC). The Consequences Of Screening and the COS-LC were used to examine the psychosocial consequences of participating in the study, by comparing the control and the screen groups' responses at the prevalence and at the incidence round. Results There was no statistically significant difference in socio-demographic characteristics or smoking habits between the two groups. Responses to the COS-LC collected before the incidence round were statistically significantly different on the scales ‘anxiety’, ‘behaviour’, ‘dejection’, ‘self-blame’, ‘focus on airway symptoms’ and ‘introvert’, with the control group reporting higher negative psychosocial consequences. Furthermore, the participants in both the control and the screen groups exhibited a mean increase in negative psychosocial consequences when their responses from the prevalence round were compared with their responses from the first incidence round. Conclusions Participation in a randomised controlled trial on lung cancer screening has negative psychosocial consequences for the apparently healthy participants—both the participants in the screen group and the control group. This negative impact was greatest for the control group. PMID:22382119

Conceptual Model of Weight Management in Overweight and Obese African-American Females.

PubMed

Sutton, Suzanne M; Magwood, Gayenell S; Nemeth, Lynne S; Jenkins, Carolyn M

2017-04-01

Weight management of overweight and obese (OWO) African-American females (AAFs) is a poorly defined concept, leading to ineffective treatment of overweight and obesity, prevention of health sequelae, and risk reduction. A conceptual model of the phenomenon of weight management in OWO AAFs was developed through dimensional analysis of the literature. Constructs were identified and sorted into the dimensions of perspective, context, conditions, process, and consequences and integrated into an explanatory matrix. Through dimensional analysis, weight management in OWO AAFs was characterized as a multidimensional concept, defined from the perspective of weight loss in community-dwelling AAFs. Behaviors associated with weight management are strongly influenced by intrinsic factors and extrinsic conditions, which influence engagement in the processes and consequences of weight management. The resulting conceptual model of weight management in OWO AAFs provides a framework for research interventions applicable in a variety of settings. © 2016 Wiley Periodicals, Inc.

Science for decision making: Transmitting hazard science using catastrophic scenarios

NASA Astrophysics Data System (ADS)

Wein, A.

2010-12-01

The ShakeOut and ARkStorm scenarios are scientifically-based, multi-disciplinary efforts to describe the damages and consequences of large, but plausible, natural disasters for use in emergency management and other planning. The ShakeOut earthquake scenario, completed in 2008, posits the occurrence of a major earthquake on the southern San Andreas Fault. It was used by more than 5,000 emergency personnel in a California statewide exercise, and it underpins the Federal Emergency Management Agency’s (FEMA) Catastrophic Plan for Southern California. The ARkStorm winter storm scenario, to be completed in 2010, posits the occurrence of a statewide disaster like the storm that occurred during 1861-1862. The ARkStorm scenario will culminate with two planning summits comprised of federal and state agencies, because such an event would exceed local response and recovery capabilities. This talk will address the following questions that are critical to transmitting science for decision making with examples and observations from the two scenarios: 1) Who are the end users of the scenarios, what types of decisions can scenarios inform, and how are stakeholders engaged? 2) What forms of information and processes work best to communicate and apply the hazard science? 3) What are the challenges of using science in decision making? 4) What future directions shall we pursue? From my perspective as coordinator of economic consequences analyses for the two scenarios, I will share insights to these questions. Framing stakeholder decisions in terms of scale (e.g., household to State) and disaster phase (e.g., emergency response, recovery, and mitigation) allows us to align methods of stakeholder engagement with stakeholder decision making. For these regional-scale scenarios, the methods of engagement included stakeholder participation in project vision, scenario construction workshops, presentations, conferences, and emergency response and recovery exercises. Champions (self-motivated individuals who took on leadership roles in their communities or industrial sectors), customized and localized analyses, and workshops enhanced the use of hazard science. Examples from the two scenarios will be used to illustrate these points. We experienced several significant challenges in using science to enhance emergency management exercises and community decision making. Some of these challenges include 1) adapting scientific results to exercise format; 2) the special needs of recovery exercises, which can mimic response exercises only with limited success, because recovery is tactical while response is strategic; 3) staff turnover; and 4) limited resources. An important future direction will be to leverage our in-depth knowledge of scenarios, multi-disciplinary network, and stakeholder relations to integrate knowledge about multiple hazards to better inform risk-based decision making for all hazards.

[Disagreements between GP trainees and their seniors. Management and impacts on the hidden curriculum. Qualitative study of 37 situations in Paris].

PubMed

Galam, Éric; Multon, Romain

2016-03-01

Disagreements and conflicts have a negative impact on the satisfaction and the performances of working team members. Young doctors in training are part of the health care team. The management of the disagreements with which they are confronted is a part of their professionalization process. To clarify and analyze the disagreements between GP trainees and their seniors in patients care and their consequences in doctor curriculum. Qualitative descriptive study. Five focus groups including a total of 25 Parisian trainees were performed to explore situations of disagreements with their seniors about patients care. Phenomenical analysis was performed by two researchers. Thirty-seven situations were reported. A number of potential sources of conflicts were highlighted. Factors that can transform a disagreement into an insoluble conflict were identified. The consequences of these disagreements on the quality of care and their impact on the empowerment of trainees were analysed. Number of disagreements related patients facing end of life. Specificities of emergency contexts and ambulatory practice were underlined. The role of the hierarchical link in the genesis and the development of the conflicts was confirmed. The personality of the trainee, his conception of responsibility, the exchange of knowledge, the "commercial" aspects of doctors practice can be at the origin of conflicts. The disagreements can play a positive role in trainees empowerment. A training in the management of anticipated or known conflicts can usefully clarify and optimize the hidden curriculum of the medical students towards professionalism. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Improving blood safety: errors management in transfusion medicine].

PubMed

Bujandrić, Nevenka; Grujić, Jasmina; Krga-Milanović, Mirjana

2014-01-01

The concept of blood safety includes the entire transfusion chain starting with the collection of blood from the blood donor, and ending with blood transfusion to the patient. The concept involves quality management system as the systematic monitoring of adverse reactions and incidents regarding the blood donor or patient. Monitoring of near-miss errors show the critical points in the working process and increase transfusion safety. The aim of the study was to present the analysis results of adverse and unexpected events in transfusion practice with a potential risk to the health of blood donors and patients. One-year retrospective study was based on the collection, analysis and interpretation of written reports on medical errors in the Blood Transfusion Institute of Vojvodina. Errors were distributed according to the type, frequency and part of the working process where they occurred. Possible causes and corrective actions were described for each error. The study showed that there were not errors with potential health consequences for the blood donor/patient. Errors with potentially damaging consequences for patients were detected throughout the entire transfusion chain. Most of the errors were identified in the preanalytical phase. The human factor was responsible for the largest number of errors. Error reporting system has an important role in the error management and the reduction of transfusion-related risk of adverse events and incidents. The ongoing analysis reveals the strengths and weaknesses of the entire process and indicates the necessary changes. Errors in transfusion medicine can be avoided in a large percentage and prevention is cost-effective, systematic and applicable.

Diagnosis of nutrient imbalances with vector analysis in agroforestry systems.

PubMed

Isaac, Marney E; Kimaro, Anthony A

2011-01-01

Agricultural intensification has had unintended environmental consequences, including increased nutrient leaching and surface runoff and other agrarian-derived pollutants. Improved diagnosis of on-farm nutrient dynamics will have the advantage of increasing yields and will diminish financial and environmental costs. To achieve this, a management support system that allows for site-specific rapid evaluation of nutrient production imbalances and subsequent management prescriptions is needed for agroecological design. Vector diagnosis, a bivariate model to depict changes in yield and nutritional response simultaneously in a single graph, facilitates identification of nutritional status such as growth dilution, deficiency, sufficiency, luxury uptake, and toxicity. Quantitative data from cocoa agroforestry systems and pigeonpea intercropping trials in Ghana and Tanzania, respectively, were re-evaluated with vector analysis. Relative to monoculture, biomass increase in cocoa ( L.) under shade (35-80%) was accompanied by a 17 to 25% decline in P concentration, the most limiting nutrient on this site. Similarly, increasing biomass with declining P concentrations was noted for pigeonpea [ (L). Millsp.] in response to soil moisture availability under intercropping. Although vector analysis depicted nutrient responses, the current vector model does not consider non-nutrient resource effects on growth, such as ameliorated light and soil moisture, which were particularly active in these systems. We revisit and develop vector analysis into a framework for diagnosing nutrient and non-nutrient interactions in agroforestry systems. Such a diagnostic technique advances management decision-making by increasing nutrient precision and reducing environmental issues associated with agrarian-derived soil contamination. American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.

Helping Dementia Caregivers Manage Medical Problems: Benefits of an Educational Resource.

PubMed

Zimmerman, Sheryl; Sloane, Philip D; Ward, Kimberly; Beeber, Anna; Reed, David; Lathren, Christine; Matchar, Bobbi; Gwyther, Lisa

2018-05-01

Family caregivers of people with dementia must attend to medical care needs of their relative, yet few available resources address comorbidities in dementia. Consequently, caregivers feel ill-equipped when medical concerns arise. In response, an educational resource-Alzheimer's Medical Advisor ( AlzMed)-was developed in 2 forms (website and book) and evaluated. Family caregivers (143 website and 51 book) used an educational resource that provides information on medical problems, vital signs, pain, dehydration, and the healthcare system. Data were collected at baseline, 3 months, and 6 months regarding confidence in sign/symptom management, burden, depression, and anxiety. Caregivers reported significantly improved confidence and (for website users) decreased role strain. Anxiety and depression also decreased, although not significantly. Improved confidence related to a reduction in role strain and anxiety, and care recipients did not experience adverse events. An educational resource focusing on care of comorbid illness may benefit caregiver outcomes.

The collapse of pelagic fishes in the upper San Francisco estuary

USGS Publications Warehouse

Sommer, T.; Armor, C.; Baxter, R.; Breuer, R.; Brown, L.; Chotkowski, M.; Culberson, S.; Feyrer, F.; Gingras, M.; Herbold, B.; Kimmerer, W.; Mueller-Solger, A.; Nobriga, M.; Souza, K.

2007-01-01

Although the pelagic fish community of the upper San Francisco Estuary historically has shown substantial variability, a recent collapse has captured the attention of resource managers, scientists, legislators, and the general public. The ecological and management consequences of the decline are most serious for delta smelt (Hypomesus transpacificus), a threatened species whose narrow range overlaps with large water diversions that supply water to over 25 million people. The decline occurred despite recent moderate hydrology, which typically results in at least modest recruitment, and investments of hundreds of millions of dollars in habitat restoration and environmental water allocations to support native fishes. In response to the pelagic fish collapse, an ambitious multi-agency research team has been working since 2005 to evaluate the causes of the decline, which likely include a combination of factors: stock-recruitment effects, a decline in habitat quality, increased mortality rates, and reduced food availability due to invasive species.

Institutions of care, moral proximity and demoralisation: The case of the emergency department

PubMed Central

Hillman, Alexandra

2016-01-01

This article draws on concepts of morality and demoralisation to understand the problematic nature of relationships between staff and patients in public health services. The article uses data from a case study of a UK hospital Emergency Department to show how staff are tasked with the responsibility of treating and caring for patients, while at the same time their actions are shaped by the institutional concerns of accountability and resource management. The data extracts illustrate how such competing agendas create a tension for staff to manage and suggests that, as a consequence of this tension, staff participate in processes of ‘effacement' that limit the presence of patients and families as a moral demand. The analysis from the Emergency Department case study suggests that demoralisation is an increasingly important lens through which to understand health-care institutions, where contemporary organisational cultures challenge the ethical quality of human interaction. PMID:26823656

Impact of public health emergencies on modern disaster taxonomy, planning, and response.

PubMed

Burkle, Frederick M; Greenough, P Gregg

2008-10-01

Current disaster taxonomy describes diversity, distinguishing characteristics, and common relations in disaster event classifications. The impact of compromised public health infrastructure and systems on health consequences defines and greatly influences the manner in which disasters are observed, planned for, and managed, especially those that are geographically widespread, population dense, and prolonged. What may first result in direct injuries and death may rapidly change to excess indirect illness and subsequent death as essential public health resources are destroyed, deteriorate, or are systematically denied to vulnerable populations. Public health and public health infrastructure and systems in developed and developing countries must be seen as strategic and security issues that deserve international public health resource monitoring attention from disaster managers, urban planners, the global humanitarian community, World Health Organization authorities, and participating parties to war and conflict. We posit here that disaster frameworks be reformed to emphasize and clarify the relation of public health emergencies and modern disasters.

OVERSEER: An Expert System Monitor for the Psychiatric Hospital

PubMed Central

Bronzino, Joseph D.; Morelli, Ralph A.; Goethe, John W.

1988-01-01

In order to improve patient care, comply with regulatory guidelines and decrease potential liability, psychiatric hospitals and clinics have been searching for computer systems to monitor the management and treatment of patients. This paper describes OVERSEER: a knowledge based system that monitors the treatment of psychiatric patients in real time. Based on procedures and protocols developed in the psychiatric setting, OVERSEER monitors the clinical database and issues alerts when standard clinical practices are not followed or when laboratory results or other clinical indicators are abnormal. Written in PROLOG, OVERSEER is designed to interface directly with the hospital's database, and, thereby utilizes all available pharmacy and laboratory data. Moreover, unlike the interactive expert systems developed for the psychiatric clinic, OVERSEER does not require extensive data entry by the clinician. Consequently, the chief benefit of OVERSEER's monitoring approach is the unobtrusive manner in which it evaluates treatment and patient responses and provides information regarding patient management.

Historical evolution of human anthrax from occupational disease to potentially global threat as bioweapon.

PubMed

D'Amelio, Enrico; Gentile, Bernardina; Lista, Florigio; D'Amelio, Raffaele

2015-12-01

Anthrax is caused by Bacillus anthracis, which can naturally infect livestock, wildlife and occupationally exposed humans. However, for its resistance due to spore formation, ease of dissemination, persistence in the environment and high virulence, B. anthracis has been considered the most serious bioterrorism agent for a long time. During the last century anthrax evolved from limited natural disease to potentially global threat if used as bioweapon. Several factors may mitigate the consequences of an anthrax attack, including 1. the capability to promptly recognize and manage the illness and its public health consequences; 2. the limitation of secondary contamination risk through an appropriate decontamination; and 3. the evolution of genotyping methods (for microbes characterization at high resolution level) that can influence the course and/or focus of investigations, impacting the response of the government to an attack. A PubMed search has been done using the key words “bioterrorism anthrax”. Over one thousand papers have been screened and the most significant examined to present a comprehensive literature review in order to discuss the current knowledge and strategies in preparedness for a possible deliberate release of B. anthracis spores and to indicate the most current and complete documents in which to deepen. The comprehensive analysis of the two most relevant unnatural anthrax release events, Sverdlovsk in the former Soviet Union (1979) and the contaminated letters in the USA (2001), shows that inhalational anthrax may easily and cheaply be spread resulting in serious consequences. The damage caused by an anthrax attack can be limited if public health organization, first responders, researchers and investigators will be able to promptly manage anthrax cases and use new technologies for decontamination methods and in forensic microbiology.

Improving parent-child interactions for families of children with developmental disabilities.

PubMed

Harrold, M; Lutzker, J R; Campbell, R V; Touchette, P E

1992-06-01

Child Management Training (CMT) involves compliance training with a focus on consistent use of antecedents and consequences. Planned Activities Training (PAT) focuses on teaching parents to plan for and engage in activities with their children. A multiple probe design counterbalancing PAT and CMT showed that PAT and CMT were about equally effective in improving mother-child interactions in four families with children with developmental disabilities. Responses to a social validation questionnaire indicated that parents were satisfied with the services received, and that PAT was the slightly preferred treatment. Prior research demonstrated that PAT enhanced the results of CMT. The practical advantages of PAT over CMT are discussed.

Are the psychosocial aspects of weapons of mass destruction incidents addressed in the Federal Response Plan: summary of an expert panel.

PubMed

Becker, S M

2001-12-01

Within the domestic preparedness community, there is a growing recognition of the importance of psychosocial issues in weapons of mass destruction (WMD) incidents. Whereas social and behavioral issues were only infrequently considered just a few years ago, they are now coming to be seen as central to consequence management efforts. As a result, discussions in the domestic preparedness community are beginning to consider the extent to which psychosocial effects are addressed in the Federal Response Plan and the degree to which additional preparedness and response steps may be needed. To grapple with this crucial issue, an expert panel was brought together at the International Conference on the Operational Impact of Psychological Casualties from Weapons of Mass Destruction. The panel brought together a wide range of specialists from federal agencies, the armed services, and the academic community. This article summarizes the views and assessments of the panelists as well as their policy recommendations for enhancing preparedness.

Cascading disasters in the huge coastal aquifer of Salento (Apulia region, Southern Italy) ensuing droughts

NASA Astrophysics Data System (ADS)

Parisi, Alessandro; Fidelibus, Maria Dolores

2017-04-01

Physical extremes can be distinguished in "sudden physical extremes" (e.g. earthquakes, tsunami) and "progressive physical extremes" (e.g. drought, desertification, landslides). They differ for frequency, intensity, spatial extent, duration and timing of occurrence. If a physical extreme, by interacting with human systems, induces negative consequences, its outcome can be a "disaster". The disasters are, in both above cases, characterized by a few phases: physical extreme occurrence, emergency, response, and recovery. However, in the case of a progressive physical extreme, the disaster develops with an overlap in the time of the above-mentioned phases. When the events are repetitive, the emergency planning (which follows a cycle) succeeds with preparedness and mitigation with the intent of reducing the risk. Both the sudden and progressive physical extremes produce cascading effects of consequences on social, environmental and economic systems. Disasters consequent to sudden and progressive extremes show, however, some differences, mainly attributable to the "visibility" of the effects and to their time scale of evolution. As matter of fact, a disaster consequent to a progressive physical extreme produces "emerging signals" that are often invisible. Moreover, the emergency phase can arise with a time delay compared to the occurrence of the physical extreme, depending on the spatial scale of impacted system. The above differences allow defining "creeping disasters" the potential disasters related to progressive physical extremes. This study deals with some peculiar "cascading disasters" consequent to drought, which is the main "creeping disaster", namely the groundwater drought and the consequent salinization of coastal aquifers. In regional flow systems, their effects are invisible in the immediate to common people (and often even to managers) because of the concealed nature of groundwater; moreover, they are difficult to assess because of the shift over time of their evolution compared to the promptness of surface effects. The study area is the Salento coastal karstic aquifer (Apulia region, Southern Italy), where the groundwater flows according to a regional flow system. It has been subject to successive meteorological droughts between 1960 and 2010. The groundwater monitoring performed during this period, even with some gaps, allows identifying time lags between superficial effects and underground system response, potential tipping points, and emerging signals of the cascading disasters.

A narrative method for analyzing transitions in urban water management: The case of the Miami-Dade Water and Sewer Department

NASA Astrophysics Data System (ADS)

Treuer, Galen; Koebele, Elizabeth; Deslatte, Aaron; Ernst, Kathleen; Garcia, Margaret; Manago, Kim

2017-01-01

Although the water management sector is often characterized as resistant to risk and change, urban areas across the United States are increasingly interested in creating opportunities to transition toward more sustainable water management practices. These transitions are complex and difficult to predict - the product of water managers acting in response to numerous biophysical, regulatory, political, and financial factors within institutional constraints. Gaining a better understanding of how these transitions occur is crucial for continuing to improve water management. This paper presents a replicable methodology for analyzing how urban water utilities transition toward sustainability. The method combines standardized quantitative measures of variables that influence transitions with contextual qualitative information about a utility's unique decision making context to produce structured, data-driven narratives. Data-narratives document the broader context, the utility's pretransition history, key events during an accelerated period of change, and the consequences of transition. Eventually, these narratives should be compared across cases to develop empirically-testable hypotheses about the drivers of and barriers to utility-level urban water management transition. The methodology is illustrated through the case of the Miami-Dade Water and Sewer Department (WASD) in Miami-Dade County, Florida, and its transition toward more sustainable water management in the 2000s, during which per capita water use declined, conservation measures were enacted, water rates increased, and climate adaptive planning became the new norm.

Patient participation during and after a self-management programme in primary healthcare - The experience of patients with chronic obstructive pulmonary disease or chronic heart failure.

PubMed

Luhr, Kristina; Holmefur, Marie; Theander, Kersti; Eldh, Ann Catrine

2018-06-01

Patient participation is facilitated by patients' ability to take responsibility for and engage in health issues. Yet, there is limited research as to the promotion of these aspects of patient participation in long-term healthcare interactions. This paper describes patient participation as experienced by patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF); the aim was to describe if and how a self-management programme in primary healthcare influenced patient participation. Patients who had participated in a self-management programme were interviewed in nine focus groups (36 patients). Data was analysed using qualitative content analysis. Patients described equality in personal interactions, opportunities to share and discuss, and a willingness to share and learn to facilitate patient participation in a self-management programme. Consequently, patient participation was promoted by a match between the individuals' personal traits and the context. Features facilitating patient participation by means of sharing and assimilating knowledge and insights should be included in self-management programmes and in the care for patients with COPD and CHF. A self-management programme can complement regular primary care regarding enhanced understanding of one's disease and support patient participation and the patient's own resources in self-management. Copyright © 2018 Elsevier B.V. All rights reserved.

Management of long term sickness absence: a systematic realist review.

PubMed

Higgins, Angela; O'Halloran, Peter; Porter, Sam

2012-09-01

The increasing impact and costs of long term sickness absence have been well documented. However, the diversity and complexity of interventions and of the contexts in which these take place makes a traditional review problematic. Therefore, we undertook a systematic realist review to identify the dominant programme theories underlying best practice, to assess the evidence for these theories, and to throw light on important enabling or disabling contextual factors. A search of the scholarly literature from 1950 to 2011 identified 5,576 articles, of which 269 formed the basis of the review. We found that the dominant programme theories in relation to effective management related to: early intervention or referral by employers; having proactive organisational procedures; good communication and cooperation between stakeholders; and workplace-based occupational rehabilitation. Significant contextual factors were identified as the level of support for interventions from top management, the size and structure of the organisation, the level of financial and organisational investment in the management of long-term sickness absence, and the quality of relationships between managers and staff. Consequently, those with responsibility for managing absence should bear in mind the contextual factors that are likely to have an impact on interventions, and do what they can to ensure stakeholders have at least a mutual understanding (if not a common purpose) in relation to their perceptions of interventions, goals, culture and practice in the management of long term sickness absence.

Threshold Responses of Forest Birds to Landscape Changes around Exurban Development

PubMed Central

Suarez-Rubio, Marcela; Wilson, Scott; Leimgruber, Peter; Lookingbill, Todd

2013-01-01

Low-density residential development (i.e., exurban development) is often embedded within a matrix of protected areas and natural amenities, raising concern about its ecological consequences. Forest-dependent species are particularly susceptible to human settlement even at low housing densities typical of exurban areas. However, few studies have examined the response of forest birds to this increasingly common form of land conversion. The aim of this study was to assess whether, how, and at what scale forest birds respond to changes in habitat due to exurban growth. We evaluated changes in habitat composition (amount) and configuration (arrangement) for forest and forest-edge species around North America Breeding Bird Survey (BBS) stops between 1986 and 2009. We used Threshold Indicator Taxa Analysis to detect change points in species occurrence at two spatial extents (400-m and 1-km radius buffer). Our results show that exurban development reduced forest cover and increased habitat fragmentation around BBS stops. Forest birds responded nonlinearly to most measures of habitat loss and fragmentation at both the local and landscape extents. However, the strength and even direction of the response changed with the extent for several of the metrics. The majority of forest birds’ responses could be predicted by their habitat preferences indicating that management practices in exurban areas might target the maintenance of forested habitats, for example through easements or more focused management for birds within existing or new protected areas. PMID:23826325

Justification for a Nuclear Global Health Workforce: multidisciplinary analysis of risk, survivability & preparedness, with emphasis on the triage management of thermal burns.

PubMed

Burkle, Frederick M; Potokar, Tom; Gosney, James E; Dallas, Cham

2017-01-01

Major challenges and crises in global health will not be solved by health alone; requiring rather a multidisciplinary, evidence-based analytical approach to prevention, preparedness and response. One such potential crisis is the continued spread of nuclear weapons to more nations concurrent with the increased volatility of international relations that has significantly escalated the risk of a major nuclear weapon exchange. This study argues for the development of a multidisciplinary global health response agenda based on the reality of the current political analysis of nuclear risk, research evidence suggesting higher-than-expected survivability risk, and the potential for improved health outcomes based on medical advances. To date, the medical consequences of such an exchange are not credibly addressed by any nation at this time, despite recent advances. While no one country could mount such a response, an international body of responders organized in the same fashion as the current World Health Organization's global health workforce initiative for large-scale natural and public health emergencies could enlist and train for just such an emergency. A Nuclear Global Health Workforce is described for addressing the unprecedented medical and public health needs to be expected in the event of a nuclear conflict or catastrophic accident. The example of addressing mass casualty nuclear thermal burns outlines the potential triage and clinical response management of survivors enabled by this global approach.

A protocol for coordinating post-tsunami field reconnaissance efforts in the USA

USGS Publications Warehouse

Wilson, Rick I.; Wood, Nathan J.; Kong, Laura; Shulters, Michael V.; Richards, Kevin D.; Dunbar, Paula; Tamura, Gen; Young, Edward J.

2015-01-01

In the aftermath of a catastrophic tsunami, much is to be learned about tsunami generation and propagation, landscape and ecological changes, and the response and recovery of those affected by the disaster. Knowledge of the impacted area directly helps response and relief personnel in their efforts to reach and care for survivors and for re-establishing community services. First-hand accounts of tsunami-related impacts and consequences also help researchers, practitioners, and policy makers in other parts of the world that lack recent events to better understand and manage their own societal risks posed by tsunami threats. Conducting post-tsunami surveys and disseminating useful results to decision makers in an effective, efficient, and timely manner is difficult given the logistical issues and competing demands in a post-disaster environment. To facilitate better coordination of field-data collection and dissemination of results, a protocol for coordinating post-tsunami science surveys was developed by a multi-disciplinary group of representatives from state and federal agencies in the USA. This protocol is being incorporated into local, state, and federal post-tsunami response planning through the efforts of the Pacific Risk Management ‘Ohana, the U.S. National Tsunami Hazard Mitigation Program, and the U.S. National Plan for Disaster Impact Assessments. Although the protocol was designed to support a coordinated US post-tsunami response, we believe it could help inform post-disaster science surveys conducted elsewhere and further the discussion on how hazard researchers can most effectively operate in disaster environments.

[Drug shortage: determinants, consequences and management].

PubMed

Reis, Adriano Max Moreira; Perini, Edson

2008-04-01

The present study analyzes drug shortage as a problem reaching beyond the logistic aspect of the health field and discusses its consequences with respect to quality, safety and cost of health care delivery. The pharmaceutical supply chain and the factors that determine the distribution and availability of drugs are discussed. The contribution of the Pharmacy and Therapeutics Committee in preventing and managing drug shortage in health institutions is stressed and measures for drug shortage management are suggested. Finally it is emphasized that drugs should be considered health products rather than consumer goods and as such be given a different treatment by the supply chain.

Dietitians in South Africa require more competencies in public health nutrition and management to address the nutritional needs of South Africans.

PubMed

Parker, Whadiah; Steyn, Nelia P; Mchiza, Zandile; Nthangeni, Gladys; Mbhenyane, Xikombiso; Dannhauser, Andre; Moeng, Lynn; Wentzel-Viljoen, Edelweiss

2013-01-01

The aim of this study was to determine whether dietitians in South Africa are competent to meet the requirements of working in a health care setting during a compulsory one-year community service (CS) program immediately after receiving their degree. A national survey was conducted using questionnaires to illicit information from dietitians on their training and competencies. In 2009, data were collected from both community service dietitians (CSDs) participating in community service programs in primary, secondary and tertiary health care centers in all provinces of South Africa, as well as from their provincial managers (nutrition coordinators). Sixteen (100% response) nutrition coordinators and 134 (80% response) dietitians participated in the quantitative survey. The majority of the CSDs reported that, overall, their academic training had prepared them for most aspects of nutrition service delivery. However, some recommended that academic programs include more training on community-based nutrition programs and in delivering optimal services to under-resourced communities as they believed that their competencies in these two areas were weakest. Furthermore, many CSDs were required to establish dietetics departments where none had previously existed; consequently, their capacity in management and administration needed improvement. In conclusion, academic training institutions should align their programs to the transformation of the health sector in South Africa by ensuring that dietitians are empowered to provide optimal public health nutrition services in under-resourced communities.

An exploratory investigation of the translation of Pacific Northwest Laboratory's print manuals system to an on-line manuals system

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

Heubach, J.G.; Hunt, S.T.; Pond, L.R.

1992-06-01

Information management technology has proliferated in the past decade in response to the information explosion. As documentation accumulates, the need to access information residing in manuals, handbooks and regulations conveniently, accurately, and quickly has increased. However, studies show that only fractions of the available information is read (Martin, 1978). Consequently, one of the biggest challenges in linking information and electronic management of information is to use the power of communication technology to meet the information needs of the audience. Pacific Northwest Laboratories' (PNL) investigation of translating its print manual system to an on-line system fits this challenge precisely. PNL's manualsmore » contain a tremendous amount of information for which manual holders are responsible. To perform their tasks in compliance with policy and procedure guidelines, users need to access information accurately, conveniently, and quickly. In order to select and use information management tools wisely, answers must be sought to a few basic questions. Communication experts cite four key questions: What do users want What do users need What characteristics of an on-line information system affect its usefulness Who are the users whose wants and needs are to be met Once these questions are answered, attention can be focused on finding the best match between user requirements and technology characteristics and weighing the costs and benefits of proposed options.« less

An exploratory investigation of the translation of Pacific Northwest Laboratory`s print manuals system to an on-line manuals system

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

Heubach, J.G.; Hunt, S.T.; Pond, L.R.

1992-06-01

Information management technology has proliferated in the past decade in response to the information explosion. As documentation accumulates, the need to access information residing in manuals, handbooks and regulations conveniently, accurately, and quickly has increased. However, studies show that only fractions of the available information is read (Martin, 1978). Consequently, one of the biggest challenges in linking information and electronic management of information is to use the power of communication technology to meet the information needs of the audience. Pacific Northwest Laboratories` (PNL) investigation of translating its print manual system to an on-line system fits this challenge precisely. PNL`s manualsmore » contain a tremendous amount of information for which manual holders are responsible. To perform their tasks in compliance with policy and procedure guidelines, users need to access information accurately, conveniently, and quickly. In order to select and use information management tools wisely, answers must be sought to a few basic questions. Communication experts cite four key questions: What do users want? What do users need? What characteristics of an on-line information system affect its usefulness? Who are the users whose wants and needs are to be met? Once these questions are answered, attention can be focused on finding the best match between user requirements and technology characteristics and weighing the costs and benefits of proposed options.« less

Nurses' requirements for relief and casualty support in disasters: a qualitative study.

PubMed

Nekooei Moghaddam, Mahmoud; Saeed, Sara; Khanjani, Narges; Arab, Mansour

2014-04-01

Nurses are among the most important groups engaged in casualty support, regardless of the cause, and they are one of the largest care groups involved in disasters. Consequently, these workers should gain proper support and skills to enable effective, timely, responsible and ethical emergency responses. In this study, we investigated the needs of nurses for proper casualty support in disasters, to facilitate better planning for disaster management. This was a qualitative content analysis study. Interviews were performed with 23 nurses, at educational hospitals and the Faculty of Nursing at Kerman Medical University, who had a minimum of five years working experience and assisted in an earthquake disaster. Intensity and snowball sampling were performed. Data was collected through semi-structured interviews. Interviews were transcribed and coded into main themes and subthemes. Four major themes emerged from the data; 1) psychological support, 2) appropriate clinical skills education, 3) appropriate disaster management, supervision and programming, and 4) the establishment of ready for action groups and emergency sites. The participants' comments highlighted the necessity of training nurses for special skills including emotion management, triage and crush syndrome, and to support nurses' families, provide security, and act according to predefined programs in disasters. There are a wide range of requirements for disaster aid. Proper aid worker selection, frequent and continuous administration of workshops and drills, and cooperation and alignment of different governmental and private organizations are among the suggested initiatives.

Obstetrical care and women's health in the aftermath of disasters: the first 14 days after the 2010 Haitian earthquake.

PubMed

Goodman, Annekathryn; Black, Lynn; Briggs, Susan

2014-01-01

Natural disasters disproportionately injure women and children. Disaster teams need intensive training in the management of obstetrics and women's healthcare at the disaster site. This article summarizes the obstetrical experience for the International Medical Surgical Response Team (IMSuRT) stationed at Gheskio in Port Au Prince during the first 2 weeks after the 2010 Haitian earthquake. The world's literature on the impact of disasters on women is reviewed. Sixty-three members of the IMSuRT and Disaster Medical Assistance Team set up a mobile surgical field hospital after the 2010 Haitian earthquake. One member (AG) managed all the obstetrical care and taught the other team members essentials of labor management and assessment in pregnancy. Six hundred patients were treated in the first 14 days. Ten percent of these patients were pregnant.There were 12 deliveries. All pregnant patients were evaluated by a Sonosite ultrasound device. Pregnant patients with earthquake-related injuries were treated for their injuries.Women in labor were managed by active management in labor. No cesarean sections were needed. Well-being of mother and babies. Sixty pregnant women presented to the mobile hospital for evaluation from January 17, 2010, through January 28, 2012. Twelve women in labor delivered healthy infants by vaginal delivery. Gestational ages ranges from 34 to 40 weeks. Active management of labor included the use of intravenous Pitocin, which was titrated to contractions. Duration of labor ranged from 2 to 12 hours. Three team members participated in each delivery. Two women were discharged on the same day as their deliveries. Eight women were discharged on the first postpartum day and two on the second postpartum day. Pregnant women suffered severe injuries. Additionally, pregnant women with pre-existing medical conditions were treated after the earthquake. Active management of labor allowed all women to deliver vaginally. The labor management required tremendous team resources to facilitate vaginal deliveries and avoid cesarean sections. Cesarean sections in an austere environment have the potential for devastating consequences such as sepsis, wound dehiscence, and the long-term risks of uterine rupture with subsequent pregnancies. Our experience highlights the need to include trained obstetrical providers on the first response team. Data from this article were included in the presentation, "An urgent need for women's health specialists in disaster response," at the Disaster Response Workshop, Annual Meeting Society Maternal Fetal Medicine, Dallas, 2012.

Developing A&E nursing responses to people who deliberately self-harm: the provision and evaluation of a series of reflective workshops.

PubMed

Holdsworth, N; Belshaw, D; Murray, S

2001-10-01

Accident & Emergency (A&E) departments and Medical Admission Units (MAUs) are an essential part of emergency mental health care in the UK. Deliberate self-harm and attempted suicide are particular challenges to nursing staff in such departments. Two registered mental nurses with experience of education facilitated a series of workshops with nurses from four A&E departments, two Minor Injuries Units and two MAUs. These were focused upon the assessment and management of deliberate self-harm and attempted suicide. During the workshops, participants provided systematic information on presentations of deliberate self-harm and attempted suicide, and on their professional responses to such presentations. These accounts provided invaluable information on deliberate self-harm and attempted suicide as seen by nursing staff in A&E and MAUs. Critical reflection upon nursing responses to these presentations revealed particular concerns nurses had relating to their experience with this client group which might inform future practice. Evaluation of the workshops indicated a subsequent decrease in work-related stress, which was probably a consequence of improved professional coping responses by the nurses concerned.

Emergent Archetype Hydrological-Biogeochemical Response Patterns in Heterogeneous Catchments

NASA Astrophysics Data System (ADS)

Jawitz, J. W.; Gall, H. E.; Rao, P.

2013-12-01

What can spatiotemporally integrated patterns observed in stream hydrologic and biogeochemical signals generated in response to transient hydro-climatic and anthropogenic forcing tell us about the interactions between spatially heterogeneous soil-mediated hydrological and biogeochemical processes? We seek to understand how the spatial structure of solute sources coupled with hydrologic responses affect observed concentration-discharge (C-Q) patterns. These patterns are expressions of the spatiotemporal structure of solute loads exported from managed catchments, and their likely ecological consequences manifested in receiving water bodies (e.g., wetlands, rivers, lakes, and coastal waters). We investigated the following broad questions: (1) How does the correlation between flow-generating areas and biogeochemical source areas across a catchment evolve under stochastic hydro-climatic forcing? (2) What are the feasible hydrologic and biogeochemical responses that lead to the emergence of the observed archetype C-Q patterns? and; (3) What implications do these coupled dynamics have for catchment monitoring and implementation of management practices? We categorize the observed temporal signals into three archetypical C-Q patterns: dilution; accretion, and constant concentration. We introduce a parsimonious stochastic model of heterogeneous catchments, which act as hydrologic and biogeochemical filters, to examine the relationship between spatial heterogeneity and temporal history of solute export signals. The core concept of the modeling framework is considering the types and degree of spatial correlation between solute source zones and flow generating zones, and activation of different portions of the catchments during rainfall events. Our overarching hypothesis is that each of the archetype C-Q patterns can be generated by explicitly linking landscape-scale hydrologic responses and spatial distributions of solute source properties within a catchment. The model simulations reproduce the three major C-Q patterns observed in published data, offering valuable insight into coupled catchment processes. The findings have important implications for effective catchment management for water quality improvement, and stream monitoring strategies.

Supported self-management for cancer survivors to address long-term biopsychosocial consequences of cancer and treatment to optimize living well.

PubMed

Howell, Doris D

2018-03-01

As individuals are living longer with cancer as a chronic disease, they face new health challenges that require the application of self-management behaviors and skills that may not be in their usual repertoire of self-regulatory health behaviors. Increasing attention is focused on supported self-management (SSM) programs to enable survivors in managing the long-term biopsychosocial consequences and health challenges of survivorship. This review explores current directions and evidence for SSM programs that enable survivors to manage these consequences and optimize health. Cancer survivors face complex health challenges that affect daily functioning and well being. Multiple systematic reviews show that SSM programs have positive effects on health outcomes in typical chronic diseases. However, the efficacy of these approaches in cancer survivors are in their infancy; and the 'one-size' fits all approach for chronic disease self-management may not be adequate for cancer as a complex chronic illness. This review suggests that SSM has promising potential for improving health and well being of cancer survivors, but there is a need for standardizing SSM for future research. Although there is increasing enthusiasm for SSM programs tailored to cancer survivors, there is a need for further research of their efficacy on long-term health outcomes.

Improved hydrological modeling using AGWA; incorporation of different management practices in hydrological modeling.

NASA Astrophysics Data System (ADS)

Vithanage, J.; Miller, S. N.; Paige, G. B.; Liu, T.

2017-12-01

We present a novel way to simulate the effects of rangeland management decisions in a GIS-based hydrologic modeling toolkit. We have implemented updates to the Automated Geospatial Watershed Assessment tool (AGWA) in which a landscape can be broken into management units (e.g., high intensity grazing, low intensity grazing, fire management, and unmanaged), each of which is assigned a different hydraulic conductivity (Ks) parameter in KINEmatic Runoff and EROSion model (KINEROS2). These updates are designed to provide modeling support to land managers tasked with rangeland watershed management planning and/or monitoring, and evaluation of water resources management. Changes to hydrologic processes and resulting hydrographs and sedigraphs are simulated within the AGWA framework. Case studies are presented in which a user selects various management scenarios and design storms, and the model identifies areas that become susceptible to change as a consequence of management decisions. The baseline (unmanaged) scenario is built using commonly available GIS data, after which the watershed is subdivided into management units. We used an array of design storms with various return periods and frequencies to evaluate the impact of management practices while changing the scale of watershed. Watershed parameters governing interception, infiltration, and surface runoff were determined with the aid of literature published on research studies carried out in the Walnut Gulch Experimental Watershed in southeast Arizona. We observed varied, but significant changes in hydrological responses (runoff) with different management practices as well with varied scales of watersheds. Results show that the toolkit can be used to quantify potential hydrologic change as a result of unitized land use decision-making.

Preparing public health nurses for pandemic influenza through distance learning.

PubMed

Macario, Everly; Benton, Lisa D; Yuen, Janet; Torres, Mara; Macias-Reynolds, Violet; Holsclaw, Patricia; Nakahara, Natalie; Jones, Marcy Connell

2007-01-01

As a global influenza pandemic appears imminent with the spread of avian influenza, the California Department of Health Services (CDHS) and the California Distance Learning Health Network (CDLHN) presented a live 90-min satellite broadcast and subsequent 2-hr small group problem-solving tabletop exercise to practice interventions needed to minimize the consequences of a pandemic event. Public health nurses (PHNs), managers, and other staff in laboratories, clinical care, veterinary medicine, environmental health, public information and safety, emergency management, and transportation down linked the program, broadcast by satellite from the CDHS Richmond Laboratory Campus, to view on-site locally. PHNs represented the professional category with the highest number of participants for those conducting the program outside of California. For those in California, PHNs represented the professional category with the second highest number of participants. Participants and distance-learning facilitators completed a training evaluation survey. Continuing education credits were provided by the Centers for Disease Control and Prevention to participants who completed the satellite broadcast evaluation. This distance-learning-by-satellite method of education paired with an activities-based tabletop exercise, and a focus on local rather than State-based responsibility, marks an innovative method of training PHNs and other staff in emergency preparedness response.

Bariatric Surgery and Precision Nutrition

PubMed Central

Nicoletti, Carolina F.; Cortes-Oliveira, Cristiana; Pinhel, Marcela A. S.; Nonino, Carla B.

2017-01-01

This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient’s genetic and epigenetic variables on the response to surgical weight loss treatment. We include investigations that demonstrate the association of single nucleotide polymorphisms with obesity phenotypes and their influence on weight loss after bariatric surgery. We also present reports on how significant weight loss induced by bariatric surgery impacts telomere length, and we discuss studies on the existence of an epigenetic signature associated with surgery outcomes and specific gene methylation profile, which may help to predict weight loss after a surgical procedure. Finally, we show articles which evidence that bariatric surgery may affect expression of numerous genes involved in different metabolic pathways and consequently induce functional and taxonomic changes in gut microbial communities. The role nutritional genomics plays in responses to weight loss after bariatric surgery is evident. Better understanding of the molecular pathways involved in this process is necessary for successful weight management and maintenance. PMID:28878180

Bariatric Surgery and Precision Nutrition.

PubMed

Nicoletti, Carolina F; Cortes-Oliveira, Cristiana; Pinhel, Marcela A S; Nonino, Carla B

2017-09-06

This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient's genetic and epigenetic variables on the response to surgical weight loss treatment. We include investigations that demonstrate the association of single nucleotide polymorphisms with obesity phenotypes and their influence on weight loss after bariatric surgery. We also present reports on how significant weight loss induced by bariatric surgery impacts telomere length, and we discuss studies on the existence of an epigenetic signature associated with surgery outcomes and specific gene methylation profile, which may help to predict weight loss after a surgical procedure. Finally, we show articles which evidence that bariatric surgery may affect expression of numerous genes involved in different metabolic pathways and consequently induce functional and taxonomic changes in gut microbial communities. The role nutritional genomics plays in responses to weight loss after bariatric surgery is evident. Better understanding of the molecular pathways involved in this process is necessary for successful weight management and maintenance.

Infants' Behaviors as Antecedents and Consequents of Mothers' Responsive and Directive Utterances

ERIC Educational Resources Information Center

Masur, Elise Frank; Flynn, Valerie; Lloyd, Carrie A.

2013-01-01

To investigate possible influences on and consequences of mothers' speech, specific infant behaviors preceding and following four pragmatic categories of mothers' utterances--responsive utterances, supportive behavioral directives, intrusive behavioral directives, and intrusive attentional directives--were examined longitudinally during dyadic…

Response and recovery measures for two floods in north China during the nineteenth century: a comparative study.

PubMed

Ye, Yu; Fang, Xiuqi; Li, Fan

2016-01-01

The process of human response to natural disasters and its mechanisms as revealed by historical events still has a broad significance for modern society. This study analyzed the disaster relief process and the social response for two floods in China: the Yongding River flood in 1801 and the Yellow River flood in 1841. These two floods reflect the different response processes between the national and provincial capitals during a stage of climate cooling and social transition in the Qing dynasty. Applying methods of historical documents analysis and qualitatively comparative analysis to the materials such as Relief Chronicles Authorized by the Emperor in XinYou and Flood Description in Bian Liang , it shows that: (1) In 1801, the central government took on a lead position, from flood surveying to relief processes. However, local government and gentries played an important role in 1841. (2) In 1801, the government successfully undertook a series of relief measures addressing production, housing, food prices, taxes, and water conservancy and administration. In 1841, the response measures were relatively simple, focusing mainly on providing shelter and food for victims. (3) The government carried out long-term disaster prevention measures such as dredging channels after the flood in 1801. In 1841, however, the efforts were focused mainly on emergency rescue. (4) Refugees in the 1801 flood were effectively managed by a centralized authority. In 1841, regulation of the flooding was delayed by corruption and conflicts between officers, leading to an expansion of the disaster's impact. Above results have led to the conclusion that disaster relief systems and response measures had a significant effect on the consequences of those floods. Various flood relief measures and natural disasters management regimes have implications for contemporary flood hazard mitigation.

Work-related stress management by Finnish enterprises.

PubMed

Kinnunen-Amoroso, Maritta; Liira, Juha

2014-01-01

Work-related stress has become one of the major problems in working societies and it increases employees' risk of disease. Its importance has been emphasized also due to its' great socio-economic consequences. Different stress management and worksite interventions have been implemented, however, the actual practices in companies have been assessed little. The purpose of this study was to examine how enterprises in Finland manage work-related stress. An assessment of work-related stress methods was conducted in 40 enterprises acting in the metropolitan area of Finland in May 2010 by a questionnaire. The concept of work-related stress was well known by participants. Enterprises rarely had their own work-related stress management protocol even though all of the workplaces had experienced work-related stress at some point. The collaboration between the workplace and occupational health services varied. Companies easily placed the responsibility for work-related stress assessment and handling on occupational health services. Workplaces have to pay more attention to work-related stress and related issues. The easiest way to do this is to collaborate with occupational health services. Protocols for collaboration should be developed jointly using the available models which have been established as cost-effective.

A Decision Support System for Concrete Bridge Maintenance

NASA Astrophysics Data System (ADS)

Rashidi, Maria; Lemass, Brett; Gibson, Peter

2010-05-01

The maintenance of bridges as a key element in transportation infrastructure has become a major concern for asset managers and society due to increasing traffic volumes, deterioration of existing bridges and well-publicised bridge failures. A pivotal responsibility for asset managers in charge of bridge remediation is to identify the risks and assess the consequences of remediation programs to ensure that the decisions are transparent and lead to the lowest predicted losses in recognized constraint areas. The ranking of bridge remediation treatments can be quantitatively assessed using a weighted constraint approach to structure the otherwise ill-structured phases of problem definition, conceptualization and embodiment [1]. This Decision Support System helps asset managers in making the best decision with regards to financial limitations and other dominant constraints imposed upon the problem at hand. The risk management framework in this paper deals with the development of a quantitative intelligent decision support system for bridge maintenance which has the ability to provide a source for consistent decisions through selecting appropriate remediation treatments based upon cost, service life, product durability/sustainability, client preferences, legal and environmental constraints. Model verification and validation through industry case studies is ongoing.

Identifying common pressure pathways from a complex network of human activities to support ecosystem-based management.

PubMed

Knights, Antony M; Koss, Rebecca S; Robinson, Leonie A

2013-06-01

The marine environment is heavily exploited, but unintentional consequences cause wide-ranging negative effects to its characteristics. Linkage frameworks (e.g., DPSIR [driver-pressure-state-impact-response]) are commonly used to describe an interaction between human activities and ecological characteristics of the ecosystem, but as each linkage is viewed independently, the diversity of pressures that affect those characteristics may not be identified or managed effectively. Here we demonstrate an approach for using linkages to build a simple network to capture the complex relationships arising from multiple sectors and their activities. Using data-analysis tools common to ecology, we show how linkages can be placed into mechanistically similar groups. Management measures can be combined into fewer and more simplified measures that target groups of pressures rather than individual pressures, which is likely to increase compliance and the success of the measure while reducing the cost of enforcement. Given that conservation objectives (regional priorities) can vary, we also demonstrate by way of a case study example from the Marine Strategy Framework Directive, how management priorities might change, and illustrate how the approach can be used to identify sectors for control that best support the conservation objectives.

A Threshold Concept in Managing: What Students in Introductory Management Courses Must Know

ERIC Educational Resources Information Center

Donovan, Paul

2017-01-01

In the field of management, a practice--theory gap has developed and consequently, management education has been criticized for being irrelevant to the needs of stakeholders. This article argues that introduction to management courses in higher education perpetuate this gap by not teaching what managers do. These courses fail to communicate well…

The Management of Horses during Fireworks in New Zealand

PubMed Central

Gronqvist, Gabriella; Rogers, Chris; Gee, Erica

2016-01-01

Simple Summary The negative effects of fireworks on companion animals have been reported, but little has been documented on the impact on horses. Horse anxiety was commonly associated with fireworks, and 26% of owners reported horse injuries as a result of fireworks. Many management strategies were seen as ineffective. The majority of horse owners were in favour of a ban on the sale of fireworks for private use. Abstract Within popular press there has been much coverage of the negative effects associated with firework and horses. The effect of fireworks has been documented in companion animals, yet no studies have investigated the negative effects, or otherwise, of fireworks on horses. This study aims to document horse responses and current management strategies to fireworks via an online survey. Of the total number of horses, 39% (1987/4765) were rated as “anxious”, 40% (1816/4765) “very anxious” and only 21% (965/4765) rated as “not anxious” around fireworks. Running (82%, 912/1107) was the most common behaviour reported, with no difference between property type (p > 0.05) or location (p > 0.05). Possibly as a consequence of the high frequency of running, 35% (384/1107) of respondents reported having horses break through fences in response to fireworks and a quarter (26%, 289/1099) reported that their horse(s) had received injuries associated with fireworks. The most common management strategy was moving their horse(s) to a paddock away from the fireworks (77%) and to stable/yard them (55%). However, approximately 30% reported these management strategies to be ineffective. Of the survey participants, 90% (996/1104) were against the sale of fireworks for private use. PMID:27005667

Use of fear and threat-based messages to motivate preparedness: Costs, consequences and other choices: part one.

PubMed

Jones, Ana-Marie

Over the last several decades, billions of dollars have been spent in the USA to increase its disaster readiness and response capacity. Virtually every poll and survey shows that the US public remains woefully underprepared. At the 2012 'Awareness to Action' workshop convened by the Federal Emergency Management Agency (FEMA) and the American Red Cross to examine the future of the long-standing 'Have a Kit. Make a Plan. Be Informed' preparedness campaign, FEMA Administrator Craig Fugate acknowledged that traditional efforts have not 'moved the preparedness needle'. The most frequently cited causes for lack of preparedness in the general public are consumer apathy, lack of time, lack of money and the lack of knowledge on how best to prepare. This paper explores the reliance on fear- and threat-based messages (also referred to as 'fear appeals' to promote preparedness as a significant cause for this lack of preparation. It will look at the growing body of fear research, how fear and threat appeals are pervasive in emergency management, as well as its costs, unintended consequences and the other choices that can be made. The author asserts that by eliminating fear and threat-based messages, new messengers can share readiness as an accessible, empowering and valued pursuit for all communities - entirely distinct from the disasters and threats that people face.

Use of fear and threat-based messages to motivate preparedness: costs, consequences and other choices. Part Two.

PubMed

Jones, Ana-Marie

2013-01-01

Over the last several decades, billions of dollars have been spent in the USA to increase disaster readiness and response capacity. Virtually every poll and survey shows that the US public remains woefully underprepared. At the 2012 'Awareness to Action' workshop convened by the Federal Emergency Management Agency (FEMA) and the American Red Cross to examine the future of the long-standing 'Have a Kit. Make a Plan. Be Informed' preparedness campaign, FEMA Administrator Craig Fugate acknowledged that traditional efforts have not 'moved the preparedness needle'. The most frequently cited causes for lack of preparedness in the general public are consumer apathy, lack of time, lack of money and the lack of knowledge on how best to prepare. This paper explores the reliance on fear and threat-based messages (also referred to as 'fear appeals') to promote preparedness as a significant cause for this lack of preparation. It will look at the growing body of fear research, how fear and threat appeals are pervasive in emergency management, as well as their costs, unintended consequences and the other choices that can be made. The author asserts that by eliminating fear and threat-based messages, new messengers can share readiness as an accessible, empowering and valued pursuit for all communities - entirely distinct from the disasters and threats that are faced.

SAFRR (Science Application for Risk Reduction) Tsunami Scenario--Executive Summary and Introduction: Chapter A in The SAFRR (Science Application for Risk Reduction) Tsunami Scenario

USGS Publications Warehouse

Ross, Stephanie L.; Jones, Lucile M.; Miller, Kevin H.; Porter, Keith A.; Wein, Anne; Wilson, Rick I.; Bahng, Bohyun; Barberopoulou, Aggeliki; Borrero, Jose C.; Brosnan, Deborah M.; Bwarie, John T.; Geist, Eric L.; Johnson, Laurie A.; Kirby, Stephen H.; Knight, William R.; Long, Kate; Lynett, Patrick; Mortensen, Carl E.; Nicolsky, Dmitry J.; Perry, Suzanne C.; Plumlee, Geoffrey S.; Real, Charles R.; Ryan, Kenneth; Suleimani, Elena; Thio, Hong Kie; Titov, Vasily V.; Whitmore, Paul M.; Wood, Nathan J.

2013-01-01

The Science Application for Risk Reduction (SAFRR) tsunami scenario depicts a hypothetical but plausible tsunami created by an earthquake offshore from the Alaska Peninsula and its impacts on the California coast. The tsunami scenario is a collaboration between the U.S. Geological Survey (USGS), the California Geological Survey, the California Governor’s Office of Emergency Services (Cal OES), the National Oceanic and Atmospheric Administration (NOAA), other Federal, State, County, and local agencies, private companies, and academic and other institutions. This document presents evidence for past tsunamis, the scientific basis for the source, likely inundation areas, current velocities in key ports and harbors, physical damage and repair costs, economic consequences, environmental and ecological impacts, social vulnerability, emergency management and evacuation challenges, and policy implications for California associated with this hypothetical tsunami. We also discuss ongoing mitigation efforts by the State of California and new communication products. The intended users are those who need to make mitigation decisions before future tsunamis, and those who will need to make rapid decisions during tsunami events. The results of the tsunami scenario will help managers understand the context and consequences of their decisions and how they may improve preparedness and response. An evaluation component will assess the effectiveness of the scenario process for target stakeholders in a separate report to improve similar efforts in the future.

Fishing in acid waters: A vulnerability assessment of the Norwegian fishing industry in the face of increasing ocean acidification.

PubMed

Heinrich, Luise; Krause, Torsten

2017-07-01

Ocean acidification (OA) describes a change in the ocean's carbonate chemistry. Whereas its chemical processes are largely understood, the biological and socioeconomic consequences particularly in relation to fisheries are less known. Norway is a major fishing nation worldwide and is potentially affected by OA. To improve the understanding of the socioeconomic consequences of OA, we conducted a risk assessment among the Norwegian counties using a modified version of a risk assessment framework introduced in the Intergovernmental Panel on Climate Change's "Special Report: Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation," which considers risk to be the sum of hazard, exposure, and vulnerability. Our results show that about 13 of 19 counties are likely to experience moderate to high risk from OA. We highlight that the success of integrated risk assessments highly depends on the availability of detailed environmental, economic, and societal data. In the case of Norway, modeling data regarding the progress of OA, improved information on potential biological impacts on a larger number of species, and statistical data on social variables are required. We conclude that although still in its infancy, integrated risk assessments are important prerequisites for any form of interdisciplinary research on OA and the development of successful response strategies. Integr Environ Assess Manag 2017;13:778-789. ©2016 SETAC. © 2016 SETAC.

A Developmental Study of School Theft.

ERIC Educational Resources Information Center

Dodson, Peter K.; Evans, Ellis D.

1985-01-01

Students (N=200) in grades 4 through 8 and 10 completed questionnaire measuring perceptions of school theft incidence and seriousness, personal responsibility for correcting theft, causal attributions of theft, and perceived consequences of thievery. Main grade effect was observed for personal responsibility and consequences, but represented…

[Public health crises in a developed society. Successes and limitations in Spain. SESPAS report 2010].

PubMed

Gérvas, Juan; Meneu, Ricard

2010-12-01

The perception, acceptability and management of risks are social construction. Consequently, in managing public health crises, the gap between facts, beliefs and feelings tests the responsiveness of official institutions to health alarms that can be objective, potential, or imaginary. On balance, a strong point of the Spanish experience of health crises is the presence of clinicians and public health officers working in an organization capable of responding adequately, although the quasi-federal Spanish political structure has both advantages and disadvantages. Weaknesses include the low profile given to public health and a management structure that relies too heavily on partitocracy. The management of these crises could be improved by transferring greater scope to health professionals in decisions about crisis identification and management (with transparency) and limiting bureaucratic inertia. For some, health crises involve visibility or business opportunities (not always legitimate). Therefore, the perception of crisis will increasingly rest less in the hands of experts and more in those of groups interested in spreading these crises or in providing solutions. While progress is needed to develop participation in strategies to respond to emerging crises, even more essential is the involvement of all healthcare levels in their preparation and dissemination. Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study.

PubMed

Varndell, Wayne; Fry, Margaret; Elliott, Doug

2017-08-01

Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department. In this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described. Synthesis of findings will generate a comprehensive picture of how emergency nurses' perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.

Pediatric parenting stress among parents of children with type 1 diabetes: the role of self-efficacy, responsibility, and fear.

PubMed

Streisand, Randi; Swift, Erika; Wickmark, Tara; Chen, Rusan; Holmes, Clarissa S

2005-09-01

Parents of children with type 1 diabetes are crucial to promoting positive disease adaptation and health outcomes among these youngsters, yet this success may come at some consequence to parents' own well-being. Little research has examined the stress faced by parents, or explored the psychological and behavioral correlates of their stress. One hundred and thirty-four parents of children with type 1 diabetes completed measures of diabetes self-efficacy, responsibility for diabetes management, fear of hypoglycemia, and a recently developed measure of pediatric parenting stress (the Pediatric Inventory for Parents [PIP]; R. Streisand, S. Braniecki, K. P. Tercyak, & A. E. Kazak, 2001). Bivariate analyses suggest that pediatric parenting stress is multifaceted; the frequency of parenting stress is negatively related to child age and family socioeconomic status and positively related to single parent status and regimen status (injections vs. insulin pump). Difficulty of parenting stress is negatively related to child age and positively related to regimen status. In multivariate analyses, a significant portion of the variance in stress frequency (32%) and difficulty (19%) are associated with parent psychological and behavioral functioning, including lower self-efficacy, greater responsibility for diabetes management, and greater fear of hypoglycemia. Each area of parent functioning associated with pediatric parenting stress is amenable to behavioral intervention aimed at stress reduction or control and improvement of parent psychological and child-health outcomes.

Causes, Consequences, and Prevention of Burnout among Substance Abuse Treatment Counselors: A Rural versus Urban Comparison

PubMed Central

Oser, Carrie B.; Biebel, Elizabeth P.; Pullen, Erin; Harp, Kathi LH

2012-01-01

Substance abuse counselors are vulnerable to burnout, which has negative repercussions for the counselor, employing organization, and clients. However, little is known about differences in counselor burnout from the counselors’ perspective in rural versus urban treatment centers. In 2008, focus group data from 28 rural and urban counselors in a southern state was analyzed, revealing three burnout themes across all counselors: causes, consequences, and prevention. However, there were various differences between rural and urban counselors in sub-themes with only rural counselors citing office politics and low occupational prestige as causes of burnout. Only urban counselors reported responses endorsing the sub-themes of role reversal, clients trying to choose their counselors, and changing jobs as consequences of burnout. All counselors cited co-worker support, clinical supervision, and self-care as important strategies for managing burnout. In sum, context clearly matters as rural counselors cited more causes of burnout; yet, the implications of burnout are universal in that they often lead to poor quality clinical care. There is a continued need for greater understanding of addiction as a disease, which would reduce stigma, especially in rural areas, as well as increase the prestige and earning potential of the substance abuse counseling occupation. PMID:23662328

Consequences and management of iron overload in sickle cell disease.

PubMed

Porter, John; Garbowski, Maciej

2013-01-01

The aims of this review are to highlight the mechanisms and consequences of iron distribution that are most relevant to transfused sickle cell disease (SCD) patients and to address the particular challenges in the monitoring and treatment of iron overload. In contrast to many inherited anemias, in SCD, iron overload does not occur without blood transfusion. The rate of iron loading in SCD depends on the blood transfusion regime: with simple hypertransfusion regimes, rates approximate to thalassemia major, but iron loading can be minimal with automated erythrocyte apheresis. The consequences of transfusional iron overload largely reflect the distribution of storage iron. In SCD, a lower proportion of transfused iron distributes extrahepatically and occurs later than in thalassemia major, so complications of iron overload to the heart and endocrine system are less common. We discuss the mechanisms by which these differences may be mediated. Treatment with iron chelation and monitoring of transfusional iron overload in SCD aim principally at controlling liver iron, thereby reducing the risk of cirrhosis and hepatocellular carcinoma. Monitoring of liver iron concentration pretreatment and in response to chelation can be estimated using serum ferritin, but noninvasive measurement of liver iron concentration using validated and widely available MRI techniques reduces the risk of under- or overtreatment. The optimal use of chelation regimes to achieve these goals is described.

The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions

PubMed Central

Atique, S.; Mayer, M. A.; Denecke, K.; Merolli, M.; Househ, M.

2016-01-01

Summary Objectives Social media is increasingly being used in conjunction with health information technology (health IT). The objective of this paper is to identify some of the undesirable outcomes that arise from this integration and to suggest solutions to these problems. Methodology After a discussion with experts to elicit the topics that should be included in the survey, we performed a narrative review based on recent literature and interviewed multidisciplinary experts from different areas. In each case, we identified and analyzed the unintended effects of social media in health IT. Results Each analyzed topic provided a different set of unintended consequences. Most relevant consequences include lack of privacy with ethical and legal issues, patient confusion in disease management, poor information accuracy in crowdsourcing, unclear responsibilities, misleading and biased information in the prevention and detection of epidemics, and demotivation in gamified health solutions with social components. Conclusions Using social media in healthcare offers several benefits, but it is not exempt of potential problems, and not all of these problems have clear solutions. We recommend careful design of digital systems in order to minimize patient’s feelings of demotivation and frustration and we recommend following specific guidelines that should be created by all stakeholders in the healthcare ecosystem. PMID:27830230

Prevention and recognition of abusive head trauma: training for healthcare professionals in Vietnam.

PubMed

Fraser, Jennifer A; Flemington, Tara; Doan, Thi Ngoc Diep; Hoang, Minh Tu Van; Doan, Thi Le Binh; Ha, Manh Tuan

2017-10-01

This study presents results from an intervention designed to improve identification and response to abusive head trauma in a tertiary paediatric hospital in Vietnam. One hundred and sixteen healthcare professionals (paediatric medical and nursing staff) completed a clinical training programme and participated in its evaluation. A pre-post-test and follow-up design was used to evaluate the outcomes. Questionnaires were used to collect data prior to training, at six weeks and at six months. Generalised linear modelling was used to examine changes in diagnostic skills and knowledge of the consequences of shaken baby syndrome (SBS) (a form of abusive head trauma), its prevention and treatment. At baseline, awareness and knowledge reflected no former abusive head trauma training. Following the intervention, participants had an increased awareness of shaken baby syndrome and the potential consequences of shaking infants and had acquired techniques to inform parents how to manage the crying infant. The intervention was effective in raising awareness of shaken baby syndrome and its consequences amongst the participating healthcare professionals in Vietnam. Training can improve detection and prevention of abusive head trauma, and the intervention has the potential to be adapted for similar settings internationally. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Management of Pregnant Women with Type 2 Diabetes Mellitus and the Consequences of Fetal Programming in Their Offspring.

PubMed

Berry, Diane C; Boggess, Kim; Johnson, Quinetta B

2016-05-01

The obesity epidemic has fueled an epidemic of prediabetes and type 2 diabetes mellitus in women of childbearing age. This paper examines the state of the science on preconception and pregnancy management of women with type 2 diabetes to optimize outcomes for the women and their infants. In addition, the consequence of fetal programming as a result of suboptimal maternal glycemic control is discussed. The paper focuses on type 2 diabetes, not type 1 diabetes or gestational diabetes. Management of women with type 2 diabetes includes preconception counseling, preconception weight management and weight loss, proper weight gain during pregnancy, self-monitoring of blood glucose levels, medication, medical nutrition therapy, and exercise.

UK report on waste management

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

Ferguson, J.

1995-09-01

Arising jointly from the National and European Union requirements for more intensive attention to be paid to the environment, the United Kingdom (UK) has taken many strides forward in protecting the environment from pollution and preventing harm to human health arising from the handling, transport and disposal of wastes. Major adjustments are taking place in Europe following the opening up of the Eastern European countries. The consequences of the illegal movement of wastes and its mistreatment and disposal are now recognised within the European Union. The UK as a member State is well aware of the consequences which arise frommore » the lack of proper waste management. This paper discusses waste management and legislation pertaining to waste management in the United Kingdom.« less

[Principles of management of All-Russia Disaster Medicine Services].

PubMed

Sakhno, I I

2000-11-01

Experience of liquidation of earthquake consequences in Armenia (1988) has shown that it is extremely necessary to create the system of management in regions of natural disaster, large accident or catastrophe before arrival of main forces in order to provide reconnaissance, to receive the arriving units. It will help to make well-grounded decisions, to set tasks in time, to organize and conduct emergency-and-rescue works. The article contains general material concerning the structure of All-Russia service of disaster medicine (ARSDM), organization of management at all levels and interaction between the components of ARSDM and other subsystems of Russian Service of Extreme Situations. It is recommended how to organize management of ARSDM during liquidation of medical-and-sanitary consequences of large-scale extreme situations.

Chief Executive Officers: Academic Leaders or Business Managers?

ERIC Educational Resources Information Center

Doring, Allan

This paper explores the role and preparation of academics for senior management and executive positions in colleges and universities, particularly in Australia. A background section cites trends in higher education management and recent critiques of that management and the consequent scrutiny of leadership effectiveness. There follows an…

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options.

PubMed

Rani, Manju; Nusrat, Sharmin; Hawken, Laura H

2012-10-16

Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions- institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms.Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as 'program management and implementation' entities rather than as lead 'technical advisory' bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. The 'technical functions' and 'implementation and management functions' should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH.The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs.

A qualitative study of governance of evolving response to non-communicable diseases in low-and middle- income countries: current status, risks and options

PubMed Central

2012-01-01

Background Segmented service delivery with consequent inefficiencies in health systems was one of the main concerns raised during scaling up of disease-specific programs in the last two decades. The organized response to NCD is in infancy in most LMICs with little evidence on how the response is evolving in terms of institutional arrangements and policy development processes. Methods Drawing on qualitative review of policy and program documents from five LMICs and data from global key-informant surveys conducted in 2004 and 2010, we examine current status of governance of response to NCDs at national level along three dimensions— institutional arrangements for stewardship and program management and implementation; policies/plans; and multisectoral coordination and partnerships. Results Several positive trends were noted in the organization and governance of response to NCDs: shift from specific NCD-based programs to integrated NCD programs, increasing inclusion of NCDs in sector-wide health plans, and establishment of high-level multisectoral coordination mechanisms. Several areas of concern were identified. The evolving NCD-specific institutional structures are being treated as ‘program management and implementation’ entities rather than as lead ‘technical advisory’ bodies, with unclear division of roles and responsibilities between NCD-specific and sector-wide structures. NCD-specific and sector-wide plans are poorly aligned and lack prioritization, costing, and appropriate targets. Finally, the effectiveness of existing multisectoral coordination mechanisms remains questionable. Conclusions The ‘technical functions’ and ‘implementation and management functions’ should be clearly separated between NCD-specific units and sector-wide institutional structures to avoid duplicative segmented service delivery systems. Institutional capacity building efforts for NCDs should target both NCD-specific units (for building technical and analytical capacity) and sector-wide organizational units (for building program management and implementation capacity) in MOH. The sector-wide health plans should reflect NCDs in proportion to their public health importance. NCD specific plans should be developed in close consultation with sector-wide health- and non-health stakeholders. These plans should expand on the directions provided by sector-wide health plans specifying strategically prioritized, fully costed activities, and realistic quantifiable targets for NCD control linked with sector-wide expenditure framework. Multisectoral coordination mechanisms need to be strengthened with optimal decision-making powers and resource commitment and monitoring of their outputs. PMID:23067232

A Primer on Risks, Issues and Opportunities

DTIC Science & Technology

2016-08-01

likelihood or consequence. A risk has three main parts: a future root cause, a likelihood and a consequence. The future root cause is determined...through root cause analysis, which is the most important part of any risk management effort. SPECIAL SECTION: RISK MANAGEMENT Defense AT&L: July-August...2016 10 Root cause analysis gets to the heart of the risk. Why does the risk exist? What is its nature? How will the risk occur? What should be

Risk Management and Critical Infrastructure Protection: Assessing, Integrating, and Managing Threats, Vulnerabilities and Consequences

DTIC Science & Technology

2004-09-02

Consequences 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...OSLGCP now administers the grants programs. 30According to the guidance, threat assessment determines the relative likelihood of a known potential...information on critical infrastructure assets. The Office of State and Local Government Coordination and Preparedness (OSLGCP) administers two grant

Risk Management and Critical Infrastructure Protection: Assessing, Integrating, and Managing Threats, Vulnerabilities and Consequences

DTIC Science & Technology

2005-02-04

Consequences 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...OSLGCP). The OSLGCP now administers the grants programs. 37 According to the guidance, threat assessment determines the relative likelihood of a...Preparedness (OSLGCP) administers two grant programs that give states the opportunity to identify critical infrastructure assets: the State Homeland Security

Prospective-pricing strategies for hospital and departmental effectiveness: the administrator's response.

PubMed

Van Etten, P

1985-10-01

The approach of the New England Medical Center toward case management and increased productivity, and the role of the pharmacy within this system, are described by a chief hospital administrator. External pressures that caused the hospital to alter its management style included changes in reimbursement, hospital overuse, increased competition, and a surplus of physicians. Variations in medical practice that affected admission rates, length of stay, and use of ancillary services existed because clinical and financial data had not been integrated, so clinicians had no information on the economic consequences of their decisions. The solution offered to this problem was to decentralize resource-use decisions to increase clinician accountability. The goal of the case-management system is to reduce the cost of intermediate product (e.g., laboratory tests) use through increased productivity. The system provides pharmacy with a new power base if pharmacists can reduce overall costs by influencing prescribers to use cost-effective therapies. Pharmacy can increase its influence within the institution by forming new relationships with administrators, physicians, and nurses that broaden its impact on cost.

Transfusion risks and transfusion-related pro-inflammatory responses.

PubMed

Despotis, George John; Zhang, Lini; Lublin, Douglas M

2007-02-01

Despite improvements in blood screening and administration techniques, serious adverse events related to transfusion continue to occur, albeit at a much lower incidence. In addition to the development and implementation of new screening and blood purification/modification techniques and implementation of an optimal blood management program, the incidence and consequences of transfusion reactions can be reduced by a basic understanding of transfusion-related complications. Although acute hemolytic transfusion reactions, transfusion-associated anaphylaxis and sepsis, and transfusion-associated acute lung injury occur infrequently, diligence in administration of blood and monitoring for development of respective signs/symptoms can minimize the severity of these potentially life-threatening complications. In addition, emerging blood-banking techniques such as psoralen-UV inactivation of pathogens and use of patient identification systems may attenuate the incidence of adverse events related to transfusion. With respect to optimizing blood management by means of an effective blood management program involving pharmacologic and nonpharmacologic strategies, the ability to reduce use of blood products and to decrease operative time or re-exploration rates has important implications for disease prevention, blood inventory and costs, and overall health care costs.

Addressing Medical Errors in Hand Surgery

PubMed Central

Johnson, Shepard P.; Adkinson, Joshua M.; Chung, Kevin C.

2014-01-01

Influential think-tank such as the Institute of Medicine has raised awareness about the implications of medical errors. In response, organizations, medical societies, and institutions have initiated programs to decrease the incidence and effects of these errors. Surgeons deal with the direct implications of adverse events involving patients. In addition to managing the physical consequences, they are confronted with ethical and social issues when caring for a harmed patient. Although there is considerable effort to implement system-wide changes, there is little guidance for hand surgeons on how to address medical errors. Admitting an error is difficult, but a transparent environment where patients are notified of errors and offered consolation and compensation is essential to maintain trust. Further, equipping hand surgeons with a guide for addressing medical errors will promote compassionate patient interaction, help identify system failures, provide learning points for safety improvement, and demonstrate a commitment to ethically responsible medical care. PMID:25154576

Reversible Holmes' tremor due to spontaneous intracranial hypotension.

PubMed

Iyer, Rajesh Shankar; Wattamwar, Pandurang; Thomas, Bejoy

2017-07-27

Holmes' tremor is a low-frequency hand tremor and has varying amplitude at different phases of motion. It is usually unilateral and does not respond satisfactorily to drugs and thus considered irreversible. Structural lesions in the thalamus and brainstem or cerebellum are usually responsible for Holmes' tremor. We present a 23-year-old woman who presented with unilateral Holmes' tremor. She also had hypersomnolence and headache in the sitting posture. Her brain imaging showed brain sagging and deep brain swelling due to spontaneous intracranial hypotension (SIH). She was managed conservatively and had a total clinical and radiological recovery. The brain sagging with the consequent distortion of the midbrain and diencephalon was responsible for this clinical presentation. SIH may be considered as one of the reversible causes of Holmes' tremor. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Large space-based systems for dealing with global environment change

NASA Technical Reports Server (NTRS)

Jenkins, Lyle M.

1992-01-01

Increased concern over the effects of global climate change and depletion of the ozone layer has resulted in support for the Global Change Research Program and the Mission to Planet Earth. Research to understand Earth system processes is critical, but it falls short of providing ways of mitigating the effects of change. Geoengineering options and alternatives to interactively manage change need to be developed. Space-based concepts for dealing with changes to the environment should be considered in addition to Earth-based actions. 'Mission for Planet Earth' describes those space-based geoengineering solutions that may combine with an international global change program to stabilize the Global environment. Large space systems that may be needed for this response challenge guidance and control engineering and technology. Definition, analysis, demonstration, and preparation of geoengineering technology will provide a basis for policy response if global change consequences are severe.

Responsive and Proactive Stakeholder Orientation in Public Universities: Antecedents and Consequences

ERIC Educational Resources Information Center

Alarcón-del-Amo, María-del-Carmen; Casablancas-Segura, Carme; Llonch, Joan

2016-01-01

This study, based on institutional theory, dynamic capabilities, and stakeholder theory, investigates the relationships between the antecedents of responsive and proactive stakeholder orientation and their consequences in the public university context. The results obtained mainly stress that the mimetic effect of copying successful university…

Living With Diabetes in Appalachia: A Focus Group Study.

PubMed

Carpenter, Roger; Smith, Mary Jane

This article presents an innovative holistic practice application based on evidence from a focus group study on managing diabetes. The purpose of this study addressed the research question: How do persons with type 2 diabetes describe ways of managing the challenge of living with diabetes? A second purpose was to link the findings on ways to manage diabetes to holistic nursing practice through story theory. Nine adults with type 2 diabetes living in rural West Virginia participated in 3 focus groups. Using content analysis, the study findings integrated themes with core qualities, and are as follows: living life as an evolving process is awakening to the present and doing it your way, being on guard is a vigilant ongoing responsibility, attending to bodily experience is awareness of body and facing life stress, and knowing the consequences is awareness of potential problems and taking charge. Merging the study findings with the concepts of story theory led to the development of an innovative practice application for managing diabetes. Managing diabetes in this practice application goes beyond problem-centeredness to a patient-centered approach, offering attention to individual preferences. Since managing diabetes is a major problem in Appalachia, there a need for innovative approaches. This study adds to the body of knowledge on how persons from Appalachia manage diabetes. In addition, it offers a story practice approach for managing diabetes-replacing a problem focus to a more holistic approach to practice leading to more meaningful and fulfilling outcomes.

Using multi-species occupancy models in structured decision making on managed lands

USGS Publications Warehouse

Sauer, John R.; Blank, Peter J.; Zipkin, Elise F.; Fallon, Jane E.; Fallon, Frederick W.

2013-01-01

Land managers must balance the needs of a variety of species when manipulating habitats. Structured decision making provides a systematic means of defining choices and choosing among alternative management options; implementation of a structured decision requires quantitative approaches to predicting consequences of management on the relevant species. Multi-species occupancy models provide a convenient framework for making structured decisions when the management objective is focused on a collection of species. These models use replicate survey data that are often collected on managed lands. Occupancy can be modeled for each species as a function of habitat and other environmental features, and Bayesian methods allow for estimation and prediction of collective responses of groups of species to alternative scenarios of habitat management. We provide an example of this approach using data from breeding bird surveys conducted in 2008 at the Patuxent Research Refuge in Laurel, Maryland, evaluating the effects of eliminating meadow and wetland habitats on scrub-successional and woodland-breeding bird species using summed total occupancy of species as an objective function. Removal of meadows and wetlands decreased value of an objective function based on scrub-successional species by 23.3% (95% CI: 20.3–26.5), but caused only a 2% (0.5, 3.5) increase in value of an objective function based on woodland species, documenting differential effects of elimination of meadows and wetlands on these groups of breeding birds. This approach provides a useful quantitative tool for managers interested in structured decision making.

Predictors of non-response and non-compliance in African American lupus patients: Findings from the Balancing Lupus Experiences with Stress Strategies (BLESS) Study.

PubMed

Williams, Edith M; Zhang, Jiajia; Zhou, Jie; Kamen, Diane; Oates, James C

2014-02-01

Arthritis self-management education has demonstrated significant improvements in health distress, self-reported global health, and activity limitation, with trends toward improvement in self efficacy and mental stress management. Consequently, numerous national agencies have recommended arthritis self-management education to complement medical care. Despite these recommendations, arthritis self-management education has reached only a limited number of people. Compliance is also a persistent problem in standardized programs. As part of the Balancing Lupus Experiences with Stress Strategies (BLESS) Study, a validated psychosocial stress intervention was piloted among a cohort of African American lupus patients participating in an SLE database project at the Medical University of South Carolina (MUSC). Recruitment attempts were made with the 330 database participants who met eligibility requirements for the study. While enrollment was limited to 30 participants (n=15 controls and n=15 intervention), two of the participants assigned to the intervention group did not attend any intervention sessions and several participants did not complete post-intervention questionnaires. Therefore, data were analyzed on 30 participants at baseline, 25 (n=13 controls and n=12 intervention) at post-intervention, and 22 (n=12 controls and n=10 intervention) at four months post-intervention. In an effort to characterize those who fully participated in the study and those who were non-compliant or non-responsive to recruitment attempts, we obtained descriptive data from African-American Lupus patients participating in the SLE Clinic Database Project. This information can be used to develop and refine future intervention activities.

Soil Bacterial Community Structure Responses to Precipitation Reduction and Forest Management in Forest Ecosystems across Germany

PubMed Central

Felsmann, Katja; Baudis, Mathias; Gimbel, Katharina; Kayler, Zachary E.; Ellerbrock, Ruth; Bruehlheide, Helge; Bruckhoff, Johannes; Welk, Erik; Puhlmann, Heike; Weiler, Markus; Gessler, Arthur; Ulrich, Andreas

2015-01-01

Soil microbial communities play an important role in forest ecosystem functioning, but how climate change will affect the community composition and consequently bacterial functions is poorly understood. We assessed the effects of reduced precipitation with the aim of simulating realistic future drought conditions for one growing season on the bacterial community and its relation to soil properties and forest management. We manipulated precipitation in beech and conifer forest plots managed at different levels of intensity in three different regions across Germany. The precipitation reduction decreased soil water content across the growing season by between 2 to 8% depending on plot and region. T-RFLP analysis and pyrosequencing of the 16S rRNA gene were used to study the total soil bacterial community and its active members after six months of precipitation reduction. The effect of reduced precipitation on the total bacterial community structure was negligible while significant effects could be observed for the active bacteria. However, the effect was secondary to the stronger influence of specific soil characteristics across the three regions and management selection of overstorey tree species and their respective understorey vegetation. The impact of reduced precipitation differed between the studied plots; however, we could not determine the particular parameters being able to modify the response of the active bacterial community among plots. We conclude that the moderate drought induced by the precipitation manipulation treatment started to affect the active but not the total bacterial community, which points to an adequate resistance of the soil microbial system over one growing season. PMID:25875835

Organizational risk management of resistance to care episodes in health facilities.

PubMed

Kable, Ashley; Guest, Maya; McLeod, Mary

2012-09-01

This article reports a study of organizational risk management approaches to resistance to care episodes in specific clinical areas: prevention measures, provision of subsequent support and follow-up by management and resultant organizational change. Resistance to care describes a patient's unwillingness to be assisted by healthcare staff and is manifested in defensive behaviours ranging from minor non-compliance/dissent to aggression. It has previously been studied in aged care settings and focused on patient behaviours and appropriate responses. This was a cross-sectional survey of a representative sample of nurses (n = 5044) who were members of the New South Wales Nurses' Association in Australia, in 2008-2009. Of 1132 participants, 80% reported being involved in resistance to care episodes during the previous month and this was higher in some settings. Episodes were not routinely reported internally, and often did not lead to organizational change. Nurses reported that talking with other staff was the most effective action in dealing with the consequences of these episodes. Half of the respondents considered that they were provided with sufficient support and follow-up after a resistance to care episode. Prevention measures and follow-up strategies adopted by employers varied across clinical settings. Resistance to care is not confined to aged care settings, and risk management of resistance to care can increase safety in the workplace. Preventive strategies such as increased staff, training and security should be focused on high risk clinical areas; and appropriate support, follow-up and organizational change instituted in response to these episodes. © 2011 Blackwell Publishing Ltd.

Soil bacterial community structure responses to precipitation reduction and forest management in forest ecosystems across Germany.

PubMed

Felsmann, Katja; Baudis, Mathias; Gimbel, Katharina; Kayler, Zachary E; Ellerbrock, Ruth; Bruelheide, Helge; Bruehlheide, Helge; Bruckhoff, Johannes; Welk, Erik; Puhlmann, Heike; Weiler, Markus; Gessler, Arthur; Ulrich, Andreas

2015-01-01

Soil microbial communities play an important role in forest ecosystem functioning, but how climate change will affect the community composition and consequently bacterial functions is poorly understood. We assessed the effects of reduced precipitation with the aim of simulating realistic future drought conditions for one growing season on the bacterial community and its relation to soil properties and forest management. We manipulated precipitation in beech and conifer forest plots managed at different levels of intensity in three different regions across Germany. The precipitation reduction decreased soil water content across the growing season by between 2 to 8% depending on plot and region. T-RFLP analysis and pyrosequencing of the 16S rRNA gene were used to study the total soil bacterial community and its active members after six months of precipitation reduction. The effect of reduced precipitation on the total bacterial community structure was negligible while significant effects could be observed for the active bacteria. However, the effect was secondary to the stronger influence of specific soil characteristics across the three regions and management selection of overstorey tree species and their respective understorey vegetation. The impact of reduced precipitation differed between the studied plots; however, we could not determine the particular parameters being able to modify the response of the active bacterial community among plots. We conclude that the moderate drought induced by the precipitation manipulation treatment started to affect the active but not the total bacterial community, which points to an adequate resistance of the soil microbial system over one growing season.

40 CFR 1400.8 - Access to off-site consequence analysis information by Federal government officials.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF JUSTICE ACCIDENTAL RELEASE PREVENTION REQUIREMENTS; RISK MANAGEMENT PROGRAMS UNDER THE CLEAN AIR ACT SECTION 112(r)(7); DISTRIBUTION OF OFF-SITE CONSEQUENCE ANALYSIS...

Unintended consequences and trade-offs of fish passage

USGS Publications Warehouse

McLaughlin, Robert L.; Smyth, Eric R.; Castro-Santos, Theodore; Jones, Michael L.; Koops, Marten A.; Pratt, Thomas C.; Vélez-Espino, Luis-Antonio

2012-01-01

We synthesized evidence for unintended consequences and trade-offs associated with the passage of fishes. Provisioning of fish passageways at dams and dam removals are being carried out increasingly as resource managers seek ways to reduce fragmentation of migratory fish populations and restore biodiversity and nature-like ecosystem services in tributaries altered by dams. The benefits of provisioning upstream passage are highlighted widely. Possible unwanted consequences and trade-offs of upstream passage are coming to light, but remain poorly examined and underappreciated. Unintended consequences arise when passage of native and desirable introduced fishes is delayed, undone (fallback), results in patterns of movement and habitat use that reduce Darwinian fitness (e.g. ecological traps), or is highly selective taxonomically and numerically. Trade-offs arise when passage decisions intended to benefit native species interfere with management decisions intended to control the unwanted spread of non-native fishes and aquatic invertebrates, or genes, diseases and contaminants carried by hatchery and wild fishes. These consequences and trade-offs will vary in importance from system to system and can result in large economic and environmental costs. For some river systems, decisions about how to manage fish passage involve substantial risks and could benefit from use of a formal, structured process that allows transparent, objective and, where possible, quantitative evaluation of these risks. Such a process can also facilitate the design of an adaptive framework that provides valuable insights into future decisions.

Patch burn grazing management in a semiarid grassland: Consequences for pronghorn, plains pricklypear and wind erosion

USDA-ARS?s Scientific Manuscript database

Rangeland management strategies that allow for spatial and temporal interactions between fire and herbivores can achieve multiple management goals related to livestock production and wildlife conservation in mesic grasslands and savannas. Less is known about integrated management of herbivores and f...

Oral antiplatelet agents for the management of acute coronary syndromes: A review for nurses and allied healthcare professionals.

PubMed

Gesheff, Tania; Barbour, Cescelle

2017-02-01

We review the use of oral antiplatelet (OAP) therapies in acute coronary syndrome (ACS) management for nurse practitioners (NPs), focusing on current guideline recommendations. Treatment guidelines and clinical articles from PubMed. Guidelines recommend that dual antiplatelet therapy with a P2Y 12 inhibitor and aspirin be initiated for ACS management. The P2Y 12 inhibitor clopidogrel has established efficacy, but is associated with suboptimal and delayed platelet inhibition and variability in response. The newer P2Y 12 inhibitors prasugrel and ticagrelor have demonstrated superior efficacy outcomes versus clopidogrel. Consequently, non-ST-segment elevation ACS (NSTE-ACS) guidelines now recommend that ticagrelor be used in preference to clopidogrel for patients treated with stents or managed medically. Because of their higher potency, prasugrel and ticagrelor are associated with increased bleeding rates versus clopidogrel, but with no increased risk of severe or life-threatening bleeding. Guidelines recommend dual antiplatelet therapy be continued ≥12 months in both medically managed and stented ACS patients, and in some cases beyond this, in absence of high bleeding risk. Updated guidelines assign preference to ticagrelor over clopidogrel for maintenance therapy in patients with NSTE-ACS and ST-elevation myocardial infarction. Enhanced NP understanding of OAP agents and current guidelines could contribute to improved ACS patient management. ©2017 American Association of Nurse Practitioners.

Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community: a mixed studies review.

PubMed

Aston, Lydia; Hilton, Andrea; Moutela, Tiago; Shaw, Rachel; Maidment, Ian

2017-10-18

Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management. A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods). Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers' knowledge of the importance of managing medication and healthcare professionals' understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication. This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes.

Self-Management Patient Education and Weight Loss

ERIC Educational Resources Information Center

Stombaugh, Angela M.

2010-01-01

Self-management of a disease is defined as "having or being able to obtain, the skills and resources necessary to best accommodate to the chronic disease and its consequences" (Holman & Lorig, 1992, p. 309). Self-management has been used in the management of several chronic conditions and this model may be useful in the management of weight loss.…

Increasing the visibility of watershed management as a land management profession

Treesearch

Daniel G. Neary; Peter F. Ffolliott; Kenneth N. Brooks

2000-01-01

Population increases will continue to severely pressure water resources in the 21st century. Consequently, the importance of watershed management will increase. The potential demand in the next century for information on, and individuals skilled in, watershed management raises several important issues: the need for watershed management to have a central voice to gain...

Large-scale interdisciplinary experiments inform current and future forestry management options in the U.S

Treesearch

C.E. Peterson; P.D. Anderson

2009-01-01

Over the last 20 years, changing public values and increased ecological understanding have led to a paradigm shift in forestry from timber management to sustainable ecosystem management on U.S. federal lands. Forest managers are now seeking alternative management approaches that simultaneously meet socio-cultural, ecological and economic goals. Consequently, many field...

Evaluation of fleet management techniques for timber highway bridges

Treesearch

Brent M. Phares; Travis K. Hosteng; Justin Dahlberg; Michael A. Ritter

2011-01-01

The general condition of the nation's bridges presents a complex management issue when considering cost, safety, and time. Consequently, the management of those bridges can become an overwhelming task. The need for a management system that is specific to rural systems may help to improve the management of this significant number of bridges. Although individual...

Alternative Perspectives on Risk

NASA Technical Reports Server (NTRS)

Davison, Jeannie; Orasanu, J.; Connors, Mary M. (Technical Monitor)

1997-01-01

The goal of the commercial air transport system is to provide air transportation to the flying public at an acceptable cost with minimal risk. in an ideal situation these three goals would support each other. In fact, it is sometimes the case that the goals conflict: getting passengers to their destinations on time may conflict with fixing a minor mechanical malfunction that may or may not impact safety; flying a route that will avoid turbulence, thereby providing passengers with a more comfortable ride, may consume more fuel; managing traffic density may mean aircraft are delayed or must use an approach that will result in a long taxi to their gates, costing time and fuel. Various players in the system--pilots, dispatchers, controllers, as well as managers in the airline carriers and traffic management system--make decisions every day that involve trade-offs of benefits and costs. The prospect of revisions in the air traffic management system, with shifts in responsibilities from controllers to users, including airline operations center personnel and pilots, means that individuals may be performing either new jobs or old jobs under new guidance. It will be essential to know how the various players (a) perceive the risks and benefits associated with the decisions they will make under the old and new control structures, and (b) how much risk they are willing to accept in making decisions. Risk is here defined as the probability and magnitude of negative events (after Slovic, 1987). Of primary interest are risks associated with traffic, weather, and operational factors such as schedule, fuel consumption, and passenger service. Previous research has documented differences between groups in perceptions of risks associated with both everyday and aviation related situations. Risk perception varies as a function of familiarity with the situation, degree to which one is potentially affected by the risk, the level of control one has over the situation, and one's level of experience and responsibility in the situation. In our presentation we will consider several factors that may influence differences in risk perception, risk tolerance and risk management among the three major categories of participants in the aviation system (pilots, dispatchers, and controllers). Primary factors that may affect risk attitudes (the collective term we will use for the three components of risk) include: expertise or job-specific knowledge or training, personal involvement or vulnerability to consequences, goals, time horizon (imminence of consequences), span of control and type of control, and information or technology support. These will be considered in the context of five different types of risk (physical threat, economic, social, legal, and ethical). A study designed to study differences between pilots and controllers in their perceptions and responses to traffic risks under the present and a user-preferred control situation will be described. Future studies involving dispatchers' risk perceptions regarding various types of risk will be discussed.

41 CFR 302-12.108 - What are the income tax consequences that we must consider when offering relocation services?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE... Constitution Avenue, NW., Room 5501, Washington, DC 20224, for information on the income tax consequences of...

41 CFR 302-12.115 - What are the income tax consequences that we must consider when offering relocation services?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE... Constitution Avenue, NW., Room 5501, Washington, DC 20224, for information on the income tax consequences of...