A report of a Conference on Advanced Composites: An Assessment of the Future

NASA Technical Reports Server (NTRS)

Harris, L. A.

1977-01-01

A conference was held to evaluate the current status and future commitment to composites by government and industry. This reassessment, was felt needed because of an apparent transition in the acceptance of composites. The management of government agencies restated their progress and commitment to the development of composites and industrial management defined their concerns and requirements to commit to the future use of composites.

CHALLENGES IN SLUDGE STABILIZATION: REGULATORY COMPLIANCE IN THE DESIGN AND OPERATION OF FACILITIES

EPA Science Inventory

Successful sewage sludge management involving the beneficial use of biosolids is predicated on acceptable quality of the product. Sludge quality can be defined in many ways. One of the most critical qualities affecting product marketability is sludge stability. While the terms &q...

Beliefs and attitudes toward lethal management of deer in Cuyahoga Valley National Park

USGS Publications Warehouse

Fulton, D.C.; Skerl, K.; Shank, E.M.; Lime, D.W.

2004-01-01

We used the theory of reasoned action to help understand attitudes and beliefs about lethal management of deer (Odocoileus virginianus) in Cuyahoga Valley National Park (CVNP), Ohio. We used a mail-back survey to collect data from Ohio residents in the surrounding 9-county area. Two strata were defined: residents <10 km from CVNP (near n = 369) and residents =10 km from CVNP (far n = 312). Respondents indicated that lethal control of deer was acceptable (near 71%??4.7%, far 62%??5.5%) and taking no action to reduce deer populations was unacceptable (near 75%??4.5%, far 72%??5.1%). Beliefs about outcomes of lethal control and evaluation of those outcomes proved to be strong predictors of the acceptability of lethal control of deer in CVNP. Lethal control was more acceptable if it was done to prevent severe consequences for humans (e.g., spread of disease, car collisions) or the natural environment (e.g., maintain a healthy deer herd) than to prevent negative aesthetic impacts or personal property damage. Results from the study can be used to assist managers at CVNP as they make decisions regarding alternatives for deer management in the park and to inform others managing abundant deer populations of socially relevant impacts of management actions.

[New approach for managing microbial risks in food].

PubMed

Augustin, Jean-Christophe

2015-01-01

The aim of the food legislation is to ensure the protection of human health. Traditionally, the food legislation requires food business operators to apply good hygiene practices and specific procedures to control foodborne pathogens. These regulations allowed reaching a high level of health protection. The improvement of the system will require risk-based approaches. Firstly, risk assessment should allow the identification of high-risk situations where resources should be allocated for a better targeting of risk management. Then, management measures should be adapted to the health objective. In this approach, the appropriate level of protection is converted intofood safety and performance objectives on the food chain, i.e., maximum microbial contamination to fulfil the acceptable risk level. When objectives are defined, the food business operators and competent authorities can identify control options to comply with the objectives and establish microbiological criteria to verify compliance with these objectives. This approach, described for approximately 10 years, operative thanks to the development of quantitative risk assessment techniques, is still difficult to use in practical terms since it requires a commitment of competent authorities to define the acceptable risk and needs also the implementation of sometimes complex risk models.

MONITORED NATURAL ATTENUATION AND RISK MANAGEMENT OF MTBE IN GROUND WATER

EPA Science Inventory

Monitored natural attenuation (as U.S. EPA defines the term) is a remedy, where natural processes bring the concentration of MTBE to an acceptable level in a reasonable period of time. The longevity of the plume is its critical property. The rate of attenuation is typically con...

Defining the drivers for accepting decision making automation in air traffic management.

PubMed

Bekier, Marek; Molesworth, Brett R C; Williamson, Ann

2011-04-01

Air Traffic Management (ATM) operators are under increasing pressure to improve the efficiency of their operation to cater for forecasted increases in air traffic movements. One solution involves increasing the utilisation of automation within the ATM system. The success of this approach is contingent on Air Traffic Control Operators' (ATCOs) willingness to accept increased levels of automation. The main aim of the present research was to examine the drivers underpinning ATCOs' willingness to accept increased utilisation of automation within their role. Two fictitious scenarios involving the application of two new automated decision-making tools were created. The results of an online survey revealed traditional predictors of automation acceptance such as age, trust and job satisfaction explain between 4 and 7% of the variance. Furthermore, these predictors varied depending on the purpose in which the automation was to be employed. These results are discussed from an applied and theoretical perspective. STATEMENT OF RELEVANCE: Efficiency improvements in ATM are required to cater for forecasted increases in air traffic movements. One solution is to increase the utilisation of automation within Air Traffic Control. The present research examines the drivers underpinning air traffic controllers' willingness to accept increased levels of automation in their role.

Overcoming Resistance to Change: An Analysis to the Department of Defense’s Anthrax Vaccine Immunization Program

DTIC Science & Technology

2004-06-01

Prahalad , C. K. (1981). Headquarters influence and strategic control in MNCs. Sloan Management Review, 23(1), 15-29. Gagne, M., Koestner, R...p. 124). Rousseau, et al. (1998) defined trust as “a psychological state comprising the intention to accept vulnerability based on the positive...expectations of the intentions or behavior of another” (p. 395). McAllister (1995) defined trust as “the extent to which a person is confident in and

Managing for climate change on protected areas: An adaptive management decision making framework.

PubMed

Tanner-McAllister, Sherri L; Rhodes, Jonathan; Hockings, Marc

2017-12-15

Current protected area management is becoming more challenging with advancing climate change and current park management techniques may not be adequate to adapt for effective management into the future. The framework presented here provides an adaptive management decision making process to assist protected area managers with adapting on-park management to climate change. The framework sets out a 4 step process. One, a good understanding of the park's context within climate change. Secondly, a thorough understanding of the park management systems including governance, planning and management systems. Thirdly, a series of management options set out as an accept/prevent change style structure, including a systematic assessment of those options. The adaptive approaches are defined as acceptance of anthropogenic climate change impact and attempt to adapt to a new climatic environment or prevention of change and attempt to maintain current systems under new climatic variations. Last, implementation and monitoring of long term trends in response to ecological responses to management interventions and assessing management effectiveness. The framework addresses many issues currently with park management in dealing with climate change including the considerable amount of research focussing on 'off-reserve' strategies, and threats and stress focused in situ park management. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Treesearch

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

1997-01-01

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

MONITORED NATURAL ATTENUATION AND RISK MANAGEMENT OF MTBE AND TBA IN GROUND WATER

EPA Science Inventory

Monitored natural attenuation (as U.S. EPA defines the term) is a remedy, where natural processes bring the concentration of MTBE or TBA to an acceptable level in a reasonable period of time. The longevity of the plume is its critical property. The rate of attenuation is typica...

The Development of Taking Responsibility and Its Influence in Organisations

ERIC Educational Resources Information Center

Klutmann, Beate

2007-01-01

Modern managers expect staff to accept more responsibility. However, not all of them want to take more responsibility. Others complain of not having enough responsibility entrusted to them and expect more autonomy and decision-making. In this paper, responsibility is defined as being accountable and fulfilling one's duty while being in charge.…

Regulatory acceptance and use of 3R models for pharmaceuticals and chemicals: expert opinions on the state of affairs and the way forward.

PubMed

Schiffelers, Marie-Jeanne W A; Blaauboer, Bas J; Bakker, Wieger E; Beken, Sonja; Hendriksen, Coenraad F M; Koëter, Herman B W M; Krul, Cyrille

2014-06-01

Pharmaceuticals and chemicals are subjected to regulatory safety testing accounting for approximately 25% of laboratory animal use in Europe. This testing meets various objections and has led to the development of a range of 3R models to Replace, Reduce or Refine the animal models. However, these models must overcome many barriers before being accepted for regulatory risk management purposes. This paper describes the barriers and drivers and options to optimize this acceptance process as identified by two expert panels, one on pharmaceuticals and one on chemicals. To untangle the complex acceptance process, the multilevel perspective on technology transitions is applied. This perspective defines influences at the micro-, meso- and macro level which need alignment to induce regulatory acceptance of a 3R model. This paper displays that there are many similar mechanisms within both sectors that prevent 3R models from becoming accepted for regulatory risk assessment and management. Shared barriers include the uncertainty about the value of the new 3R models (micro level), the lack of harmonization of regulatory requirements and acceptance criteria (meso level) and the high levels of risk aversion (macro level). In optimizing the process commitment, communication, cooperation and coordination are identified as critical drivers. Copyright © 2014 Elsevier Inc. All rights reserved.

Acceptable knowledge document for INEEL stored transuranic waste -- Rocky Flats Plant waste. Revision 2

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

NONE

1998-01-23

This document and supporting documentation provide a consistent, defensible, and auditable record of acceptable knowledge for waste generated at the Rocky Flats Plant which is currently in the accessible storage inventory at the Idaho National Engineering and Environmental Laboratory. The inventory consists of transuranic (TRU) waste generated from 1972 through 1989. Regulations authorize waste generators and treatment, storage, and disposal facilities to use acceptable knowledge in appropriate circumstances to make hazardous waste determinations. Acceptable knowledge includes information relating to plant history, process operations, and waste management, in addition to waste-specific data generated prior to the effective date of the RCRAmore » regulations. This document is organized to provide the reader a comprehensive presentation of the TRU waste inventory ranging from descriptions of the historical plant operations that generated and managed the waste to specific information about the composition of each waste group. Section 2 lists the requirements that dictate and direct TRU waste characterization and authorize the use of the acceptable knowledge approach. In addition to defining the TRU waste inventory, Section 3 summarizes the historical operations, waste management, characterization, and certification activities associated with the inventory. Sections 5.0 through 26.0 describe the waste groups in the inventory including waste generation, waste packaging, and waste characterization. This document includes an expanded discussion for each waste group of potential radionuclide contaminants, in addition to other physical properties and interferences that could potentially impact radioassay systems.« less

Design of a flight director/configuration management system for piloted STOL approaches

NASA Technical Reports Server (NTRS)

Hoh, R. H.; Klein, R. H.; Johnson, W. A.

1973-01-01

The design and characteristics of a flight director for V/STOL aircraft are discussed. A configuration management system for piloted STOL approaches is described. The individual components of the overall system designed to reduce pilot workload to an acceptable level during curved, decelerating, and descending STOL approaches are defined. The application of the system to augmentor wing aircraft is analyzed. System performance checks and piloted evaluations were conducted on a flight simulator and the results are summarized.

Determining your organization's 'risk capability'.

PubMed

Hannah, Bill; Hancock, Melinda

2014-05-01

An assessment of a provider's level of risk capability should focus on three key elements: Business intelligence, including sophisticated analytical models that can offer insight into the expected cost and quality of care for a given population. Clinical enterprise maturity, marked by the ability to improve health outcomes and to manage utilization and costs to drive change. Revenue transformation, emphasizing the need for a revenue cycle platform that allows for risk acceptance and management and that provides incentives for performance against defined objectives.

Safety analysis report for the Waste Storage Facility. Revision 2

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

Bengston, S.J.

1994-05-01

This safety analysis report outlines the safety concerns associated with the Waste Storage Facility located in the Radioactive Waste Management Complex at the Idaho National Engineering Laboratory. The three main objectives of the report are: define and document a safety basis for the Waste Storage Facility activities; demonstrate how the activities will be carried out to adequately protect the workers, public, and environment; and provide a basis for review and acceptance of the identified risk that the managers, operators, and owners will assume.

Load Balancing Integrated Least Slack Time-Based Appliance Scheduling for Smart Home Energy Management.

PubMed

Silva, Bhagya Nathali; Khan, Murad; Han, Kijun

2018-02-25

The emergence of smart devices and smart appliances has highly favored the realization of the smart home concept. Modern smart home systems handle a wide range of user requirements. Energy management and energy conservation are in the spotlight when deploying sophisticated smart homes. However, the performance of energy management systems is highly influenced by user behaviors and adopted energy management approaches. Appliance scheduling is widely accepted as an effective mechanism to manage domestic energy consumption. Hence, we propose a smart home energy management system that reduces unnecessary energy consumption by integrating an automated switching off system with load balancing and appliance scheduling algorithm. The load balancing scheme acts according to defined constraints such that the cumulative energy consumption of the household is managed below the defined maximum threshold. The scheduling of appliances adheres to the least slack time (LST) algorithm while considering user comfort during scheduling. The performance of the proposed scheme has been evaluated against an existing energy management scheme through computer simulation. The simulation results have revealed a significant improvement gained through the proposed LST-based energy management scheme in terms of cost of energy, along with reduced domestic energy consumption facilitated by an automated switching off mechanism.

Competency-based education in anesthesiology: history and challenges.

PubMed

Ebert, Thomas J; Fox, Chris A

2014-01-01

The Accreditation Council for Graduate Medical Education is transitioning to a competency-based system with milestones to measure progress and define success of residents. The confines of the time-based residency will be relaxed. Curriculum must be redesigned and assessments will need to be precise and in-depth. Core anesthesiology faculty will be identified and will be the "trained observers" of the residents' progress. There will be logistic challenges requiring creative management by program directors. There may be residents who achieve "expert" status earlier than the required 36 months of clinical anesthesia education, whereas others may struggle to achieve acceptable status and will require additional education time. Faculty must accept both extremes without judgment. Innovative new educational opportunities will need to be created for fast learners. Finally, it will be important that residents embrace this change. This will require programs to clearly define the specific aims and measurement endpoints for advancement and success.

Towards the Improvement of the Student Experience of Assessment and Feedback in Construction Management Education

ERIC Educational Resources Information Center

Scott, Lloyd; Fortune, Chris

2013-01-01

It is widely accepted across Higher Education that assessment practices have a link with learning and a key factor in this link is formative assessment. Formative assessment is generally defined as taking place during a module/programme with the express purpose of improving and enhancing student learning. It is important to understand how…

Developing Crew Health Care and Habitability Systems for the Exploration Vision

NASA Technical Reports Server (NTRS)

Laurini, Kathy; Sawin, Charles F.

2006-01-01

This paper will discuss the specific mission architectures associated with the NASA Exploration Vision and review the challenges and drivers associated with developing crew health care and habitability systems to manage human system risks. Crew health care systems must be provided to manage crew health within acceptable limits, as well as respond to medical contingencies that may occur during exploration missions. Habitability systems must enable crew performance for the tasks necessary to support the missions. During the summer of 2005, NASA defined its exploration architecture including blueprints for missions to the moon and to Mars. These mission architectures require research and technology development to focus on the operational risks associated with each mission, as well as the risks to long term astronaut health. This paper will review the highest priority risks associated with the various missions and discuss NASA s strategies and plans for performing the research and technology development necessary to manage the risks to acceptable levels.

Assessing and managing the health risk due to ingestion of inorganic arsenic from fish and shellfish farmed in blackfoot disease areas for general Taiwanese.

PubMed

Liang, Ching-Ping; Liu, Chen-Wuing; Jang, Cheng-Shin; Wang, Sheng-Wei; Lee, Jin-Jing

2011-02-15

This paper assesses health risks due to the ingestion of inorganic arsenic from fish and shellfish farmed in blackfoot disease areas by general public in Taiwan. The provisional tolerable weekly intake of arsenic set by FAO/WHO and the target cancer risk assessment model proposed by USEPA were integrated to evaluate the acceptable consumption rate. Five aquacultural species, tilapia (Oreochromis mossambicus), milkfish (Chanos chanos), mullet (Mugil cephalus), clam (Meretrix lusoria) and oyster (Crassostrea gigas) were included. Monte Carlo analysis was used to propagate the parameter uncertainty and to probabilistically assess the health risk associated with the daily intake of inorganic As from farmed fish and shellfish. The integrated risk-based analysis indicates that the associated 50th and 95th percentile health risk are 2.06×10(-5) and 8.77×10(-5), respectively. Moreover, the acceptable intakes of inorganic As are defined and illustrated by a two dimensional graphical model. According to the relationship between C(inorg) and IR(f) derived from this study, two risk-based curves are constructed. An acceptable risk zone is determined (risk ranging from 1×10(-5) to 6.07×10(-5)) which is recommended for acceptable consumption rates of fish and shellfish. To manage the health risk due to the ingestion of inorganic As from fish and shellfish in BFD areas, a risk-based management scheme is derived which provide a convenient way for general public to self-determine the acceptable seafood consumption rate. Copyright © 2010 Elsevier B.V. All rights reserved.

Improving organisational resilience through enterprise security risk management.

PubMed

Petruzzi, John; Loyear, Rachelle

Enterprise Security Risk Management (ESRM) is a new philosophy and method of managing security programmes through the use of traditional risk principles. As a philosophy and life cycle, ESRM is focused on creating a business partnership between security practitioners and business leaders to more effectively provide protection against security risks in line with acceptable risk tolerances as defined by business asset owners and stakeholders. This paper explores the basics of the ESRM philosophy and life cycle and also shows how embracing the ESRM philosophy and implementing a risk-based security management model in the business organisation can lead to higher levels of organisational resilience as desired by organisation leaders, executives and the board of directors.

The role of point of care ultrasound in prehospital critical care: a systematic review.

PubMed

Bøtker, Morten Thingemann; Jacobsen, Lars; Rudolph, Søren Steemann; Knudsen, Lars

2018-06-26

In 2011, the role of Point of Care Ultrasound (POCUS) was defined as one of the top five research priorities in physician-provided prehospital critical care and future research topics were proposed; the feasibility of prehospital POCUS, changes in patient management induced by POCUS and education of providers. This systematic review aimed to assess these three topics by including studies examining all kinds of prehospital patients undergoing all kinds of prehospital POCUS examinations and studies examining any kind of POCUS education in prehospital critical care providers. By a systematic literature search in MEDLINE, EMBASE, and Cochrane databases, we identified and screened titles and abstracts of 3264 studies published from 2012 to 2017. Of these, 65 studies were read in full-text for assessment of eligibility and 27 studies were ultimately included and assessed for quality by SIGN-50 checklists. No studies compared patient outcome with and without prehospital POCUS. Four studies of acceptable quality demonstrated feasibility and changes in patient management in trauma. Two studies of acceptable quality demonstrated feasibility and changes in patient management in breathing difficulties. Four studies of acceptable quality demonstrated feasibility, outcome prediction and changes in patient management in cardiac arrest, but also that POCUS may prolong pauses in compressions. Two studies of acceptable quality demonstrated that short (few hours) teaching sessions are sufficient for obtaining simple interpretation skills, but not image acquisition skills. Three studies of acceptable quality demonstrated that longer one- or two-day courses including hands-on training are sufficient for learning simple, but not advanced, image acquisition skills. Three studies of acceptable quality demonstrated that systematic educational programs including supervised examinations are sufficient for learning advanced image acquisition skills in healthy volunteers, but that more than 50 clinical examinations are required for expertise in a clinical setting. Prehospital POCUS is feasible and changes patient management in trauma, breathing difficulties and cardiac arrest, but it is unknown if this improves outcome. Expertise in POCUS requires extensive training by a combination of theory, hands-on training and a substantial amount of clinical examinations - a large part of these needs to be supervised.

Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements.

PubMed

El-Sayed, Amel A F

2017-10-01

This review is divided into three parts. The first part briefly describes the pathogenesis of preeclampsia. This is followed by reviewing previously reported management strategies of the disease based on its pathophysiological derangements. Finally, the author defines the safe and acceptable methods/medications that may be used to 'prevent' preeclampsia (in high risk patients) and those that may be used to 'treat' preeclampsia (meant to prolong the pregnancy in patients with established preeclampsia). The review concludes that multi-center trials are required to include multiple drugs in the same management protocol. Copyright © 2017. Published by Elsevier B.V.

The concept of work ability.

PubMed

Tengland, Per-Anders

2011-06-01

The concept of "work ability" is central for many sciences, especially for those related to working life and to rehabilitation. It is one of the important concepts in legislation regulating sickness insurance. How the concept is defined therefore has important normative implications. The concept is, however, often not sufficiently well defined. AIM AND METHOD The objective of this paper is to clarify, through conceptual analysis, what the concept can and should mean, and to propose a useful definition for scientific and practical work. RESULTS Several of the defining characteristics found in the literature are critically scrutinized and discussed, namely health, basic standard competence, occupational competence, occupational virtues, and motivation. These characteristics are related to the work tasks and the work environment. One conclusion is that we need two definitions of work ability, one for specific jobs that require special training or education, and one for jobs that most people can manage given a short period of practice. Having work ability, in the first sense, means having the occupational competence, the health required for the competence, and the occupational virtues that are required for managing the work tasks, assuming that the tasks are reasonable and that the work environment is acceptable. In the second sense, having work ability is having the health, the basic standard competence and the relevant occupational virtues required for managing some kind of job, assuming that the work tasks are reasonable and that the work environment is acceptable. CONCLUSION These definitions give us tools for understanding and discussing the complex, holistic and dynamic aspects of work ability, and they can lay the foundations for the creation of instruments for evaluating work ability, as well as help formulate strategies for rehabilitation.

Investing: reducing risks to enhance returns.

PubMed

West, J; Glickman, S; Seidner, A G

1996-09-01

The financial assets of a healthcare organization can present many opportunities for investment. In order to develop a profitable investment program that avoids risky speculation, however, healthcare financial managers must fully understand the nature and risks of their organizations' investments. They must define and monitor their investment objectives, limitations, levels of acceptable risk and policies and conditions through a statement of investment policy and comprehensive investment guidelines.

Practical approaches for health care: Indoor air quality management

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

Turk, A.R.; Poulakos, E.M.

1996-05-01

The management of indoor air quality (IAQ) is of interest to building occupants, managers, owners, and regulators alike. Whether by poor design, improper attention, inadequate maintenance or the intent to save energy, many buildings today have significantly degraded IAQ levels. Acceptable IAQ is defined by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) in Standard 62-1989 {open_quotes}Ventilation for Acceptable Indoor Air Quality{close_quotes} as {open_quotes}air in which there are no known contaminants at harmful concentrations as determined by cognizant authorities and with which a substantial majority (80 percent or more) of the people exposed do not express dissatisfaction.{close_quotes}more » ASHRAE`s definition not only addresses the chemical compounds that may be present in the air, but it also recognizes a need to address both physiological and psychosocial comfort. The second step is to conduct a performance review of the HVAC systems based on equipment design specifications and guidelines for acceptable IAQ. And the third step is to identify potential chemical, physical and biological sources that are known to contribute to adverse air quality. Upon completion of these three steps, you will able to identify the more significant contributors to IAQ problems and establish applications for prevention and mitigation.« less

Load Balancing Integrated Least Slack Time-Based Appliance Scheduling for Smart Home Energy Management

PubMed Central

Silva, Bhagya Nathali; Khan, Murad; Han, Kijun

2018-01-01

The emergence of smart devices and smart appliances has highly favored the realization of the smart home concept. Modern smart home systems handle a wide range of user requirements. Energy management and energy conservation are in the spotlight when deploying sophisticated smart homes. However, the performance of energy management systems is highly influenced by user behaviors and adopted energy management approaches. Appliance scheduling is widely accepted as an effective mechanism to manage domestic energy consumption. Hence, we propose a smart home energy management system that reduces unnecessary energy consumption by integrating an automated switching off system with load balancing and appliance scheduling algorithm. The load balancing scheme acts according to defined constraints such that the cumulative energy consumption of the household is managed below the defined maximum threshold. The scheduling of appliances adheres to the least slack time (LST) algorithm while considering user comfort during scheduling. The performance of the proposed scheme has been evaluated against an existing energy management scheme through computer simulation. The simulation results have revealed a significant improvement gained through the proposed LST-based energy management scheme in terms of cost of energy, along with reduced domestic energy consumption facilitated by an automated switching off mechanism. PMID:29495346

Management of fear of radiation exposure in carers of outpatients treated with iodine-131.

PubMed

Calais, Phillipe J; Page, Andrew C; Turner, J Harvey

2012-07-01

To characterise potential fear of radiation exposure in a normal population of individuals who have volunteered to care for a radioactive family member or friend after outpatient radioimmunotherapy (RIT) treatment for cancer, and obtain their knowing and willing acceptance of the risk. Over 750 carers of 300 patients confined to their homes for 1 week following outpatient iodine-131 rituximab RIT of lymphoma were interviewed by a nuclear medicine physicist according to a multi-visit integrated protocol designed to minimise radiation exposure, define risk and gain informed consent. Median radiation exposure of carers was 0.49 mSv (range 0.01-3.7 mSv) which is below the Western Australian regulatory limit of 5 mSv for consenting adult carers of radioactive patients. After signing a declaration of consent, only 2 carers of 750 abrogated their responsibility and none of those who carried out their duties expressed residual concerns at the end of the exit interview with respect to their radiation exposure. Fear of radiation exposure in a normal population may be characterised as a normal emotional response. In the special case of carers of radioactive patients, this fear may be successfully managed by rational, authoritative and empathic explanation to define the risk and gain willing acceptance within the context of domiciliary patient care.

Insights into managed care--operational, legal and actuarial.

PubMed

Melek, S P; Johnson, B A; Schryver, D

1997-01-01

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

Physician and Staff Acceptance of Care Managers in Primary Care Offices.

PubMed

Malouin, Jean M; Malouin, Rebecca A; Sarinopoulos, Issidoros; Beisel, Marie; Bechel-Marriot, Diane; First, Amanda; Gamble, Ginger M; Tanner, Clare

2017-01-01

Embedded care managers are increasingly implemented as part of the care team within primary care practices, yet previous studies have indicated variability in acceptance by physicians and staff. This study assesses the acceptability of care managers among staff and physicians within the Michigan Primary Care Transformation (MiPCT) demonstration. Care manager acceptance was measured using a web-based survey distributed to practices participating in the MiPCT demonstration. Both physicians and staff reported high levels of care manager acceptance. Longer length of care manager employment at the practice, higher care manager FTE dedicated to care management, and care manager employed by practice were all significantly associated with care manager acceptance. The MiPCT demonstration found high care manager acceptance across all care team members. The high level of acceptance may be due to the structures and processes developed by MiPCT to support implementation of care managers and the length of the intervention period. The MiPCT demonstration confirms that following three years of implementation, embedded care managers are acceptable to both physicians and staff within primary care practices. Importantly, embeddedness, or the amount of time care managers are located within practices, is associated with increased acceptance. © Copyright 2017 by the American Board of Family Medicine.

How family carers engage with technical health procedures in the home: a grounded theory study

PubMed Central

McDonald, Janet; McKinlay, Eileen; Keeling, Sally; Levack, William

2015-01-01

Objectives To explore the experiences of family carers who manage technical health procedures at home and describe their learning process. Design A qualitative study using grounded theory. Participants New Zealand family carers (21 women, 5 men) who managed technical health procedures such as enteral feeding, peritoneal dialysis, tracheostomy care, a central venous line or urinary catheter. In addition, 15 health professionals involved in teaching carers were interviewed. Methods Semistructured interviews were coded soon after completion and preliminary analysis influenced subsequent interviews. Additional data were compared with existing material and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was described. Interviewing continued until no new ideas emerged and concepts were well defined. Results The response of carers to the role of managing technical health procedures in the home is presented in terms of five dispositions: (1) Embracing care, (2) Resisting, (3) Reluctant acceptance, (4) Relinquishing and (5) Being overwhelmed. These dispositions were not static and carers commonly changed between them. Embracing care included cognitive understanding of the purpose and benefits of a procedure; accepting a ‘technical’ solution; practical management; and an emotional response. Accepting embrace is primarily motivated by perceived benefits for the recipient. It may also be driven by a lack of alternatives. Resisting or reluctant acceptance results from a lack of understanding about the procedure or willingness to manage it. Carers need adequate support to avoid becoming overwhelmed, and there are times when it is appropriate to encourage them to relinquish care for the sake of their own needs. Conclusions The concept of embracing care encourages health professionals to extend their attention beyond simply the practical aspects of technical procedures to assessing and addressing carers’ emotional and behavioural responses to health technology during the training process. PMID:26150143

How family carers engage with technical health procedures in the home: a grounded theory study.

PubMed

McDonald, Janet; McKinlay, Eileen; Keeling, Sally; Levack, William

2015-07-06

To explore the experiences of family carers who manage technical health procedures at home and describe their learning process. A qualitative study using grounded theory. New Zealand family carers (21 women, 5 men) who managed technical health procedures such as enteral feeding, peritoneal dialysis, tracheostomy care, a central venous line or urinary catheter. In addition, 15 health professionals involved in teaching carers were interviewed. Semistructured interviews were coded soon after completion and preliminary analysis influenced subsequent interviews. Additional data were compared with existing material and as analysis proceeded, initial codes were grouped into higher order concepts until a core concept was described. Interviewing continued until no new ideas emerged and concepts were well defined. The response of carers to the role of managing technical health procedures in the home is presented in terms of five dispositions: (1) Embracing care, (2) Resisting, (3) Reluctant acceptance, (4) Relinquishing and (5) Being overwhelmed. These dispositions were not static and carers commonly changed between them. Embracing care included cognitive understanding of the purpose and benefits of a procedure; accepting a 'technical' solution; practical management; and an emotional response. Accepting embrace is primarily motivated by perceived benefits for the recipient. It may also be driven by a lack of alternatives. Resisting or reluctant acceptance results from a lack of understanding about the procedure or willingness to manage it. Carers need adequate support to avoid becoming overwhelmed, and there are times when it is appropriate to encourage them to relinquish care for the sake of their own needs. The concept of embracing care encourages health professionals to extend their attention beyond simply the practical aspects of technical procedures to assessing and addressing carers' emotional and behavioural responses to health technology during the training process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Recommended approach to sofware development

NASA Technical Reports Server (NTRS)

Mcgarry, F. E.; Page, J.; Eslinger, S.; Church, V.; Merwarth, P.

1983-01-01

A set of guideline for an organized, disciplined approach to software development, based on data collected and studied for 46 flight dynamics software development projects. Methods and practices for each phase of a software development life cycle that starts with requirements analysis and ends with acceptance testing are described; maintenance and operation is not addressed. For each defined life cycle phase, guidelines for the development process and its management, and the products produced and their reviews are presented.

Forecasting Traditional vs Blended Retirement System for Individual Service Members

DTIC Science & Technology

2017-03-23

Service (IRS) puts retirement plan options offered to employees into four categories: profit-sharing plans, defined benefit plans, money purchase...Retirement System to allow the continuation pay to be offered at no less than eight years of service and no more than 12 years of service . The acceptance... Service Members Kevin M. Dwyer Follow this and additional works at: https://scholar.afit.edu/etd Part of the Business Administration, Management, and

Recommended approach to software development, revision 3

NASA Technical Reports Server (NTRS)

Landis, Linda; Waligora, Sharon; Mcgarry, Frank; Pajerski, Rose; Stark, Mike; Johnson, Kevin Orlin; Cover, Donna

1992-01-01

Guidelines for an organized, disciplined approach to software development that is based on studies conducted by the Software Engineering Laboratory (SEL) since 1976 are presented. It describes methods and practices for each phase of a software development life cycle that starts with requirements definition and ends with acceptance testing. For each defined life cycle phase, guidelines for the development process and its management, and for the products produced and their reviews are presented.

In acceptance we trust? Conceptualising acceptance as a viable approach to NGO security management.

PubMed

Fast, Larissa A; Freeman, C Faith; O'Neill, Michael; Rowley, Elizabeth

2013-04-01

This paper documents current understanding of acceptance as a security management approach and explores issues and challenges non-governmental organisations (NGOs) confront when implementing an acceptance approach to security management. It argues that the failure of organisations to systematise and clearly articulate acceptance as a distinct security management approach and a lack of organisational policies and procedures concerning acceptance hinder its efficacy as a security management approach. The paper identifies key and cross-cutting components of acceptance that are critical to its effective implementation in order to advance a comprehensive and systematic concept of acceptance. The key components of acceptance illustrate how organisational and staff functions affect positively or negatively an organisation's acceptance, and include: an organisation's principles and mission, communications, negotiation, programming, relationships and networks, stakeholder and context analysis, staffing, and image. The paper contends that acceptance is linked not only to good programming, but also to overall organisational management and structures. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

Experimental application of Business Process Management technology to manage clinical pathways: a pediatric kidney transplantation follow up case.

PubMed

Andellini, Martina; Fernandez Riesgo, Sandra; Morolli, Federica; Ritrovato, Matteo; Cosoli, Piero; Petruzzellis, Silverio; Rosso, Nicola

2017-11-03

To test the application of Business Process Management technology to manage clinical pathways, using a pediatric kidney transplantation as case study, and to identify the benefits obtained from using this technology. Using a Business Process Management platform, we implemented a specific application to manage the clinical pathway of pediatric patients, and monitored the activities of the coordinator in charge of the case management during a 6-month period (from June 2015 to November 2015) using two methodologies: the traditional procedure and the one under study. The application helped physicians and nurses to optimize the amount of time and resources devoted to management purposes. In particular, time reduction was close to 60%. In addition, the reduction of data duplication, the integrated event management and the efficient data collection improved the quality of the service. The use of Business Process Management technology, usually related to well-defined processes with high management costs, is an established procedure in multiple environments; its use in healthcare, however, is innovative. The use of already accepted clinical pathways is known to improve outcomes. The combination of these two techniques, well established in their respective areas of application, could represent a revolution in clinical pathway management. The study has demonstrated that the use of this technology in a clinical environment, using a proper architecture and identifying a well-defined process, leads to real benefits in terms of resources optimization and quality improvement.

Food safety objectives for Listeria monocytogenes in Spanish food sampled in cafeterias and restaurants.

PubMed

Doménech, E; Amorós, J A; Escriche, I

2011-09-01

To gain more insight into the context of food safety management by public administrations, food safety objectives must be studied. The Valencian administration quantified the prevalence of Listeria monocytogenes in cafeterias and restaurants in this region of Spain between 2002 and 2010. The results obtained from this survey are presented here for 2,262 samples of fish, salad, egg, cold meat, and mayonnaise dishes. Microbiological criteria defined for L. monocytogenes were used to differentiate acceptable and unacceptable samples; more than 99.9% of the samples were acceptable. These findings indicate that established food safety objectives are achievable, consumer health at the time of consumption can be safeguarded, and food safety management systems such as hazard analysis critical control point plans or good manufacturing practices implemented in food establishments are effective. Monitoring of foods and food safety is an important task that must continue to reduce the current L. monocytogenes prevalence of 0.1% in restaurant or cafeteria dishes, which could adversely affect consumer health.

Questioning the Faith - Models and Prediction in Stream Restoration (Invited)

NASA Astrophysics Data System (ADS)

Wilcock, P.

2013-12-01

River management and restoration demand prediction at and beyond our present ability. Management questions, framed appropriately, can motivate fundamental advances in science, although the connection between research and application is not always easy, useful, or robust. Why is that? This presentation considers the connection between models and management, a connection that requires critical and creative thought on both sides. Essential challenges for managers include clearly defining project objectives and accommodating uncertainty in any model prediction. Essential challenges for the research community include matching the appropriate model to project duration, space, funding, information, and social constraints and clearly presenting answers that are actually useful to managers. Better models do not lead to better management decisions or better designs if the predictions are not relevant to and accepted by managers. In fact, any prediction may be irrelevant if the need for prediction is not recognized. The predictive target must be developed in an active dialog between managers and modelers. This relationship, like any other, can take time to develop. For example, large segments of stream restoration practice have remained resistant to models and prediction because the foundational tenet - that channels built to a certain template will be able to transport the supplied sediment with the available flow - has no essential physical connection between cause and effect. Stream restoration practice can be steered in a predictive direction in which project objectives are defined as predictable attributes and testable hypotheses. If stream restoration design is defined in terms of the desired performance of the channel (static or dynamic, sediment surplus or deficit), then channel properties that provide these attributes can be predicted and a basis exists for testing approximations, models, and predictions.

[How to establish the hospital information system security policies].

PubMed

Gong, Qing-Yue; Shi, Cheng

2008-03-01

It is important to establish the hospital information system security policies. While these security policies are being established, a comprehensive consideration should be given to the acceptable levels of users, IT supporters and hospital managers. We should have a formal policy designing process that is consistently followed by all security policies. Reasons for establishing the security policies and their coverage and applicable objects should be stated clearly. Besides, each policy should define user's responsibilities and penalties of violation. Every organization will need some key policies, such as of information sources usage, remote access, information protection, perimeter security, and baseline host/device security. Security managing procedures are the mechanisms to enforce the policies. An incident-handling procedure is the most important security managing procedure for all organizations.

Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework.

PubMed

Sekhon, Mandeep; Cartwright, Martin; Francis, Jill J

2017-01-26

It is increasingly acknowledged that 'acceptability' should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions.

Unique Regulatory Approach for Licensing the Port Hope Remediation Project in Canada - 13315

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

Kostova, M.; Howard, D.; Elder, P.

2013-07-01

The Port Hope remediation project is a part of a larger initiative of the Canadian Federal Government the Port Hope Area Initiative (PHAI) which is based upon a community proposal. The Government of Canada, through Natural Resources Canada (NRCan) is investing $1.28 billion over 10 years to clean up historic low-level radioactive waste in the Port Hope Area and to provide long-term safe management of the low-level radioactive wastes in the Port Hope Area. These wastes arose from the activities of a former Federal Crown Corporation (Eldorado Nuclear) and its private sector predecessors. In Canada, historic waste are defined asmore » low-level radioactive waste that was managed in a manner no longer considered acceptable, but for which the original producer cannot reasonably be held responsible or no longer exists and for which the Federal Government has accepted responsibility. In Canada, under the current regulatory framework, the environmental remediation is not considered as a distinct phase of the nuclear cycle. The regulatory approach for dealing with existing sites contaminated with radioactive residues is defined on the basis of risk and application of existing regulations. A unique regulatory approach was taken by the Canadian Nuclear Safety Commission (CNSC) to address the various licensing issues and to set out the requirements for licensing of the Port Hope Project within the current regulatory framework. (authors)« less

Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease

PubMed Central

Andreyev, H Jervoise N; Muls, Ann C; Norton, Christine; Ralph, Charlotte; Watson, Lorraine; Shaw, Clare; Lindsay, James O

2015-01-01

Background A recent randomised trial suggested that an algorithmic approach to investigating and managing gastrointestinal symptoms of pelvic radiation disease (PRD) is beneficial and that specially trained nurses can manage patients as effectively as a gastroenterologist. Aims The aim of the development and peer review of the guide was to make the algorithm used in the trial accessible to all levels of clinician. Methods Experts who manage patients with PRD were asked to review the guide, rating each section for agreement with the recommended measures and suggesting amendments if necessary. Specific comments were discussed and incorporated as appropriate, and this process was repeated for a second round of review. Results 34 gastroenterologists, 10 nurses, 9 dietitians, 7 surgeons and 5 clinical oncologists participated in round one. Consensus (defined prospectively as 60% or more panellists selecting ‘strongly agree’ or ‘agree’) was reached for 27 of the original 28 sections in the guide, with a median of 75% of panellists agreeing with each section. 86% of panellists agreed that the guide was acceptable for publication or acceptable with minor revisions. 55 of the original 65 panellists participated in round two. 89% agreed it was acceptable for publication after the first revision. Further minor amendments were made in response to round two. Conclusions Development of the guide in response to feedback included ▸ improvement of occasional algorithmic steps ▸ a more user-friendly layout ▸ clearer timeframes for referral to other teams ▸ expansion of reference list ▸ addition of procedures to the appendix. PMID:25580207

Performance Evaluation of Resource Management in Cloud Computing Environments.

PubMed

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price.

Performance Evaluation of Resource Management in Cloud Computing Environments

PubMed Central

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price. PMID:26555730

Risk Management for Human Support Technology Development

NASA Technical Reports Server (NTRS)

jones, Harry

2005-01-01

NASA requires continuous risk management for all programs and projects. The risk management process identifies risks, analyzes their impact, prioritizes them, develops and carries out plans to mitigate or accept them, tracks risks and mitigation plans, and communicates and documents risk information. Project risk management is driven by the project goal and is performed by the entire team. Risk management begins early in the formulation phase with initial risk identification and development of a risk management plan and continues throughout the project life cycle. This paper describes the risk management approach that is suggested for use in NASA's Human Support Technology Development. The first step in risk management is to identify the detailed technical and programmatic risks specific to a project. Each individual risk should be described in detail. The identified risks are summarized in a complete risk list. Risk analysis provides estimates of the likelihood and the qualitative impact of a risk. The likelihood and impact of the risk are used to define its priority location in the risk matrix. The approaches for responding to risk are either to mitigate it by eliminating or reducing the effect or likelihood of a risk, to accept it with a documented rationale and contingency plan, or to research or monitor the risk, The Human Support Technology Development program includes many projects with independently achievable goals. Each project must do independent risk management, considering all its risks together and trading them against performance, budget, and schedule. Since the program can succeed even if some projects fail, the program risk has a complex dependence on the individual project risks.

Voice, perceived fairness, agency trust, and acceptance of management decisions among Minnesota anglers

USGS Publications Warehouse

Schroeder, Susan A.; Fulton, David C.

2017-01-01

Although researchers agree that public participation in natural resource decision making is critical to institutional acceptance by stakeholders and the general public, the processes to gain public perceptions of fairness, agency trust, and acceptance of management decisions are not clear. Using results from a mail survey of Minnesota resident anglers, we used structural equation modeling to examine how instrumental versus symbolic motives related to anglers’ perceptions of agency fairness, trustworthiness, and ultimately acceptance of fisheries management decisions. We applied laboratory research on relationships among procedural fairness, trust, and management acceptance, and then tested models incorporating anglers’ perceptions of voice for anglers and nonanglers in management decisions. Results suggested that trust fully mediated the relationship between procedural fairness and management acceptance. Angler perceptions of angler and nonangler voice both related to views of procedural fairness, but angler voice was more strongly related and was also significantly related to acceptance of management decisions.

Specifying content and mechanisms of change in interventions to change professionals' practice: an illustration from the Good Goals study in occupational therapy.

PubMed

Kolehmainen, Niina; Francis, Jill J

2012-10-18

It is widely agreed that interventions to change professionals' practice need to be clearly specified. This involves (1) selecting and defining the intervention techniques, (2) operationalising the techniques and deciding their delivery, and (3) formulating hypotheses about the mechanisms through which the techniques are thought to result in change. Descriptions of methods to achieve these objectives are limited. This paper reports methods and illustrates outputs from a study to meet these objectives, specifically from the Good Goals study to improve occupational therapists' caseload management practice. (1) Behaviour change techniques were identified and selected from an existing matrix that maps techniques to determinants. An existing coding manual was used to define the techniques. (2) A team of occupational therapists generated context-relevant, acceptable modes of delivery for the techniques; these data were compared and contrasted with previously collected data, literature on caseload management, and the aims of the intervention. (3) Hypotheses about the mechanisms of change were formulated by drawing on the matrix and on theories of behaviour change. (1) Eight behaviour change techniques were selected: goal specified; self-monitoring; contract; graded tasks; increasing skills (problem solving, decision making, goal setting); coping skills; rehearsal of relevant skills; social processes of encouragement, support, and pressure; demonstration by others; and feedback. (2) A range of modes of delivery were generated (e.g., graded tasks' consisting of series of clinical cases and situations that become increasingly difficult). Conditions for acceptable delivery were identified (e.g., 'self-monitoring' was acceptable only if delivered at team level). The modes of delivery were specified as face-to-face training, task sheets, group tasks, DVDs, and team-based weekly meetings. (3) The eight techniques were hypothesized to target caseload management practice through eleven mediating variables. Three domains were hypothesized to be most likely to change: beliefs about capabilities, motivation and goals, and behavioural regulation. The project provides an exemplar of a systematic and reportable development of a quality-improvement intervention, with its methods likely to be applicable to other projects. A subsequent study of the intervention has provided early indication that use of systematic methods to specify interventions may help to maximize acceptability and effectiveness.

A Contract Between Science and Society

NASA Astrophysics Data System (ADS)

Dowdeswell, Elizabeth

2009-05-01

Growing energy demand, global climate disruption and the prospect of a carbon-constrained world have opened the door for discussion of a potential nuclear renaissance. The fact that deployment of nuclear energy has not been fully embraced points to a number of challenges. These range from concerns about safety, security and proliferation of nuclear materials to questions of feasibiity and economics. Others cite the continuing quest for an acceptable approach to the management of long-lived wastes and uncertainty about risks to human health and the environment. Arguably public acceptance of nuclear energy will require policy makers to examine many social and ethical concerns, both real and perceived. Yet research suggests that public trust in governments and institutions is eroding while society's expectations to be involved in decision-making have become more intense and sophisticated. The recent Canadian experience of selecting an approach for the long-term management of used nuclear fuel illustrates the complexity of obtaining a ``social licence'' to proceed. A key objective was to gather and document the terms and conditions that would make such a project acceptable to society and to reflect a fundamental understanding and respect for these factors in the project's actual design and implementation. The underlying philosophy was that the analysis of scientific and technical evidence, while essential, could not be the sole determining factor. Ultimately it is society that will determine which risks it is prepared to accept. The mission of developing collaboratively with Canadians a management approach that would be socially acceptable, technically sound, environmentally responsible and economically feasible required the development of an integrated, systemic analytical framework and an interactive and transparent process of dialogue and deliberation. This investment in seeking diversity of perspectives resulted in the mergence of common ground among citizens and specialists. It defined the terms of a socio-scientific contract: safety, fairness and flexibility and taught us the importance of continuing to earn trust and confidence.

Conceptualising and managing trade-offs in sustainability assessment

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

Morrison-Saunders, Angus, E-mail: A.Morrison-Saunders@murdoch.edu.au; School of Environmental Science, Murdoch University; Pope, Jenny

One of the defining characteristics of sustainability assessment as a form of impact assessment is that it provides a forum for the explicit consideration of the trade-offs that are inherent in complex decision-making processes. Few sustainability assessments have achieved this goal though, and none has considered trade-offs in a holistic fashion throughout the process. Recent contributions such as the Gibson trade-off rules have significantly progressed thinking in this area by suggesting appropriate acceptability criteria for evaluating substantive trade-offs arising from proposed development, as well as process rules for how evaluations of acceptability should occur. However, there has been negligible uptakemore » of these rules in practice. Overall, we argue that there is inadequate consideration of trade-offs, both process and substantive, throughout the sustainability assessment process, and insufficient considerations of how process decisions and compromises influence substantive outcomes. This paper presents a framework for understanding and managing both process and substantive trade-offs within each step of a typical sustainability assessment process. The framework draws together previously published literature and offers case studies that illustrate aspects of the practical application of the framework. The framing and design of sustainability assessment are vitally important, as process compromises or trade-offs can have substantive consequences in terms of sustainability outcomes delivered, with the choice of alternatives considered being a particularly significant determinant of substantive outcomes. The demarcation of acceptable from unacceptable impacts is a key aspect of managing trade-offs. Offsets can be considered as a form of trade-off within a category of sustainability that are utilised to enhance preferred alternatives once conditions of impact acceptability have been met. In this way they may enable net gains to be delivered; another imperative for progress to sustainability. Understanding the nature and implications of trade-offs within sustainability assessment is essential to improving practice. - Highlights: Black-Right-Pointing-Pointer A framework for understanding trade-offs in sustainability assessment is presented. Black-Right-Pointing-Pointer Trade-offs should be considered as early as possible in any sustainability assessment process. Black-Right-Pointing-Pointer Demarcation of acceptable from unacceptable impacts is needed for effective trade-off management. Black-Right-Pointing-Pointer Offsets in place, time or kind can ensure and attain a net benefit outcome overall. Black-Right-Pointing-Pointer Gibson's trade-off rules provide useful acceptability criteria and process guidance.« less

The Naval Enlisted Aviation Maintenance Manpower System: Advancing Readiness Through Improved Utilization of Intellectual Capital

DTIC Science & Technology

2011-09-01

human capital can be. The other 2 important aspect of human capital which differentiates it from any other form of capital is its requirement to...century, management has come to accept that people, not cash, buildings, or equipment, are the critical differentiators of a business enterprise. (Fitz...capital” as what has been referred to as a “critical differentiator .” Differentiator , from the word differentiate , is defined as “to form or mark

The problem of institutional fit in integrated water resources management: A case of Zimbabwe’s Mazowe catchment

NASA Astrophysics Data System (ADS)

Chereni, A.

Integrated Water Resources Management (IWRM) concepts have now been accepted in various contexts and efforts are now being made to implement these concepts. Zimbabwe adopted and indigenized IWRM within the 1990s Water Reforms and stakeholder institutions designed to engender cross-sectoral efforts are now in place. Using evidence from Mazowe Catchment, this paper observes that far from fostering integration, institutions involved in water resources management are multiple, disparate and discordant. In practice, associational relationships - specifications of mandate based roles, lines and direction of accountability and evaluation criteria - of institutions intended to foster sectoral integration in natural resources management are not defined. These poorly defined associational relationships coupled with a dearth of a catchment management and development outline plan have translated into a lack of compulsion of duty among institutions. The study derives its evidence from a blend of qualitative unstructured interviews, participant observation and secondary sources. Although the weaknesses of IWRM are more contextual, it is argued, there are certain weaknesses that are also conceptual. IWRM, it is argued, has to contend with a growing plethora of methodological and motivational questions. Whilst it is agreeable within IWRM discourse that institutions need to be integrated, in practice, the approach falls short of a methodological approach that addresses ways in which the various aspects of these disparate institutions could be harmonized. The paper suggests that associational relationships or modes of interaction among institutions need to be defined. This definition should be based on a catchment development master plan.

An analysis of electronic document management in oncology care.

PubMed

Poulter, Thomas; Gannon, Brian; Bath, Peter A

2012-06-01

In this research in progress, a reference model for the use of electronic patient record (EPR) systems in oncology is described. The model, termed CICERO, comprises technical and functional components, and emphasises usability, clinical safety and user acceptance. One of the functional components of the model-an electronic document and records management (EDRM) system-is monitored in the course of its deployment at a leading oncology centre in the UK. Specifically, the user requirements and design of the EDRM solution are described.The study is interpretative and forms part a wider research programme to define and validate the CICERO model. Preliminary conclusions confirm the importance of a socio-technical perspective in Onco-EPR system design.

Art of disaster preparedness in European union: a survey on the health systems.

PubMed

Djalali, Ahmadreza; Della Corte, Francesco; Foletti, Marco; Ragazzoni, Luca; Ripoll Gallardo, Alba; Lupescu, Olivera; Arculeo, Chris; von Arnim, Götz; Friedl, Tom; Ashkenazi, Michael; Fischer, Philipp; Hreckovski, Boris; Khorram-Manesh, Amir; Komadina, Radko; Lechner, Konstanze; Patru, Cristina; Burkle, Frederick M; Ingrassia, Pier Luigi

2014-12-17

Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries. A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient. Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%). This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal. Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union.

Art of Disaster Preparedness in European Union: a Survey on the Health Systems

PubMed Central

Djalali, Ahmadreza; Della Corte, Francesco; Foletti, Marco; Ragazzoni, Luca; Ripoll Gallardo, Alba; Lupescu, Olivera; Arculeo, Chris; von Arnim, Götz; Friedl, Tom; Ashkenazi, Michael; Fischer, Philipp; Hreckovski, Boris; Khorram-Manesh, Amir; Komadina, Radko; Lechner, Konstanze; Patru, Cristina; Burkle, Frederick M.; Ingrassia, Pier Luigi

2014-01-01

Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries. Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient. Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%). Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal. Keywords: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union PMID:25685628

Solid Waste Management Requirements Definition for Advanced Life Support Missions: Results

NASA Technical Reports Server (NTRS)

Alazraki, Michael P.; Hogan, John; Levri, Julie; Fisher, John; Drysdale, Alan

2002-01-01

Prior to determining what Solid Waste Management (SWM) technologies should be researched and developed by the Advanced Life Support (ALS) Project for future missions, there is a need to define SWM requirements. Because future waste streams will be highly mission-dependent, missions need to be defined prior to developing SWM requirements. The SWM Working Group has used the mission architecture outlined in the System Integration, Modeling and Analysis (SIMA) Element Reference Missions Document (RMD) as a starting point in the requirement development process. The missions examined include the International Space Station (ISS), a Mars Dual Lander mission, and a Mars Base. The SWM Element has also identified common SWM functionalities needed for future missions. These functionalities include: acceptance, transport, processing, storage, monitoring and control, and disposal. Requirements in each of these six areas are currently being developed for the selected missions. This paper reviews the results of this ongoing effort and identifies mission-dependent resource recovery requirements.

Managing scuba divers to meet ecological goals for coral reef conservation.

PubMed

Sorice, Michael G; Oh, Chi-Ok; Ditton, Robert B

2007-06-01

Marine protected areas increasingly are challenged to maintain or increase tourism benefits while adequately protecting resources. Although carrying capacity strategies can be used to cope with use-related impacts, there is little understanding of divers themselves, their management preferences, and how preferences relate to conservation goals. By using a stated preference choice modeling approach, we investigated the choices divers make in selecting diving trips to marine protected areas as defined by use level, access, level of supervision, fees, conservation education, and diving expectations. Logit models showed that divers preferred a more restrictive management scenario over the status quo. Divers favored reductions in the level of site use and increased levels of conservation education. Divers did not favor fees to access protected areas, having less access to the resource, or extensive supervision. Finally, divers were much more willing to accept increasingly restrictive management scenarios when they could expect to see increased marine life.

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.

Fluvial geomorphology and river engineering: future roles utilizing a fluvial hydrosystems framework

NASA Astrophysics Data System (ADS)

Gilvear, David J.

1999-12-01

River engineering is coming under increasing public scrutiny given failures to prevent flood hazards and economic and environmental concerns. This paper reviews the contribution that fluvial geomorphology can make in the future to river engineering. In particular, it highlights the need for fluvial geomorphology to be an integral part in engineering projects, that is, to be integral to the planning, implementation, and post-project appraisal stages of engineering projects. It should be proactive rather than reactive. Areas in which geomorphologists will increasingly be able to complement engineers in river management include risk and environmental impact assessment, floodplain planning, river audits, determination of instream flow needs, river restoration, and design of ecologically acceptable channels and structures. There are four key contributions that fluvial geomorphology can make to the engineering profession with regard to river and floodplain management: to promote recognition of lateral, vertical, and downstream connectivity in the fluvial system and the inter-relationships between river planform, profile, and cross-section; to stress the importance of understanding fluvial history and chronology over a range of time scales, and recognizing the significance of both palaeo and active landforms and deposits as indicators of levels of landscape stability; to highlight the sensitivity of geomorphic systems to environmental disturbances and change, especially when close to geomorphic thresholds, and the dynamics of the natural systems; and to demonstrate the importance of landforms and processes in controlling and defining fluvial biotopes and to thus promote ecologically acceptable engineering. Challenges facing fluvial geomorphology include: gaining full acceptance by the engineering profession; widespread utilization of new technologies including GPS, GIS, image analysis of satellite and airborne remote sensing data, computer-based hydraulic modeling and geophysical techniques; dovetailing engineering approaches to the study of river channels which emphasize reach-scale flow resistance, shear stresses, and material strength with catchment scale geomorphic approaches, empirical predictions, bed and bank processes, landform evolution, and magnitude-frequency concepts; producing accepted river channel typologies; fundamental research aimed at producing more reliable deterministic equations for prediction of bed and bank stability and bedload transport; and collaboration with aquatic biologists to determine the role and importance of geomorphologically and hydraulically defined habitats.

A preliminary evaluation of the ability of from-reactor casks to geometrically accommodate commercial LWR spent nuclear fuel

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

Andress, D.; Joy, D.S.; McLeod, N.B.

The Department of Energy has sponsored a number of cask design efforts to define several transportation casks to accommodate the various assemblies expected to be accepted by the Federal Waste Management System. At this time, three preliminary cask designs have been selected for the final design--the GA-4 and GA-9 truck casks and the BR-100 rail cask. In total, this assessment indicates that the current Initiative I cask designs can be expected to dimensionally accommodate 100% of the PWR fuel assemblies (other than the extra-long South Texas Fuel) with control elements removed, and >90% of the assemblies having the control elementsmore » as an integral part of the fuel assembly. For BWR assemblies, >99% of the assemblies can be accommodated with fuel channels removed. This paper summarizes preliminary results of one part of that evaluation related to the ability of the From-Reactor Initiative I casks to accommodate the physical and radiological characteristics of the Spent Nuclear Fuel projected to be accepted into the Federal Waste Management System. 3 refs., 5 tabs.« less

Applicability of an established management algorithm for colon injuries following blunt trauma.

PubMed

Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Shahan, Charles P; Cullinan, Darren R; Fabian, Timothy C; Croce, Martin A

2013-02-01

Operative management at our institution for all colon injuries have followed a defined algorithm (ALG) based on risk factors originally identified for penetrating injuries. The purpose of this study was to evaluate the applicability of the ALG to blunt colon injuries. Patients with blunt colon injuries during 13 years were identified. As per the ALG, nondestructive (ND) injuries are treated with primary repair. Patients with destructive wounds (serosal tear of ≥50% colon circumference, mesenteric devascularization, and perforations) and concomitant risk factors (transfusion of >6 U packed red blood cells and/or presence of significant comorbidities) are diverted, while patients with no risk factors undergo resection plus anastomosis (RA). Outcomes included suture line failure (SLF), abscess, and mortality. Stratification analysis was performed to determine additional risk factors in the management of blunt colon injuries. A total 151 patients were identified: 76 with destructive injuries and 75 with ND injuries. Of those with destructive injuries, 44 (59%) underwent RA and 29 (39%) underwent diversion. All ND injuries underwent primary repair. Adherence to the ALG was 95%: three patients with destructive injuries underwent primary repair, and five patients with risk factors underwent RA. There were three SLFs (2%) (one involved deviation from the ALG) and eight abscesses (5%). Colon-related mortality was 2.1%. Stratification analysis based on mesenteric involvement, degree of shock, and need for abbreviated laparotomy failed to identify additional risk factors for SLF following RA for blunt colon injuries. Adherence to an ALG, originally defined for penetrating colon injuries, simplified the management of blunt colon injuries. ND injuries should be primarily repaired. For destructive wounds, management based on a defined ALG achieves an acceptably low morbidity and mortality rate. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

MINIS: Multipurpose Interactive NASA Information System

NASA Technical Reports Server (NTRS)

1976-01-01

The Multipurpose Interactive NASA Information Systems (MINIS) was developed in response to the need for a data management system capable of operation on several different minicomputer systems. The desired system had to be capable of performing the functions of a LANDSAT photo descriptive data retrieval system while remaining general in terms of other acceptable user definable data bases. The system also had to be capable of performing data base updates and providing user-formatted output reports. The resultant MINI System provides all of these capabilities and several other features to complement the data management system. The MINI System is currently implemented on two minicomputer systems and is in the process of being installed on another minicomputer system. The MINIS is operational on four different data bases.

How the definition of acceptable antigens and epitope analysis can facilitate transplantation of highly sensitized patients with excellent long-term graft survival.

PubMed

Heidt, Sebastiaan; Haasnoot, Geert W; Claas, Frans H J

2018-05-24

Highly sensitized patients awaiting a renal transplant have a low chance of receiving an organ offer. Defining acceptable antigens and using this information for allocation purposes can vastly enhance transplantation of this subgroup of patients, which is the essence of the Eurotransplant Acceptable Mismatch program. Acceptable antigens can be determined by extensive laboratory testing, as well as on basis of human leukocyte antigen (HLA) epitope analyses. Within the Acceptable Mismatch program, there is no effect of HLA mismatches on long-term graft survival. Furthermore, patients transplanted through the Acceptable Mismatch program have similar long-term graft survival to nonsensitized patients transplanted through regular allocation. Although HLA epitope analysis is already being used for defining acceptable HLA antigens for highly sensitized patients in the Acceptable Mismatch program, increasing knowledge on HLA antibody - epitope interactions will pave the way toward the definition of acceptable epitopes for highly sensitized patients in the future. Allocation based on acceptable antigens can facilitate transplantation of highly sensitized patients with excellent long-term graft survival.

Alchemy to reason: Effective use of Cumulative Effects Assessment in resource management

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

Hegmann, George, E-mail: george.hegmann@stantec.com; Yarranton, G.A., E-mail: yarran@shaw.ca

2011-09-15

Cumulative Effects Assessment (CEA) is a tool that can be useful in making decisions about natural resource management and allocation. The decisions to be made include those (i) necessary to construct planning and regulatory frameworks to control development activity so that societal goals will be achieved and (ii) whether or not to approve individual development projects, with or without conditions. The evolution of CEA into a more successful tool cannot occur independently of the evolution of decision making processes. Currently progress is painfully slow on both fronts. This paper explores some opportunities to accelerate improvements in decision making in naturalmore » resource management and in the utility of CEA as a tool to assist in making such decisions. The focus of the paper is on how to define the public interest by determining what is acceptable.« less

Value-driven process management: using value to improve processes.

PubMed

Melnyk, S A; Christensen, R T

2000-08-01

Every firm can be viewed as consisting of various processes. These processes affect everything that the firm does from accepting orders and designing products to scheduling production. In many firms, the management of processes often reflects considerations of efficiency (cost) rather than effectiveness (value). In this article, we introduce a well-structured process for managing processes that begins not with the process, but rather with the customer and the product and the concept of value. This process progresses through a number of steps which include issues such as defining value, generating the appropriate metrics, identifying the critical processes, mapping and assessing the performance of these processes, and identifying long- and short-term areas for action. What makes the approach presented in this article so powerful is that it explicitly links the customer to the process and that the process is evaluated in term of its ability to effectively serve the customers.

Economic analysis of gradual "social exhaustion" of waste management capacity.

PubMed

Koide, Hideo; Nakayama, Hirofumi

2013-12-01

This article proposes to analyze the quantitative effects of a gradual physical and "social" exhaustion of a landfill site on an equilibrium waste management service. A gradual social exhaustion of a landfill is defined here as an upward shift of a "subjective factor" associated with the amount of waste, based on the plausible hypothesis that an individual will not accept excessive presence of landfilled waste. Physical exhaustion occurs when the absolute capacity of a landfill site decreases. The paper shows some numerical examples using specific functions and parameters, and proposes appropriate directions for three policy objectives: to decrease the equilibrium waste disposal, to increase the economic surplus of the individual and/or the waste management firm, and to lower the equilibrium collection fee. Copyright © 2013 The Research Centre for Eco-Environmental Sciences, Chinese Academy of Sciences. Published by Elsevier B.V. All rights reserved.

Quality assessment of occupational health and safety management at the level of business units making up the organizational structure of a coal mine: a case study.

PubMed

Korban, Zygmunt

2015-01-01

The audit of the health and safety management system is understood as a form and tool of controlling. The objective of the audit is to define whether the undertaken measures and the obtained results are in conformity with the predicted assumptions or plans, whether the agreed decisions have been implemented and whether they are suitable in view of the accepted health and safety policy. This paper presents the results of an audit examination carried out on the system of health and safety management between 2002 and 2012 on a group of respondents, the employees of two mining departments (G-1 and G-2) of Jan, a coal mine. The audit was carried out using the questionnaire developed by the author based on the MERIT-APBK survey.

Update on pigment dispersion syndrome and pigmentary glaucoma.

PubMed

Okafor, Kingsley; Vinod, Kateki; Gedde, Steven J

2017-03-01

The present article reviews the clinical features and pathogenesis of pigment dispersion syndrome and pigmentary glaucoma and provides an update regarding their diagnosis and management. Newer imaging modalities including ultrasound biomicroscopy and anterior segment optical coherence tomography facilitate visualization of the iris concavity characteristic of eyes with pigment dispersion syndrome and pigmentary glaucoma. Patients with pigmentary glaucoma may be distinguished from those with other glaucoma types by the presence of typical symptoms, personality type, and patterns of diurnal intraocular pressure fluctuation. Although laser iridotomy has been shown to alter iris anatomy in pigmentary glaucoma, it is not proven to slow visual field progression. Multiple trials have validated the safety and efficacy of filtering surgery in treating pigmentary glaucoma, with fewer studies published on the role of micro-invasive glaucoma surgery. Literature from the review period has further defined the unique clinical characteristics of pigment dispersion syndrome and pigmentary glaucoma. Laser surgery has a limited role in the management of these entities, whereas trabeculectomy remains an acceptable first-line surgical treatment. Further studies are needed to define the potential application of the newer micro-invasive glaucoma procedures in pigmentary glaucoma.

Neonatal hypertension.

PubMed

Sharma, Deepak; Farahbakhsh, Nazanin; Shastri, Sweta; Sharma, Pradeep

2017-03-01

Neonatal hypertension (HT) is a frequently under reported condition and is seen uncommonly in the intensive care unit. Neonatal HT has defined arbitrarily as blood pressure more than 2 standard deviations above the base as per the age or defined as systolic BP more than 95% for infants of similar size, gestational age and postnatal age. It has been diagnosed long back but still is the least studied field in neonatology. There is still lack of universally accepted normotensive data for neonates as per gestational age, weight and post-natal age. Neonatal HT is an important morbidity that needs timely detection and appropriate management, as it can lead to devastating short-term effect on various organs and also poor long-term adverse outcomes. There is no consensus yet about the treatment guidelines and majority of treatment protocols are based on the expert opinion. Neonate with HT should be evaluated in detail starting from antenatal, perinatal, post-natal history, and drug intake by neonate and mother. This review article covers multiple aspects of neonatal hypertension like definition, normotensive data, various etiologies and methods of BP measurement, clinical features, diagnosis and management.

Use of risk stratification to guide ambulatory management of neutropenic fever. Australian Consensus Guidelines 2011 Steering Committee.

PubMed

Worth, L J; Lingaratnam, S; Taylor, A; Hayward, A M; Morrissey, S; Cooney, J; Bastick, P A; Eek, R W; Wei, A; Thursky, K A

2011-01-01

Utilization of risk-stratification tools in the setting of neutropenic fever is currently limited by inadequate knowledge and lack of awareness. Within this context, the approach to management of low-risk patients with neutropenic fever is inconsistent with the available evidence across many Australian treating centres. These clinical guidelines define and clarify an accepted standard of care for this patient group given the current evidence base. The Multinational Association for Supportive Care in Cancer risk index is presented as the preferred risk assessment tool for determining patient risk. Suitability of ambulatory care within specific patient populations is discussed, with defined eligibility criteria provided to guide clinical decision-making. Detailed recommendations for implementing appropriate ambulatory strategies, such as early discharge and outpatient antibiotic therapy, are also provided. Due consideration is given to infrastructural requirements and other supportive measures at a resourcing and operational level. An analysis of the relevant health economics is also presented. © 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

Implementing the NICE osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model osteoarthritis consultation in primary care--the Management of OsteoArthritis In Consultations (MOSAICS) study protocol.

PubMed

Dziedzic, Krysia S; Healey, Emma L; Porcheret, Mark; Ong, Bie Nio; Main, Chris J; Jordan, Kelvin P; Lewis, Martyn; Edwards, John J; Jinks, Clare; Morden, Andrew; McHugh, Gretl A; Ryan, Sarah; Finney, Andrew; Jowett, Sue; Oppong, Raymond; Afolabi, Ebenezer; Pushpa-Rajah, Angela; Handy, June; Clarkson, Kris; Mason, Elizabeth; Whitehurst, Tracy; Hughes, Rhian W; Croft, Peter R; Hay, Elaine M

2014-08-27

There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain. A mixed methods study with a nested cluster randomised controlled trial. This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations. The main output from the study will be to determine whether the MOAC intervention is clinically and cost effective. Additional outputs will be the development of the MOAC for patients consulting with joint pain in primary care, training and educational materials, and resources for patients and professionals regarding supported self-management and uptake of NICE guidance. ISRCTN number: ISRCTN06984617.

Scholarship for Nuclear Communications and Methods for Evaluation of Nuclear Project Acceptability

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

Golay, Michael

This project aims to go beyond effective communication in understanding how to design nuclear enterprise projects that will gain stakeholder acceptability. Much of what we are studying is generally applicable to controversial projects, and we expect our results to be of broad value beyond the nuclear arena. Acceptability is more than effective communication; it also requires varying degrees of engagement with a disparate number of stakeholder groups. In the nuclear enterprise, previous attempts have been well designed physically (i.e., technologically sound), but have floundered by being insensitive concerning acceptance. Though effective communication is a necessary, but insufficient, condition for suchmore » success, there is a lack of scholarship regarding how to gain stakeholder acceptance for new controversial projects, including nuclear ones. Our work is building a model for use in assessing the performance of a project in the area of acceptability. In the nuclear-social nexus, gaining acceptance requires a clear understanding of factors regarded as being important by the many stakeholders that are common to new nuclear project (many of whom hold an effective veto power). Projects tend to become socially controversial when public beliefs, expert opinion and decision-maker understanding are misaligned. As such, stakeholder acceptance is hypothesized as both an ongoing process and an initial project design parameter comprised of complex, social, cognitive and technical components. Controversial projects may be defined as aspects of modern technologies that some people question, or are cautious about. They could range from genetic modifications, biological hazards, effects of chemical agents, nuclear radiation or hydraulic fracturing operations. We intend that our work will result in a model likely to be valuable for refining project design and implementation to increase the knowledge needed for successful management of stakeholder relationships.« less

[Efficient document management by introduction of a new, dynamic quality manual application according to DIN EN ISO 9001:2000].

PubMed

Pache, G; Saueressig, U; Baumann, T; Dürselen, L; Langer, M; Kotter, E

2008-06-01

Evaluation of the impact of a new, dynamic computer-aided quality manual application (QMA) regarding the acceptance and efficiency of a quality management system (QMS) according to DIN EN ISO 9001:2000. The QMA combines static pages of HTML with active content generated from an underlying database. Through user access rights, a hierarchy is defined to create and administer quality documents. Document workflow, feedback management and employee survey were analyzed to compare the performance of the new QMH with the formerly used static version. Integration of a document editor and automated document re-approval accelerated the document process by an average of 10 min. In spite of an increase of the yearly document changes of 60%, the administration effort was reduced by approximately 160 h. Integration of the feedback management system into the QMA decreased handling time from an average of 16.5 to 3.4 days. Simultaneously the number of feedback messages increased from 160 in 2005 to 306 in 2006. Employee satisfaction was raised (old: 3.19+/-1.02, new: 1.91+/-0.8). The number of users who partook in the QMA more than once a week also increased from 29.5% to 60%. The computer-aided quality manual application constitutes the basis for the success of our QMS. The possibility to actively participate in the quality management process has led to broad acceptance and usage by the employees. The administration effort was able to be tremendously decreased as compared to conventional QMS.

Traffic sharing algorithms for hybrid mobile networks

NASA Technical Reports Server (NTRS)

Arcand, S.; Murthy, K. M. S.; Hafez, R.

1995-01-01

In a hybrid (terrestrial + satellite) mobile personal communications networks environment, a large size satellite footprint (supercell) overlays on a large number of smaller size, contiguous terrestrial cells. We assume that the users have either a terrestrial only single mode terminal (SMT) or a terrestrial/satellite dual mode terminal (DMT) and the ratio of DMT to the total terminals is defined gamma. It is assumed that the call assignments to and handovers between terrestrial cells and satellite supercells take place in a dynamic fashion when necessary. The objectives of this paper are twofold, (1) to propose and define a class of traffic sharing algorithms to manage terrestrial and satellite network resources efficiently by handling call handovers dynamically, and (2) to analyze and evaluate the algorithms by maximizing the traffic load handling capability (defined in erl/cell) over a wide range of terminal ratios (gamma) given an acceptable range of blocking probabilities. Two of the algorithms (G & S) in the proposed class perform extremely well for a wide range of gamma.

41 CFR 101-27.506 - Determination of acceptability for credit.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-INVENTORY MANAGEMENT 27.5-Return of GSA Stock Items § 101-27.506 Determination of acceptability for credit... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Determination of acceptability for credit. 101-27.506 Section 101-27.506 Public Contracts and Property Management Federal...

Image-guided radiation therapy in lymphoma management

PubMed Central

Eng, Tony

2015-01-01

Image-guided radiation therapy (IGRT) is a process of incorporating imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), Positron emission tomography (PET), and ultrasound (US) during radiation therapy (RT) to improve treatment accuracy. It allows real-time or near real-time visualization of anatomical information to ensure that the target is in its position as planned. In addition, changes in tumor volume and location due to organ motion during treatment can be also compensated. IGRT has been gaining popularity and acceptance rapidly in RT over the past 10 years, and many published data have been reported on prostate, bladder, head and neck, and gastrointestinal cancers. However, the role of IGRT in lymphoma management is not well defined as there are only very limited published data currently available. The scope of this paper is to review the current use of IGRT in the management of lymphoma. The technical and clinical aspects of IGRT, lymphoma imaging studies, the current role of IGRT in lymphoma management and future directions will be discussed. PMID:26484299

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

PubMed

Lima, Juliano de Carvalho; Rivera, Francisco Javier Uribe

2006-10-01

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

Managing Competing Influences: Risk Acceptance in Operation Rolling Thunder

DTIC Science & Technology

2017-03-12

Managing Competing Influences: Risk Acceptance in Operation Rolling Thunder A Monograph by Major Benjamin C. Williams US Air Force School of...REPORT TYPE Master’s Thesis 3. DATES COVERED (From - To) JUN 2016 – MAY 2017 4. TITLE AND SUBTITLE Managing Competing Influences: Risk Acceptance in...ANSI Std. Z39.18 ii Monograph Approval Page Name of Candidate: Major Benjamin C. Williams, USAF Monograph Title: Managing Competing Influences

How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis.

PubMed

Jones, Virginia; Crowe, Marie

2017-11-01

The increasing prevalence of diabetes is well-documented along with the findings that some ethnic minorities have a higher prevalence than non-minority individuals. Along with possible biological differences between ethnicities, access to economic, social, cultural and symbolic capital may impact on the success of managing type-2 diabetes. To examine how people from ethnic minorities in Western countries describe their experiences of managing type-2 diabetes mellitus. PubMed and Ovid Medline databases. Studies between 1946 and July 2016 were included if they were qualitative in design and presented findings in relation to adults from ethnic minorities and their descriptions of self-managing type-2 diabetes mellitus. The CASP evaluation for qualitative studies was used for quality appraisal and synthesis involved thematic analysis and evaluation of evidence using GRADE-CERQual approach. Twenty-seven papers were included in the review. The primary studies were all conducted in middle-high income western countries with people from diverse ethnicities, although the majority were Black American. There was high confidence in the evidence that a sense of powerlessness, issues of treatment accessibility and acceptability, and the culturally defined roles within families impacted on how some participants managed their diabetes. There was moderate confidence in the evidence in relation to the cultural significance of food and for the cultural effect of stigma. The potential for a sense of powerlessness to manage diabetes, the acceptability and accessibility of treatment, the significance of food, the impact of cultural roles and stigma needs to be pivotal to diabetes education for people from ethnic minorities in Western countries. Copyright © 2017 Elsevier Ltd. All rights reserved.

Overview and Status of the Bioastronautics Critical Path Roadmap (BCPR)

NASA Technical Reports Server (NTRS)

Charles, John

2004-01-01

Viewgraphs on the status and overview of the Bioastronautics Critical Path Roadmap (BCPR) are presented. The topics include: 1) BCPR Objectives; 2) BCPR and OBPR Program Management; 3) BCPR Disciplines & Cross-Cutting Areas; 4) Characteristics of BCPR Reference Missions; 5) Bioastronautics Timetable (notional); 6) BCPR Processes Risk Identification, Assessment, and Management; 7) Types of BCPR Risks; 8) Enabling Questions Categories; 9) Risk Mitigation Status; 10) Defining Levels of Accepted Risk; 11) BCPR Integration; 12) BCPR Implementation, Integration, and Validation; 13) BCPR Refinement Schedule; 14) Academy Review; 15) Rating Bioastronautics Risks; 16) Risk Rating Exercises; 17) Human Health Risk Assessment Criteria (examples); 18) A Recent Risk Rating Exercise; 19) Consensus Workshop Background; 20) Consensus Workshop Rating Analysis; 21) Consensus Workshop Selected Preliminary Recommendations; and 22) Access to BCPR Content.

12 CFR 621.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... accepted accounting principles means that body of conventions, rules, and procedures necessary to define accepted accounting practices at a particular time, as promulgated by the Financial Accounting Standards... profession in the United States. Generally accepted accounting principles include not only broad guidelines...

Airline business continuity and IT disaster recovery sites.

PubMed

Haji, Jassim

2016-01-01

Business continuity is defined as the capability of the organisation to continue delivery of products or services at acceptable predefined levels following a disruptive incident. Business continuity is fast evolving to become a critical and strategic decision for any organisation. Transportation in general, and airlines in particular, is a unique sector with a specialised set of requirements, challenges and opportunities. Business continuity in the airline sector is a concept that is generally overlooked by the airline managements. This paper reviews different risks related to airline processes and will also propose solutions to these risks based on experiences and good industry practices.

Social Acceptance of Wind Energy: Managing and Evaluating Its Market Impacts (Presentation)

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

Baring-Gould, I.

2012-06-01

As with any industrial-scale technology, wind power has impacts. As wind technology deployment becomes more widespread, a defined opposition will form as a result of fear of change and competing energy technologies. As the easy-to-deploy sites are developed, the costs of developing at sites with deployment barriers will increase, therefore increasing the total cost of power. This presentation provides an overview of wind development stakeholders and related stakeholder engagement questions, Energy Department activities that provide wind project deployment information, and the quantification of deployment barriers and costs in the continental United States.

A strategic management model for evaluation of health, safety and environmental performance.

PubMed

Abbaspour, Majid; Toutounchian, Solmaz; Roayaei, Emad; Nassiri, Parvin

2012-05-01

Strategic health, safety, and environmental management system (HSE-MS) involves systematic and cooperative planning in each phase of the lifecycle of a project to ensure that interaction among the industry group, client, contractor, stakeholder, and host community exists with the highest level of health, safety, and environmental standard performances. Therefore, it seems necessary to assess the HSE-MS performance of contractor(s) by a comparative strategic management model with the aim of continuous improvement. The present Strategic Management Model (SMM) has been illustrated by a case study and the results show that the model is a suitable management tool for decision making in a contract environment, especially in oil and gas fields and based on accepted international standards within the framework of management deming cycle. To develop this model, a data bank has been created, which includes the statistical data calculated by converting the HSE performance qualitative data into quantitative values. Based on this fact, the structure of the model has been formed by defining HSE performance indicators according to the HSE-MS model. Therefore, 178 indicators have been selected which have been grouped into four attributes. Model output provides quantitative measures of HSE-MS performance as a percentage of an ideal level with maximum possible score for each attribute. Defining the strengths and weaknesses of the contractor(s) is another capability of this model. On the other hand, this model provides a ranking that could be used as the basis for decision making at the contractors' pre-qualification phase or during the execution of the project.

Women in management means women in power: implications for society, family and culture in the Arab world.

PubMed

King-irani, L

1995-01-01

A May 1995 conference in Beirut on "The Arab Woman and Business Management" focused on the fact that women are relatively absent from decision-making positions in the public and private sectors in the Arab world. Conference participants also identified characteristics of Arab women who have successfully penetrated the ranks of management, discussed how to balance work and home life, and considered the potentially important role of women managers in the nonprofit sector. Recurring and interrelated themes of the conference addressed the fact that women who have become empowered at work will have increased self-confidence in every aspect of their lives. Also, women who have successfully managed a busy household are able to transfer these skills to the workplace. Women will increasingly demand access to the highest ranks of decision-making, but their culturally-shaped sense of themselves may ultimately hinder them from attaining positions currently reserved for men. Research has shown that women's conceptions of power are more egalitarian and cooperative than the competitiveness exhibited by men. Women may, therefore, offer an important approach to the rapidly changing world market which requires the cooperation of people from diverse backgrounds. Ultimately, it is women who define themselves (rather than accept an identity chosen by society, the family, or culture) who will progress the fastest and achieve the highest ranks in management. Women should neither passively wait to be handed power not allow men to define the nature and uses of power. Instead they must seize their own power and exercise it in their own ways.

Historical development of limits of acceptable change: conceptual clarifications and possible extensions

Treesearch

David N. Cole; George H. Stankey

1997-01-01

The Limits of Acceptable Change (LAC) process was developed to deal with the issue of recreational carrying capacity. For that purpose, the LAC process sought to explicitly define a compromise between resource/visitor experience protection and recreation use goals. The most critical and unique element of the process is the specification of LAC standards that define...

16 CFR Table 3 to Part 1512 - Minimum Acceptable Values for the Quantity A Defined in the Retroreflective Tire and Rim Test...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Minimum Acceptable Values for the Quantity A Defined in the Retroreflective Tire and Rim Test Procedure 3 Table 3 to Part 1512 Commercial Practices... Retroreflective Tire and Rim Test Procedure Observation angle (degrees) Entrance angle (degrees) Minimum...

Using Predictive Evaluation to Design, Evaluate, and Improve Training for Polio Volunteers

PubMed Central

Traicoff, Denise A.; Basarab, Dave; Ehrhardt, Derek T.; Brown, Sandi; Celaya, Martin; Jarvis, Dennis; Howze, Elizabeth H.

2018-01-01

Background Predictive Evaluation (PE) uses a four-step process to predict results then designs and evaluates a training intervention accordingly. In 2012, the Sustainable Management Development Program (SMDP) at the Centers for Disease Control and Prevention used PE to train Stop Transmission of Polio (STOP) program volunteers. Methods Stakeholders defined specific beliefs and practices that volunteers should demonstrate. These predictions and adult learning practices were used to design a curriculum to train four cohorts. At the end of each workshop, volunteers completed a beliefs survey and wrote goals for intended actions. The goals were analyzed for acceptability based on four PE criteria. The percentage of acceptable goals and the beliefs survey results were used to define the quality of the workshop. A postassignment adoption evaluation was conducted for two cohorts, using an online survey and telephone or in-person structured interviews. The results were compared with the end of workshop findings. Results The percentage of acceptable goals across the four cohorts ranged from 49% to 85%. In the adoption evaluation of two cohorts, 88% and 94% of respondents reported achieving or making significant progress toward their goal. A comparison of beliefs survey responses across the four cohorts indicated consistencies in beliefs that aligned with stakeholders’ predictions. Conclusions Goal statements that participants write at the end of a workshop provide data to evaluate training quality. Beliefs surveys surface attitudes that could help or hinder workplace performance. The PE approach provides an innovative framework for health worker training and evaluation that emphasizes performance. PMID:29457126

Quality by design for herbal drugs: a feedforward control strategy and an approach to define the acceptable ranges of critical quality attributes.

PubMed

Yan, Binjun; Li, Yao; Guo, Zhengtai; Qu, Haibin

2014-01-01

The concept of quality by design (QbD) has been widely accepted and applied in the pharmaceutical manufacturing industry. There are still two key issues to be addressed in the implementation of QbD for herbal drugs. The first issue is the quality variation of herbal raw materials and the second issue is the difficulty in defining the acceptable ranges of critical quality attributes (CQAs). To propose a feedforward control strategy and a method for defining the acceptable ranges of CQAs for the two issues. In the case study of the ethanol precipitation process of Danshen (Radix Salvia miltiorrhiza) injection, regression models linking input material attributes and process parameters to CQAs were built first and an optimisation model for calculating the best process parameters according to the input materials was established. Then, the feasible material space was defined and the acceptable ranges of CQAs for the previous process were determined. In the case study, satisfactory regression models were built with cross-validated regression coefficients (Q(2) ) all above 91 %. The feedforward control strategy was applied successfully to compensate the quality variation of the input materials, which was able to control the CQAs in the 90-110 % ranges of the desired values. In addition, the feasible material space for the ethanol precipitation process was built successfully, which showed the acceptable ranges of the CQAs for the concentration process. The proposed methodology can help to promote the implementation of QbD for herbal drugs. Copyright © 2013 John Wiley & Sons, Ltd.

A management-control system to assist with the development, contracting, and monitoring of new services for older people: you can always get what you want (with apologies to the Rolling Stones).

PubMed

Jacobs, Stephen

2007-10-01

Implementing community services can be a very complex process where people end up "not seeing the wood for the trees" and then accepting a compromise nobody wants. Neither agency theory nor stewardship theory is particularly robust when explaining the reality that funders and managers of community health service for older people face in managing contracts. There are particular difficulties with goal divergence between policy directives and implementation practices, which result from goals not being well understood and performance requirements being ambiguously defined and infrequently monitored. This leads to accountability issues for public managers, and raises efficiency and effectiveness issues. This paper provides an interim report on a project developing a management-control system to provide a process for health planners and funders to use when developing and contracting services. A major focus is inviting stakeholders into a process of communication that ensures that they have shared understandings of where they want to get to, and what has to be done to get there.

Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia.

PubMed

Kaisey, Marwa; Mittman, Brian; Pearson, Marjorie; Connor, Karen I; Chodosh, Joshua; Vassar, Stefanie D; Nguyen, France T; Vickrey, Barbara G

2012-10-01

Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p < 0.001), lesser severity of dementia (p = 0.03), and higher patient comorbidity (p = 0.03); it also varied across healthcare organization sites. Understanding factors that influence care management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials. Copyright © 2011 John Wiley & Sons, Ltd.

A Distributive Model of Treatment Acceptability

ERIC Educational Resources Information Center

Carter, Stacy L.

2008-01-01

A model of treatment acceptability is proposed that distributes overall treatment acceptability into three separate categories of influence. The categories are comprised of societal influences, consultant influences, and influences associated with consumers of treatments. Each of these categories are defined and their inter-relationships within…

Tolerance, Acceptance and the Virtue of Orthonomy: A Reply to Lawrence Blum and Brenda Almond

ERIC Educational Resources Information Center

Ciurria, Michelle

2011-01-01

In the "Journal of Moral Education," 39(2), Brenda Almond and Lawrence Blum debate the importance of tolerance versus acceptance in sex education. Blum defines acceptance as "positive regard", in contradistinction to mere tolerance, "a live and let live attitude toward others, an acceptance of coexistence, but with a…

The promise of acceptance as an NGO security management approach.

PubMed

Fast, Larissa; Freeman, Faith; O'Neill, Michael; Rowley, Elizabeth

2015-04-01

This paper explores three questions related to acceptance as a security management approach. Acceptance draws upon relationships with community members, authorities, belligerents and other stakeholders to provide consent for the presence and activities of a non-governmental organisation (NGO), thereby reducing threats from these actors. Little is documented about how NGOs gain and maintain acceptance, how they assess and monitor the presence and degree of acceptance, or how they determine whether acceptance is effective in a particular context. Based on field research conducted in April 2011 in Kenya, South Sudan and Uganda, we address each of these three issues and argue that acceptance must be actively sought as both a programme and a security management strategy. In the paper we delineate elements common to all three contexts as well as missed opportunities, which identify areas that NGOs can and should address as part of an acceptance approach. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

Herbal medicines for the management of opioid addiction: safe and effective alternatives to conventional pharmacotherapy?

PubMed

Ward, Jeanine; Rosenbaum, Christopher; Hernon, Christina; McCurdy, Christopher R; Boyer, Edward W

2011-12-01

Striking increases in the abuse of opioids have expanded the need for pharmacotherapeutic interventions. The obstacles that confront effective treatment of opioid addiction - shortage of treatment professionals, stigma associated with treatment and the ability to maintain abstinence - have led to increased interest in alternative treatment strategies among both treatment providers and patients alike. Herbal products for opioid addiction and withdrawal, such as kratom and specific Chinese herbal medications such as WeiniCom, can complement existing treatments. Unfortunately, herbal treatments, while offering some advantages over existing evidence-based pharmacotherapies, have poorly described pharmacokinetics, a lack of supportive data derived from well controlled clinical trials, and severe toxicity, the cause for which remains poorly defined. Herbal products, therefore, require greater additional testing in rigorous clinical trials before they can expect widespread acceptance in the management of opioid addiction.

An approach to define semantics for BPM systems interoperability

NASA Astrophysics Data System (ADS)

Rico, Mariela; Caliusco, María Laura; Chiotti, Omar; Rosa Galli, María

2015-04-01

This article proposes defining semantics for Business Process Management systems interoperability through the ontology of Electronic Business Documents (EBD) used to interchange the information required to perform cross-organizational processes. The semantic model generated allows aligning enterprise's business processes to support cross-organizational processes by matching the business ontology of each business partner with the EBD ontology. The result is a flexible software architecture that allows dynamically defining cross-organizational business processes by reusing the EBD ontology. For developing the semantic model, a method is presented, which is based on a strategy for discovering entity features whose interpretation depends on the context, and representing them for enriching the ontology. The proposed method complements ontology learning techniques that can not infer semantic features not represented in data sources. In order to improve the representation of these entity features, the method proposes using widely accepted ontologies, for representing time entities and relations, physical quantities, measurement units, official country names, and currencies and funds, among others. When the ontologies reuse is not possible, the method proposes identifying whether that feature is simple or complex, and defines a strategy to be followed. An empirical validation of the approach has been performed through a case study.

Towards hospital standardization in Europe.

PubMed

Shaw, Charles; Bruneau, Charles; Kutryba, Basia; de Jongh, Guido; Suñol, Rosa

2010-08-01

There is no simple tool to assess compliance with common national and European directives, guidance and professional advice on the management of healthcare institutions. Despite evidence of unacceptable variations in the protection of patient and staff safety little attention has been given to harmonizing the way services are organized and managed. Existing systems which define organizational standards, or assess compliance with them, are not in a position to extend this activity into or across national borders in Europe. Certification, accreditation and licensing programmes are too variable to provide a common basis for consistent assessment. Consensual standards would inevitably be minimal if they were to achieve acceptance by all or a majority of member state governments; they would not be standards for excellence or help the majority of organizations to improve performance. This paper proposes the development of a framework and measurement tool, initially for hospitals, which could be used for self-assessment or peer review to demonstrate compliance with European legislation, guidance and public expectations without infringing national responsibilities. A common code of management practice could be developed through a process similar to that adopted for clinical practice guidelines by the European commission-funded project on appraisal of guidelines research and evaluation. In practice, the legal relationships between member states and intergovernmental organizations inhibit the harmonization of management practice across-borders. Faster progress to higher levels of performance would be achieved by voluntary, non-regulatory cooperation of enthusiasts to define, measure and improve the quality of healthcare in European hospitals.

Industrial Program of Waste Management - Cigeo Project - 13033

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

Butez, Marc; Bartagnon, Olivier; Gagner, Laurent

2013-07-01

The French Planning Act of 28 June 2006 prescribed that a reversible repository in a deep geological formation be chosen as the reference solution for the long-term management of high-level and intermediate-level long-lived radioactive waste. It also entrusted the responsibility of further studies and design of the repository (named Cigeo) upon the French Radioactive Waste Management Agency (Andra), in order for the review of the creation-license application to start in 2015 and, subject to its approval, the commissioning of the repository to take place in 2025. Andra is responsible for siting, designing, implementing, operating the future geological repository, including operationalmore » and long term safety and waste acceptance. Nuclear operators (Electricite de France (EDF), AREVA NC, and the French Commission in charge of Atomic Energy and Alternative Energies (CEA) are technically and financially responsible for the waste they generate, with no limit in time. They provide Andra, on one hand, with waste packages related input data, and on the other hand with their long term industrial experiences of high and intermediate-level long-lived radwaste management and nuclear operation. Andra, EDF, AREVA and CEA established a cooperation agreement for strengthening their collaborations in these fields. Within this agreement Andra and the nuclear operators have defined an industrial program for waste management. This program includes the waste inventory to be taken into account for the design of the Cigeo project and the structural hypothesis underlying its phased development. It schedules the delivery of the different categories of waste and defines associated flows. (authors)« less

41 CFR 101-26.506-4 - Acceptance and processing of requests.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Acceptance and processing of requests. 101-26.506-4 Section 101-26.506-4 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26...

Social acceptability of forest conditions and management practices: a problem analysis.

Treesearch

Bruce A. Shindler; Mark Brunson; George H. Stankey

2002-01-01

The purpose of this report is to improve understanding of the complex sociopolitical processes related to resource management and to help structure management response to conflict and contentiousness, misunderstanding among participants, and failed citizen-agency interactions. Public acceptance is essential to every resource management decision public agencies must...

Managerial Concerns and Hispanic Culture in the American Workplace.

ERIC Educational Resources Information Center

Cellini, Alva V.

With changing social and economic realities, certain cultural differences in the management of Hispanic workers must be accepted and accommodated in the American workplace, where the scientific approach to management is the general rule. The scientific view of management is hardly accepted by Latin Americans whose management philosophy is more…

Stakeholders and public involvement in river management: heterogeneous acceptance of participatory processes among Swiss institutions.

NASA Astrophysics Data System (ADS)

Buletti, Nora; Utz, Stephan; Ejderyan, Olivier; Graefe, Olivier; Lane, Stuart; Reynard, Emmanuel

2014-05-01

This research explores participatory processes in the domain of river management in Switzerland. The main objective is to better understand how participatory processes are incorporated into river management practice. Switzerland being a federal state, river management is a cantonal (regional) responsibility, under the supervision (and co-funding) of the State (a Confederation). The federal funding includes the opportunity to fund additional participatory activities to aid river management, not least because the federal authorities consider the involvement of wider stakeholders and the public in decision-making as a means of aiding the progression of projects. This is a particularly important goal in a Swiss setting where direct democracy (the possibility of calling the decision of any level of government into question through a popular vote) means that a reasonable level of project acceptance is a necessary element of project progression. River management in Switzerland now includes both flood protection and river restoration objectives, which has served to increase its controversy: river corridors contain competing interests with different objectives (e.g. ecological enhancement, protection of agricultural land, flood risk reduction). We were asked by the Confederation to evaluate participatory processes it sponsored and one element of this evaluation aimed to develop a typology of stakeholder participation. We conducted interviews with the 26 cantonal officers in charge of river management. These interviews were based upon thematically structured open ended questions, with the responses analyzed qualitatively. We have identified significant divergence in the implementation of participatory processes between the cantons. These appear to be related to two factors: (1) the canton's historical experience of river management; and (2) the methods used to select stakeholders for inclusion in the decisional process. Cantons that refer to guidelines or pre-established handbooks for the selection of stakeholders often conduct instrumental participation, limited to information dissemination. On the other hand, in some cantons participatory processes characterized by normative rationales take place. Here the goals of participatory processes are not limited to outcomes (e.g. acceptance of the project), but value the process of participation in itself. In these cantons actors are selected via social connections and the claimed 'common sense' of cantonal project officers. Here, the opportunity of public debate opens up, the inclusion of actors often start earlier in the decision-making processes and objectives are defined publicly and collectively. Cantonal authorities involved in river management do not all consider participatory processes as important. The acknowledgment of participatory processes is less related to an authority's recognition of the importance of participation and more to specific local experience.

Pattern of parental acceptance of management techniques used in pediatric dentistry.

PubMed

Peretz, Benjamin; Kharouba, Johnny; Blumer, Sigalit

2013-01-01

To evaluate parents' acceptance of management techniques in Israeli pediatric dental clinics. Ninety parents who accompanied their children to three pediatric dental clinics provided information on selected parameters including their attitudes about management techniques. 68.9% of the parents preferred to stay in the treatment room. The most accepted technique was positive reinforcement (81.1%) followed by tell-show-do (TSD) (76.7%, with younger parents more accepting than older, p = 0.049). The least accepted techniques were restraint (1.1%) and voice control (7.8%, especially by parents with the highest dental anxiety, p = 0.002). Sedation was unacceptable by 15.6% of the parents: those with the lowest dental anxiety agreed to sedation significantly more than those with greater dental anxiety (p = 0.031). Parents preferred more positive approaches and management techniques that involve demonstrations geared for the child's level of understanding. Restraint and voice control were more strongly rejected than sedation.

Geographic variation in social acceptability of wildland fuels management in the western United States

USGS Publications Warehouse

Brunson, M.; Schindler, Bruce A.

2004-01-01

Contemporary natural resource management requires consideration of the social acceptability of management practices and conditions. Agencies wishing to measure, respond to, and influence social acceptability must understand the nuances of public perception regarding controversial issues. This study explores social acceptability judgments about one such issue: reduction of wildland fuel hazards on federal lands in the western United States. Citizens were surveyed in four locations where fire has been a significant ecological disturbance agent and public land agencies propose to reduce wildland fuel levels and wildfire hazards via prescribed burning, thinning, brush removal, and/or livestock grazing. Respondents in different locations differed in their knowledge about fire and fuel issues as well in their acceptability judgments. Differences are associated with location-specific social and environmental factors as well as individual beliefs. Results argue against using a??one-size-fits-alla?? policies or information strategies about fuels management.

Improving imperfect data from health management information systems in Africa using space-time geostatistics.

PubMed

Gething, Peter W; Noor, Abdisalan M; Gikandi, Priscilla W; Ogara, Esther A A; Hay, Simon I; Nixon, Mark S; Snow, Robert W; Atkinson, Peter M

2006-06-01

Reliable and timely information on disease-specific treatment burdens within a health system is critical for the planning and monitoring of service provision. Health management information systems (HMIS) exist to address this need at national scales across Africa but are failing to deliver adequate data because of widespread underreporting by health facilities. Faced with this inadequacy, vital public health decisions often rely on crudely adjusted regional and national estimates of treatment burdens. This study has taken the example of presumed malaria in outpatients within the largely incomplete Kenyan HMIS database and has defined a geostatistical modelling framework that can predict values for all data that are missing through space and time. The resulting complete set can then be used to define treatment burdens for presumed malaria at any level of spatial and temporal aggregation. Validation of the model has shown that these burdens are quantified to an acceptable level of accuracy at the district, provincial, and national scale. The modelling framework presented here provides, to our knowledge for the first time, reliable information from imperfect HMIS data to support evidence-based decision-making at national and sub-national levels.

NASA System Safety Handbook. Volume 2: System Safety Concepts, Guidelines, and Implementation Examples

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Benjamin, Allan; Everett, Christopher; Feather, Martin; Rutledge, Peter; Sen, Dev; Youngblood, Robert

2015-01-01

This is the second of two volumes that collectively comprise the NASA System Safety Handbook. Volume 1 (NASASP-210-580) was prepared for the purpose of presenting the overall framework for System Safety and for providing the general concepts needed to implement the framework. Volume 2 provides guidance for implementing these concepts as an integral part of systems engineering and risk management. This guidance addresses the following functional areas: 1.The development of objectives that collectively define adequate safety for a system, and the safety requirements derived from these objectives that are levied on the system. 2.The conduct of system safety activities, performed to meet the safety requirements, with specific emphasis on the conduct of integrated safety analysis (ISA) as a fundamental means by which systems engineering and risk management decisions are risk-informed. 3.The development of a risk-informed safety case (RISC) at major milestone reviews to argue that the systems safety objectives are satisfied (and therefore that the system is adequately safe). 4.The evaluation of the RISC (including supporting evidence) using a defined set of evaluation criteria, to assess the veracity of the claims made therein in order to support risk acceptance decisions.

Improving Imperfect Data from Health Management Information Systems in Africa Using Space–Time Geostatistics

PubMed Central

Gething, Peter W; Noor, Abdisalan M; Gikandi, Priscilla W; Ogara, Esther A. A; Hay, Simon I; Nixon, Mark S; Snow, Robert W; Atkinson, Peter M

2006-01-01

Background Reliable and timely information on disease-specific treatment burdens within a health system is critical for the planning and monitoring of service provision. Health management information systems (HMIS) exist to address this need at national scales across Africa but are failing to deliver adequate data because of widespread underreporting by health facilities. Faced with this inadequacy, vital public health decisions often rely on crudely adjusted regional and national estimates of treatment burdens. Methods and Findings This study has taken the example of presumed malaria in outpatients within the largely incomplete Kenyan HMIS database and has defined a geostatistical modelling framework that can predict values for all data that are missing through space and time. The resulting complete set can then be used to define treatment burdens for presumed malaria at any level of spatial and temporal aggregation. Validation of the model has shown that these burdens are quantified to an acceptable level of accuracy at the district, provincial, and national scale. Conclusions The modelling framework presented here provides, to our knowledge for the first time, reliable information from imperfect HMIS data to support evidence-based decision-making at national and sub-national levels. PMID:16719557

Product-line administration: a framework for redefining medical record department services.

PubMed

Postal, S N

1990-06-01

Product-line administration is a viable approach for managing medical records services in an environment that demands high quantity and quality service levels. Product-line administration directs medical record department team members to look outside of the department and seek input from the customers it is intended to serve. The feedback received may be alarming at first, as the current state of products usually reveals a true lack of customer input. As the planning, defining, managing, and marketing phases are implemented, the road will not be easy and rewards will be slow to come. Product-line administration does not provide quick fixes, but it does provide long-term problem resolution as products are refined and new products developed to meet customer needs and expectations. In addition to better meeting the needs of the department's external customers, the department's internal customers' needs and expectations will be addressed. The participative management approach will help nurture each team member's creativity. The team members will have the opportunity to reach their full potential while reaping the rewards and benefits of providing products and services that meet the needs and expectations of all department customers. The future of the health care industry promises more changes as the country moves toward some form of prospective payment in the ambulatory setting. Reactive management and the constant struggle to catch up can no longer be accepted as a management approach. It is imperative that the medical record department be viewed as a business with product lines composed of quality products. The planning, defining, managing, and marketing components of product-line administration afford responsiveness to the current situation and the development of quality products that will ensure that medical record departments are prepared for the future.

The TMIS life-cycle process document, revision A

NASA Technical Reports Server (NTRS)

1991-01-01

The Technical and Management Information System (TMIS) Life-Cycle Process Document describes the processes that shall be followed in the definition, design, development, test, deployment, and operation of all TMIS products and data base applications. This document is a roll out of TMIS Standards Document (SSP 30546). The purpose of this document is to define the life cycle methodology that the developers of all products and data base applications and any subsequent modifications shall follow. Included in this methodology are descriptions of the tasks, deliverables, reviews, and approvals that are required before a product or data base application is accepted in the TMIS environment.

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.

Predictive Management of Asian Carps in the Upper Mississippi River System

USGS Publications Warehouse

Vondracek, Bruce C.; Carlson, Andrew K.

2014-01-01

Prolific non-native organisms pose serious threats to ecosystems and economies worldwide. Nonnative bighead carp (Hypophthalmichthys nobilis) and silver carp (H. molitrix), collectively referred to as Asian carps, continue to colonize aquatic ecosystems throughout the central United States. These species are r-selected, exhibiting iteroparous spawning, rapid growth, broad environmental tolerance, high density, and long-distance movement. Hydrological, thermal, and physicochemical conditions are favorable for establishment beyond the current range, rendering containment and control imperative. Ecological approaches to confine Asian carp populations and prevent colonization characterize contemporary management in the United States. Foraging and reproduction of Asian carps govern habitat selection and movement, providing valuable insight for predictive control. Current management approaches are progressive and often anticipatory but deficient in human dimensions. We define predictive management of Asian carps as synthesis of ecology and human dimensions at regional and local scales to develop strategies for containment and control. We illustrate predictive management in the Upper Mississippi River System and suggest resource managers integrate predictive models, containment paradigms, and human dimensions to design effective, socially acceptable management strategies. Through continued research, university-agency collaboration, and public engagement, predictive management of Asian carps is an auspicious paradigm for preventing and alleviating consequences of colonization in the United States.

Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test

PubMed Central

Dou, Kaili; Yu, Ping; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

2017-01-01

Background Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management. Methods Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients’ acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients’ actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results The model accounted for .412 of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. Age and gender had no significant influence on patients’ acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. Conclusions This study developed a theoretical model to predict patients’ acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients’ awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. PMID:29212629

Defining indicators and standards for tourism impacts in protected areas: Cape Range National Park, Australia.

PubMed

Moore, Susan A; Polley, Amanda

2007-03-01

Visitors' perceptions of impacts and acceptable standards for environmental conditions can provide essential information for the sustainable management of tourist destinations, especially protected areas. To this end, visitor surveys were administered during the peak visitor season in Cape Range National Park, on the northwest coast of Western Australia and adjacent to the iconic Ningaloo Reef. The central focus was visitors' perceptions regarding environmental conditions and standards for potential indicators. Conditions considered of greatest importance in determining visitors' quality of experience included litter, inadequate disposal of human waste, presence of wildlife, levels of noise, and access to beach and ocean. Standards were determined, based on visitors' perceptions, for a range of site-specific and non-site-specific indicators, with standards for facilities (e.g., acceptable number of parking bays, signs) and for negative environmental impacts (e.g., levels of littering, erosion) sought. The proposed standards varied significantly between sites for the facilities indicators; however, there was no significant difference between sites for environmental impacts. For the facilities, the standards proposed by visitors were closely related to the existing situation, suggesting that they were satisfied with the status quo. These results are considered in the context of current research interest in the efficacy of visitor-derived standards as a basis for protected area management.

Residents warming up to fuels management: homeowners? acceptance of wildfire and fuels management in the wildland-urban interface

Treesearch

Greg Winter; Christine Vogt; Sarah McCaffrey

2006-01-01

Many wildland fire managers, concerned about public acceptance of local fuels management programs, want to better communicate with local residents about these programs. Research at diverse study sites shows wildland-urban interface (WUI) residents rely on common factors to decide whether or not to support particular fuels management approaches such as prescribed...

The Implementation of a Positive Behaviour Management Programme in a Primary Classroom: A Case Study.

ERIC Educational Resources Information Center

Atherley, Carole

1990-01-01

Positive behavior management has been recommended as a more acceptable form of classroom management than traditional behavioral modification. This paper discusses the application of stimulus and contingency control methods (positive behavior management) to elicit more socially and academically acceptable behavior from elementary school children.…

41 CFR 102-38.290 - What types of payment may we accept?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What types of payment may we accept? 102-38.290 Section 102-38.290 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION PERSONAL PROPERTY 38-SALE OF PERSONAL...

A Methodology for Writing High Quality Requirement Specifications and for Evaluating Existing Ones

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hammer, Theodore

1999-01-01

Requirements development and management have always been critical in the implementation of software systems-engineers are unable to build what analysts can not define. It is generally accepted that the earlier in the life cycle potential risks are identified the easier it is to eliminate or manage the conditions that introduce that risk. Problems that are not found until testing are approximately 14 times more costly to fix than if the problem was found in the requirement phase. The requirements specification, as the first tangible representation of the capability to be produced, establishes the basis for all of the project's engineering management and assurance functions. If the quality of the requirements specification is poor it can give rise to risks in all areas of the project. Recently, automated tools have become available to support requirements management. The use of these tools not only provides support in the definition and tracing of requirements, but it also opens the door to effective use of metrics in characterizing and assessing the quality of the requirement specifications.

A Methodology for Writing High Quality Requirements Specification and Evaluating Existing Ones

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hammer, Theodore

1999-01-01

Requirements development and management have always been critical in the implementation of software systems; engineers are unable to build what analysts can't define. It is generally accepted that the earlier in the life cycle potential risks are identified the easier it is to eliminate or manage the conditions that introduce that risk. Problems that are not found until testing are approximately 14 times more costly to fix than if the problem was found in the requirement phase. The requirements specification, as the first tangible representation of the capability to be produced, establishes the basis for all of the project's engineering management and assurance functions. If the quality of the requirements specification is poor it can give rise to risks in all areas of the project. Recently, automated tools have become available to support requirements management. The use of these tools not only provides support in the definition and tracing of requirements, but it also opens the door to effective use of metrics in characterizing and assessing the quality of the requirement specifications.

Interest and limits of the six sigma methodology in medical laboratory.

PubMed

Scherrer, Florian; Bouilloux, Jean-Pierre; Calendini, Ors'Anton; Chamard, Didier; Cornu, François

2017-02-01

The mandatory accreditation of clinical laboratories in France provides an incentive to develop real tools to measure performance management methods and to optimize the management of internal quality controls. Six sigma methodology is an approach commonly applied to software quality management and discussed in numerous publications. This paper discusses the primary factors that influence the sigma index (the choice of the total allowable error, the approach used to address bias) and compares the performance of different analyzers on the basis of the sigma index. Six sigma strategy can be applied to the policy management of internal quality control in a laboratory and demonstrates through a comparison of four analyzers that there is no single superior analyzer in clinical chemistry. Similar sigma results are obtained using approaches toward bias based on the EQAS or the IQC. The main difficulty in using the six sigma methodology lies in the absence of official guidelines for the definition of the total error acceptable. Despite this drawback, our comparison study suggests that difficulties with defined analytes do not vary with the analyzer used.

Endotracheal tube placement by EMT-Basics in a rural EMS system.

PubMed

Pratt, Jeffrey C; Hirshberg, Alan J

2005-01-01

To evaluate the effectiveness of an intubation-training module and special-waiver project in which Emergency Medical Technician (EMT)-Basics were trained to perform endotracheal intubations in a rural community. This was a prospective observational study over a four-year period (July 1998 through May 2002) of all intubation attempts by EMT-Basics in the field. The authors observed intubation data, training methods, and quality-assurance methods of a special-waiver project agreed to by the State Department of Public Health to train and allow EMT-Basics to intubate patients. Data were from documentation unique to the project. Project documentation evaluated the placement and complication(s) of endotracheal tube (ETT) placement after arrival to the emergency department. An intubation attempt was defined as direct laryngoscopy. A successful attempt was defined as an appropriately sized ETT placed and secured in the trachea below the vocal cords and above the carina. Confirmation of placement in the field included accepted clinical methods and the use of qualitative colorimetric end-tidal carbon dioxide detectors. The EMT-Basics were trained using a paramedic curriculum, including operating room intubations on live adult patients. All patients were in either cardiopulmonary or respiratory arrest. Thirty-two intubations were performed by EMT-Basics. Thirty attempts were successful and two were unsuccessful (94%; 95% confidence interval [CI] 80-98%). Unsuccessful ETT placements were managed with accepted basic life support airway standards. There were no unrecognized esophageal ETT placements (0%; 95% CI 0-11%). This study demonstrated that with an intensive training program using selected highly motivated providers and close monitoring, a program of EMT-Basic ETT placement in a rural setting can achieve acceptable success rates in patients in cardiac or respiratory arrest.

Evaluation of the Acceptance of Audience Response System by Corporations Using the Technology Acceptance Model

NASA Astrophysics Data System (ADS)

Chu, Hsing-Hui; Lu, Ta-Jung; Wann, Jong-Wen

The purpose of this research is to explore enterprises' acceptance of Audience Response System (ARS) using Technology Acceptance Model (TAM). The findings show that (1) IT characteristics and facilitating conditions could be external variables of TAM. (2) The degree of E-business has positive significant correlation with behavioral intention of employees. (3) TAM is a good model to predict and explain IT acceptance. (4) Demographic variables, industry and firm characteristics have no significant correlation with ARS acceptance. The results provide useful information to managers and ARS providers that (1) ARS providers should focus more on creating different usages to enhance interactivity and employees' using intention. (2) Managers should pay attention to build sound internal facilitating conditions for introducing IT. (3) According to the degree of E-business, managers should set up strategic stages of introducing IT. (4) Providers should increase product promotion and also leverage academic and government to promote ARS.

14 CFR 435.35 - Acceptable reentry risk for reentry of a reentry vehicle.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Acceptable reentry risk for reentry of a reentry vehicle. 435.35 Section 435.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL... reentry vehicle, does not exceed acceptable risk for the conduct of an RLV mission as defined in...

14 CFR 435.35 - Acceptable reentry risk for reentry of a reentry vehicle.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Acceptable reentry risk for reentry of a reentry vehicle. 435.35 Section 435.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL... reentry vehicle, does not exceed acceptable risk for the conduct of an RLV mission as defined in...

14 CFR 435.35 - Acceptable reentry risk for reentry of a reentry vehicle.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Acceptable reentry risk for reentry of a reentry vehicle. 435.35 Section 435.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL... reentry vehicle, does not exceed acceptable risk for the conduct of an RLV mission as defined in...

14 CFR 435.35 - Acceptable reentry risk for reentry of a reentry vehicle.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Acceptable reentry risk for reentry of a reentry vehicle. 435.35 Section 435.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL... reentry vehicle, does not exceed acceptable risk for the conduct of an RLV mission as defined in...

14 CFR 435.35 - Acceptable reentry risk for reentry of a reentry vehicle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Acceptable reentry risk for reentry of a reentry vehicle. 435.35 Section 435.35 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL... reentry vehicle, does not exceed acceptable risk for the conduct of an RLV mission as defined in...

Seeing Eye-to-Eye on Natural Resource Management: Trust, Value Similarity, and Action Consistency / Justification

Treesearch

George T. Cvetkovich; Patricia L. Winter

2004-01-01

A series of natural resource management studies has explored a salient values similarity model of trust introduced by Earle & Cvetkovich (1995). Forest Service management topics investigated by these studies include acceptance of a proposed forest research program, evaluations of management interventions to protect a watershed, acceptance of a proposed fee...

41 CFR 102-37.275 - May a SASP accept personal checks and non-official payment methods in payment of service charges?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false May a SASP accept....275 Public Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION PERSONAL PROPERTY 37-DONATION OF SURPLUS PERSONAL PROPERTY State Agency for...

International Space Station Increment Operations Services

NASA Astrophysics Data System (ADS)

Michaelis, Horst; Sielaff, Christian

2002-01-01

The Industrial Operator (IO) has defined End-to-End services to perform efficiently all required operations tasks for the Manned Space Program (MSP) as agreed during the Ministerial Council in Edinburgh in November 2001. Those services are the result of a detailed task analysis based on the operations processes as derived from the Space Station Program Implementation Plans (SPIP) and defined in the Operations Processes Documents (OPD). These services are related to ISS Increment Operations and ATV Mission Operations. Each of these End-to-End services is typically characterised by the following properties: It has a clearly defined starting point, where all requirements on the end-product are fixed and associated performance metrics of the customer are well defined. It has a clearly defined ending point, when the product or service is delivered to the customer and accepted by him, according to the performance metrics defined at the start point. The implementation of the process might be restricted by external boundary conditions and constraints mutually agreed with the customer. As far as those are respected the IO has the free choice to select methods and means of implementation. The ISS Increment Operations Service (IOS) activities required for the MSP Exploitation program cover the complete increment specific cycle starting with the support to strategic planning and ending with the post increment evaluation. These activities are divided into sub-services including the following tasks: - ISS Planning Support covering the support to strategic and tactical planning up to the generation - Development &Payload Integration Support - ISS Increment Preparation - ISS Increment Execution These processes are tight together by the Increment Integration Management, which provides the planning and scheduling of all activities as well as the technical management of the overall process . The paper describes the entire End-to-End ISS Increment Operations service and the implementation to support the Columbus Flight 1E related increment and subsequent ISS increments. Special attention is paid to the implications caused by long term operations on hardware, software and operations personnel.

On risky ground: the water professional in politics.

PubMed

Holmes, P R

2004-01-01

Best practice in drainage basin management requires consultation and stakeholder engagement in the formulation and implementation of plans. The water management professional, engaging with the political world, is on risky ground, thanks to many stakeholders' accidental or chosen unwillingness to accept science-based advice. Technical specialists produce good advice, yet progress is inhibited because they do not connect effectively with politicians, administrators and managers. A series of short case studies from three countries in different but related fields provides evidence of the problems that are encountered. Professionals may be cut off from the political world within comfort zones defined by the cultural norms and behaviours of bureaucracy, their profession or their preferred communications style. The consequence of the professionals' lack of engagement in the political world can be that scarce money and effort is wasted on low priority issues, and the case for sound, sustainable environmental management is discredited. Stakeholder support is worth winning, because it can bring positive benefits in the effectiveness of environmental management programmes. Where outside help is needed to bring about this result, it should be provided by advisers who are sensitive to the culture, at the national, professional and organizational level, of the recipients.

Acceptance- versus Change-Based Pain Management: The Role of Psychological Acceptance

ERIC Educational Resources Information Center

Blacker, Kara J.; Herbert, James D.; Forman, Evan M.; Kounios, John

2012-01-01

This study compared two theoretically opposed strategies for acute pain management: an acceptance-based and a change-based approach. These two strategies were compared in a within-subjects design using the cold pressor test as an acute pain induction method. Participants completed a baseline pain tolerance assessment followed by one of the two…

48 CFR 46.502 - Responsibility for acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Responsibility for acceptance. 46.502 Section 46.502 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 46.502 Responsibility for acceptance. Acceptance of...

Target biomarker profile for the clinical management of paracetamol overdose

PubMed Central

Vliegenthart, A D Bastiaan; Antoine, Daniel J; Dear, James W

2015-01-01

Paracetamol (acetaminophen) overdose is one of the most common causes of acute liver injury in the Western world. To improve patient care and reduce pressure on already stretched health care providers new biomarkers are needed that identify or exclude liver injury soon after an overdose of paracetamol is ingested. This review highlights the current state of paracetamol poisoning management and how novel biomarkers could improve patient care and save healthcare providers money. Based on the widely used concept of defining a target product profile, a target biomarker profile is proposed that identifies desirable and acceptable key properties for a biomarker in development to enable the improved treatment of this patient population. The current biomarker candidates, with improved hepatic specificity and based on the fundamental mechanistic basis of paracetamol-induced liver injury, are reviewed and their performance compared with our target profile. PMID:26076366

An Example of an INPRO Assessment of an INS in the Area of Waste Management

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

Allan, C.; Busurin, Y.; Depisch, F.

2006-07-01

Following a resolution of the General Conference of the IAEA in the year 2000 the International Project on Innovative Nuclear Reactors and Fuel Cycles, referred to as INPRO, was initiated. INPRO has defined requirements organized in a hierarchy of Basic Principles, User Requirements and Criteria (consisting of an indicator and an acceptance limit) to be met by innovative nuclear reactor systems (INS) in six areas, namely: economics, safety, waste management, environment, proliferation resistance, and infrastructure. If an INS meets all requirements in all areas it represents a sustainable system for the supply of energy, capable of making a significant contributionmore » to meeting the energy needs of the 21. century. Draft manuals have been developed, for each INPRO area, to provide guidance for performing an assessment of whether an INS meets the INPRO requirements in a given area. The manuals set out the information that needs to be assembled to perform an assessment and provide guidance on selecting the acceptance limits and, for a given INS, for determining the value of the indicators for comparison with the associated acceptance limits. Each manual also includes an example of a specific assessment to illustrate the guidance. This paper discusses the example presented in the manual for performing an INPRO assessment in the area of waste management. The example, chosen solely for the purpose of illustrating the INPRO methodology, describes an assessment of an INS based on the DUPIC fuel cycle. It is assumed that uranium is mined, milled, converted, enriched, and fabricated into LWR fuel in Canada. The LWR fuel is assumed to be leased to a utility in the USA. The spent LWR fuel is assumed to be returned to Canada where it is processed into CANDU DUPIC fuel, which is then burned in CANDU reactors. The assessment steps and the results are presented in detail in the paper. The example illustrates an assessment performed for an INS at an early stage of development. (authors)« less

A fuzzy stochastic framework for managing hydro-environmental and socio-economic interactions under uncertainty

NASA Astrophysics Data System (ADS)

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

2014-05-01

An amplified interconnectedness between a hydro-environmental and socio-economic system brings about profound challenges of water management decision making. In this contribution, we present a fuzzy stochastic approach to solve a set of decision making problems, which involve hydrologically, environmentally, and socio-economically motivated criteria subjected to uncertainty and ambiguity. The proposed methodological framework combines objective and subjective criteria in a decision making procedure for obtaining an acceptable ranking in water resources management alternatives under different type of uncertainty (subjective/objective) and heterogeneous information (quantitative/qualitative) simultaneously. The first step of the proposed approach involves evaluating the performance of alternatives with respect to different types of criteria. The ratings of alternatives with respect to objective and subjective criteria are evaluated by simulation-based optimization and fuzzy linguistic quantifiers, respectively. Subjective and objective uncertainties related to the input information are handled through linking fuzziness and randomness together. Fuzzy decision making helps entail the linguistic uncertainty and a Monte Carlo simulation process is used to map stochastic uncertainty. With this framework, the overall performance of each alternative is calculated using an Order Weighted Averaging (OWA) aggregation operator accounting for decision makers' experience and opinions. Finally, ranking is achieved by conducting pair-wise comparison of management alternatives. This has been done on the basis of the risk defined by the probability of obtaining an acceptable ranking and mean difference in total performance for the pair of management alternatives. The proposed methodology is tested in a real-world hydrosystem, to find effective and robust intervention strategies for the management of a coastal aquifer system affected by saltwater intrusion due to excessive groundwater extraction for irrigated agriculture and municipal use. The results show that the approach gives useful support for robust decision-making and is sensitive to the decision makers' degree of optimism.

Beyond wilderness: Broadening the applicability of limits of acceptable change

Treesearch

Mark W. Brunson

1977-01-01

The Limits of Acceptable Change (LAC) process helps managers preserve wilderness attributes along with recreation opportunities. Ecosystem management likewise requires managers to balance societal and ecosystem needs. Both are more likely to succeed through collaborative planning. Consequently, LAC can offer a conceptual framework for achieving sustainable solutions...

A Study of the Relationship between Personality Types and the Acceptance of Technical Knowledge Management Systems (TKMS)

ERIC Educational Resources Information Center

Sullivan, Maureen S.

2012-01-01

Technical knowledge management systems (TKMSs) are not achieving the usage (acceptance) and the benefits that have been forecasted and are therefore, not enhancing competitive advantage and profits in organizations (Comb, 2004, "Assessing customer relationship management strategies for creating competitive advantage in electronic…

Contribution of the Multi-attribute Value Theory to conflict resolution in groundwater management. Application to the Mancha Oriental system (Spain)

NASA Astrophysics Data System (ADS)

Apperl, B.; Pulido-Velazquez, M.; Andreu, J.; Llopis-Albert, C.

2012-04-01

The implementation of the EU Water Framework Directive, with consideration of environmental, economic and social objectives, claims for participatory water resource management methods. To deal with different conflicting objectives it is necessary to apply a method for clarifying stakeholders' positions (identifying values and opinions of stakeholders, and quantifying their valuations), improving transparency with respect to outcomes of alternatives, and moving the discussion from alternatives towards fundamental objectives (value-thinking approach) and valuing trade-offs, facilitating negotiation. The method allows the incorporation of stakeholders in the planning process, which should guarantee a higher acceptance of the policies to be implemented. This research has been conducted in the Mancha Oriental groundwater system Spain, subject to an intensive use of groundwater for irrigation. The main goals according to the WFD are: a good qualitative and quantitative status of the aquifer and a good quantitative and ecological status of related surface water resources (mainly the Jucar river and dependent ecosystems). The aim is to analyze the contribution of the MAVT for conflict resolution and a sustainable groundwater management, involving the stakeholders in the valuation process. A complex set of objectives and attributes has been defined. The alternatives have been evaluated according to the compliance of ecological, economic and social interests. Results show that the acceptation of alternatives depends strongly on the combination of measures and the implementation status. A high conflict potential is expected from alternatives consisting of one unique measure. Uncertainties of the results are notable, but do not influence heavily on the alternative ranking. Different future scenarios also influence on the preference of alternatives. For instance, an expected reduction of future groundwater resources by climate change increases the conflict potential, with two observed reactions: acceptance of more rigorous measures, on one hand, and a tendency to soft measures with the same cost, as a reaction to the decreased effectiveness of the alternatives. The implementation of the method to a very complex case study, with many conflicting objectives and alternatives and uncertain outcomes, including future scenarios (climate change) illustrate the potential of the method for supporting management decisions.

Evaluation of computerized decision support for oral anticoagulation management based in primary care.

PubMed

Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

1996-09-01

Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability.

The role of public communication in decision making for waste management infrastructure.

PubMed

Kirkman, Richard; Voulvoulis, Nikolaos

2017-12-01

Modern waste management provision seeks to meet challenging objectives and strategies while reflecting community aspirations and ensuring cost-effective compliance with statutory obligations. Its social acceptability, which affects both what systems (infrastructure) can be put in place and to what extent their implementation will be successful, is a multi-dimensional phenomenon, often not well understood. In light of the growing evidence that decisions to build new infrastructure are often contested by the public, there is a clear need to understand the role of scientific evidence in public perception, particularly as environmental infrastructure delivery is often objected to by the public on environmental grounds. In this paper the need for waste management infrastructure is reviewed, and the way its delivery in the UK has evolved is used as an example of the role of public perception in the planning and delivery of waste facilities. Findings demonstrate the vital role of public communication in waste management infrastructure delivery. Public perception must be taken into account early in the decision making process, with the public informed and engaged from the start. There is a pressing need for people not simply to accept but to understand and appreciate the need for infrastructure, the nature of infrastructure investments and development, the costs and the benefits involved, and the technological aspects. Scientific evidence and literacy have a critical role to play, facilitating public engagement in a process that empowers people, allowing them to define and handle challenges and influence decisions that will impact their lives. Problem ownership, and an increased probability of any solutions proposed being selected and implemented successfully are potential benefits of such approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test.

PubMed

Dou, Kaili; Yu, Ping; Deng, Ning; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

2017-12-06

Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use and actual use of smartphone health apps for chronic disease management. This study developed a theoretical model to predict patients' acceptance of smartphone health technology for chronic disease management. Although resistance to change is a significant barrier to technology acceptance, careful management of doctor-patient relationship, and raising patients' awareness of the negative effect of chronic disease can negate the effect of resistance and encourage acceptance and use of smartphone health technology to support chronic disease management for patients in the community. ©Kaili Dou, Ping Yu, Ning Deng, Fang Liu, YingPing Guan, Zhenye Li, Yumeng Ji, Ningkai Du, Xudong Lu, Huilong Duan. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.12.2017.

Multiscale Resilience of Complex Systems

NASA Astrophysics Data System (ADS)

Tchiguirinskaia, I.; Schertzer, D. J. M.; Giangola-Murzyn, A.; Hoang Cong, T.

2014-12-01

We first argue the need for well defined resilience metrics to better evaluate the resilience of complex systems such as (peri-)urban flood management systems. We review both the successes and limitations of resilience metrics in the framework of dynamical systems and their generalization in the framework of the viability theory. We then point out that the most important step to achieve is to define resilience across scales instead of doing it at a given scale. Our preliminary, critical analysis of the series of attempts to define an operational resilience metrics led us to consider a scale invariant metrics based on the scale independent codimension of extreme singularities. Multifractal downscaling of climate scenarios can be considered as a first illustration. We focussed on a flood scenario evaluation method with the help of two singularities γ_s and γ_Max, corresponding respectively to an effective and a probable maximum singularity, that yield an innovative framework to address the issues of flood resilience systems in a scale independent manner. Indeed, the stationarity of the universal multifractal parameters would result into a rather stable value of probable maximum singularity γ_s. By fixing the limit of acceptability for a maximum flood water depth at a given scale, with a corresponding singularity, we effectively fix the threshold of the probable maximum singularity γ_s as a criterion of the flood resilience we accept. Then various scenarios of flood resilient measures could be simulated with the help of Multi-Hydro under upcoming climat scenarios. The scenarios that result in estimates of either γ_Max or γ_s below the pre-selected γ_s value will assure the effective flood resilience of the whole modeled system across scales. The research for this work was supported, in part, by the EU FP7 SMARTesT and INTERREG IVB RainGain projects.

Defining incidental perineural invasion: the need for a national registry.

PubMed

Buchanan, Lauren; De'Ambrosis, Brian; DeAmbrosis, Kathryn; Warren, Timothy; Huilgol, Shyamala; Soyer, H Peter; Panizza, Benedict

2014-05-01

This article by the Perineural Invasion (PNI) Registry Group aims to clarify clinical and histopathological ambiguities surrounding PNI in non-melanoma skin cancer (NMSC). PNI is reportedly present in approximately 2-6% of cases of NMSC and is associated with greater rates of morbidity and mortality. The distinction between clinical PNI and incidental PNI is somewhat unclear, especially in regard to management and prognosis. One important objective of the PNI Registry is to develop a standardised method of classifying perineural invasion. Hence, in this article we propose a definition for PNI and for its sub-classification. This article also provides a critical analysis of the current literature on the treatment of incidental PNI by evaluating the key cohort studies that have investigated the use of surgery or radiotherapy in the management of incidental PNI. At present, there are no universal clinical guidelines that specify the acceptable treatment of NMSC exhibiting incidental PNI. Consequently, patients often receive surgery with varying wider margins, or radiotherapy despite the limited evidence substantiating such management options. It is evident from the existing literature that current opinion is divided over the benefit of adjuvant radiotherapy. Certain prognostic factors have been proposed, such as the size and depth of tumour invasion, nerve diameter, the presence of multifocal PNI and the type of tumour. The PNI Registry is a web-based registry that has been developed to assist in attaining further data pertaining to incidental PNI in NMSC. It is envisaged that this information will provide the foundation for identifying and defining best practice in managing incidental PNI. © 2013 The Australasian College of Dermatologists.

Knowledge and perception of plastic surgery among tertiary education students in Enugu, South-East Nigeria.

PubMed

Isiguzo, C M; Nwachukwu, C D

2016-01-01

Knowledge, perception, and acceptance of plastic surgery among any population are influenced by channel of presentation. A good understanding of the public awareness will define the way plastic surgery services will be provided. To assess the knowledge, awareness of availability, and acceptance of plastic surgery practice in Enugu, South East Nigeria. A questionnaire-based prospective study. The electronic media is the most common medium of awareness. Less than half the sample knew about the existence of plastic surgeons in Enugu even though a large proportion was aware of the existence of plastic surgery as a specialty. The concentration of plastic surgeons in a center is directly related to awareness of plastic surgery services in that facility. The most common esthetic procedure done by a plastic surgeon in Enugu is tattoo removal and scar refashioning. Orthopedic surgeons are thought to be key players in the management of burn patients as much as the plastic surgeons due to the "SIGNPOST EFFECT." The level of awareness is high in the sampled population with associated increase in acceptance of its practice and willing utilization. All public hospitals should be encouraged to employ the services of plastic surgeons. Appropriate branding of specialized hospitals where plastic surgery service is available will advance the practice significantly.

Traffic Management Plan Effectiveness Study, Final Report

DOT National Transportation Integrated Search

1993-05-28

MULTI-DIMENSIONAL TRAFFIC MANAGEMENT PLANS (TMPS) HAVE BECOME INCREASINGLY ACCEPTED BY TRANSPORTATION PROFESSIONALS, STATE AND LOCAL GOVERNMENTS AND THE PUBLIC AS A VIABLE MEANS OF MAINTANING ACCEPTABLE LEVELS OF TRAFFIC FLOW DURING PERIODS OF TRAFFI...

Treatment acceptability among mexican american parents.

PubMed

Borrego, Joaquin; Ibanez, Elizabeth S; Spendlove, Stuart J; Pemberton, Joy R

2007-09-01

There is a void in the literature with regard to Hispanic parents' views about common interventions for children with behavior problems. The purpose of this study was to examine the treatment acceptability of child management techniques in a Mexican American sample. Parents' acculturation was also examined to determine if it would account for differences in treatment acceptability. Mexican American parents found response cost, a punishment-based technique, more acceptable than positive reinforcement-based techniques (e.g., differential attention). Results suggest that Mexican American parents' acculturation has little impact on acceptability of child management interventions. No association was found between mothers' acculturation and treatment acceptability. However, more acculturated Mexican American fathers viewed token economy as more acceptable than less acculturated fathers. Results are discussed in the context of clinical work and research with Mexican Americans.

Moving Toward Quantifying Reliability - The Next Step in a Rapidly Maturing PV Industry: Preprint

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

Kurtz, Sarah; Sample, Tony; Wohlgemuth, John

2015-12-07

Some may say that PV modules are moving toward being a simple commodity, but most major PV customers ask: 'How can I minimize chances of a module recall?' Or, 'How can I quantify the added value of a 'premium' module?' Or, 'How can I assess the value of an old PV system that I'm thinking of purchasing?' These are all questions that PVQAT (the International PV Quality Assurance Task Force) and partner organizations are working to answer. Defining standard methods for ensuring minimal acceptable quality of PV modules, differentiating modules that provide added value in the toughest of environments, andmore » creating a process (e.g. through IECRE [1]) that can follow a PV system from design through installation and operation are tough tasks, but having standard approaches for these will increase confidence, reduce costs, and be a critical foundation of a mature PV industry. This paper summarizes current needs for new tests, some challenges for defining those tests, and some of the key efforts toward development of international standards, emphasizing that meaningful quantification of reliability (as in defining a service life prediction) must be done in the context of a specific product with design parameters defined through a quality management system.« less

Understanding the social acceptability of natural resource decisionmaking processes by using a knowledge base modeling approach.

Treesearch

Christina Kakoyannis; Bruce Shindler; George Stankey

2001-01-01

Natural resource managers are being confronted with increasing conflict and litigation with those who find their management plans unacceptable. Compatible and sustainable management decisions necessitate that natural resource agencies generate plans that are not only biologically possible and economically feasible but also socially acceptable. Currently, however, we...

Development and validation of a questionnaire to evaluate patient satisfaction with diabetes disease management.

PubMed

Paddock, L E; Veloski, J; Chatterton, M L; Gevirtz, F O; Nash, D B

2000-07-01

To develop a reliable and valid questionnaire to measure patient satisfaction with diabetes disease management programs. Questions related to structure, process, and outcomes were categorized into 14 domains defining the essential elements of diabetes disease management. Health professionals confirmed the content validity. Face validity was established by a patient focus group. The questionnaire was mailed to 711 patients with diabetes who participated in a disease management program. To reduce the number of questionnaire items, a principal components analysis was performed using a varimax rotation. The Scree test was used to select significant components. To further assess reliability and validity; Cronbach's alpha and product-moment correlations were calculated for components having > or =3 items with loadings >0.50. The validated 73-item mailed satisfaction survey had a 34.1% response rate. Principal components analysis yielded 13 components with eigenvalues > 1.0. The Scree test proposed a 6-component solution (39 items), which explained 59% of the total variation. Internal consistency reliabilities computed for the first 6 components (alpha = 0.79-0.95) were acceptable. The final questionnaire, the Diabetes Management Evaluation Tool (DMET), was designed to assess patient satisfaction with diabetes disease management programs. Although more extensive testing of the questionnaire is appropriate, preliminary reliability and validity of the DMET has been demonstrated.

The Low-Level Radioactive Waste Management Office: Thirty Years of Experience in Canada - 13308

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

Benitez, Liliana; Gardiner, Mark J.; Zelmer, Robert L.

2013-07-01

This paper reviews thirty years of progress by the Low-Level Radioactive Waste Management Office (LLRWMO) in developing and implementing low-level radioactive waste (LLRW) remediation projects and environmentally safe co-existence strategies. It reports on the present status and the future of the national historic waste program in Canada. There are over two million cubic metres of historic LLRW in Canada. Historic LLRW is broadly defined as LLRW that was managed in the past in a manner that is no longer considered acceptable and for which the original owner cannot reasonably be held accountable. In many cases, the original owner can notmore » be identified or no longer exists. The LLRWMO was established in 1982 as Canada's agent to carry out the responsibilities of the federal government for the management of historic LLRW. The LLRWMO is operated by Atomic Energy of Canada Limited (AECL) through a cost-recovery agreement with Natural Resources Canada (NRCan), the federal department that provides the funding and establishes national policy for radioactive waste management in Canada. The LLRWMO expertise includes project managers, environmental remediation specialists, radiation surveyors, communications staff and administrative support staff. The LLRWMO in providing all aspects of project oversight and implementation contracts additional resources supplementing core staff capacity as project/program demands require. (authors)« less

Comparison of municipal solid waste management systems in Canada and Ghana: A case study of the cities of London, Ontario, and Kumasi, Ghana

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

Asase, Mizpah; Yanful, Ernest K.; Mensah, Moses

2009-10-15

Integrated waste management has been accepted as a sustainable approach to solid waste management in any region. It can be applied in both developed and developing countries. The difference is the approach taken to develop the integrated waste management system. This review looks at the integrated waste management system operating in the city of London, Ontario-Canada and how lessons can be drawn from the system's development and operation that will help implement a sustainable waste management system in the city of Kumasi, Ghana. The waste management system in London is designed such that all waste generated in the city ismore » handled and disposed of appropriately. The responsibility of each sector handling waste is clearly defined and monitored. All major services are provided and delivered by a combination of public and private sector forces. The sustainability of the waste management in the city of London is attributed to the continuous improvement strategy framework adopted by the city based on the principles of integrated waste management. It is perceived that adopting a strategic framework based on the principles of integrated waste management with a strong political and social will, can transform the current waste management in Kumasi and other cities in developing countries in the bid for finding lasting solutions to the problems that have plagued the waste management system in these cities.« less

An Embedded Multi-Agent Systems Based Industrial Wireless Sensor Network

PubMed Central

Brennan, Robert W.

2017-01-01

With the emergence of cyber-physical systems, there has been a growing interest in network-connected devices. One of the key requirements of a cyber-physical device is the ability to sense its environment. Wireless sensor networks are a widely-accepted solution for this requirement. In this study, an embedded multi-agent systems-managed wireless sensor network is presented. A novel architecture is proposed, along with a novel wireless sensor network architecture. Active and passive wireless sensor node types are defined, along with their communication protocols, and two application-specific examples are presented. A series of three experiments is conducted to evaluate the performance of the agent-embedded wireless sensor network. PMID:28906452

Flight Systems Integration and Test

NASA Technical Reports Server (NTRS)

Wright, Michael R.

2011-01-01

Topics to be Covered in this presentation are: (1) Integration and Test (I&T) Planning (2) Integration and Test Flows (3) Overview of Typical Mission I&T (4) Supporting Elements (5) Lessons-Learned and Helpful Hints (6) I&T Mishaps and Failures (7) The Lighter Side of I&T and (8) Small-Group Activity. This presentation highlights a typical NASA "in-house" I&T program (1) For flight systems that are developed by NASA at a space flight center (like GSFC) (2) Requirements well-defined: qualification/acceptance, documentation, configuration management. (3) Factors: precedents, human flight, risk-aversion ("failure-phobia"), taxpayer dollars, jobs and (4) Some differences among NASA centers, but generally a resource-intensive process

Conceptual framework to ensure water security in Ukraine

NASA Astrophysics Data System (ADS)

Gadzalo, Yaroslav; Romashchenko, Mykhailo; Yatsiuk, Mykhailo

2018-02-01

As a result of global climate change against the background of natural water supply deterioration and river water content reductions, nowadays Ukraine is facing the problem of environmental degradation of river basins. In light of this, we suggest that achieving an acceptable level of water security in Ukraine should be defined as the strategic objective of national water policy. The state of national water security should be evaluated by its progress in certain sectors. The basic principles of the new water policy of Ukraine are supposed to be represented in Water Strategy of Ukraine. Integrated water management by the basin principle should serve as the main tool for achieving the objectives of water security.

An Embedded Multi-Agent Systems Based Industrial Wireless Sensor Network.

PubMed

Taboun, Mohammed S; Brennan, Robert W

2017-09-14

With the emergence of cyber-physical systems, there has been a growing interest in network-connected devices. One of the key requirements of a cyber-physical device is the ability to sense its environment. Wireless sensor networks are a widely-accepted solution for this requirement. In this study, an embedded multi-agent systems-managed wireless sensor network is presented. A novel architecture is proposed, along with a novel wireless sensor network architecture. Active and passive wireless sensor node types are defined, along with their communication protocols, and two application-specific examples are presented. A series of three experiments is conducted to evaluate the performance of the agent-embedded wireless sensor network.

DCS: A Case Study of Identification of Knowledge and Disposition Gaps Using Principles of Continuous Risk Management

NASA Technical Reports Server (NTRS)

Norcross, Jason; Steinberg, Susan; Kundrot, Craig; Charles, John

2011-01-01

The Human Research Program (HRP) is formulated around the program architecture of Evidence-Risk-Gap-Task-Deliverable. Review of accumulated evidence forms the basis for identification of high priority risks to human health and performance in space exploration. Gaps in knowledge or disposition are identified for each risk, and a portfolio of research tasks is developed to fill them. Deliverables from the tasks inform the evidence base with the ultimate goal of defining the level of risk and reducing it to an acceptable level. A comprehensive framework for gap identification, focus, and metrics has been developed based on principles of continuous risk management and clinical care. Research towards knowledge gaps improves understanding of the likelihood, consequence or timeframe of the risk. Disposition gaps include development of standards or requirements for risk acceptance, development of countermeasures or technology to mitigate the risk, and yearly technology assessment related to watching developments related to the risk. Standard concepts from clinical care: prevention, diagnosis, treatment, monitoring, rehabilitation, and surveillance, can be used to focus gaps dealing with risk mitigation. The research plan for the new HRP Risk of Decompression Sickness (DCS) used the framework to identify one disposition gap related to establishment of a DCS standard for acceptable risk, two knowledge gaps related to DCS phenomenon and mission attributes, and three mitigation gaps focused on prediction, prevention, and new technology watch. These gaps were organized in this manner primarily based on target for closure and ease of organizing interim metrics so that gap status could be quantified. Additional considerations for the knowledge gaps were that one was highly design reference mission specific and the other gap was focused on DCS phenomenon.

Defining Mental Health in Later Life.

ERIC Educational Resources Information Center

Qualls, Sara Honn

2002-01-01

Traditional models for defining mental health have used statistical definitions and symptom-based definitions. In a lifespan psychological approach, mental health in later life is defined as acceptance of the aging self as an active being who creates meaning, maintains maximum autonomy, and sustains positive relationships. (Contains 12…

77 FR 47827 - Intent To Prepare an Environmental Impact Statement for the Kissimmee Basin Modified Water...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... more acceptable balance among flood control, water supply, aquatic plant management, and natural... achieve a more acceptable balance among flood control, water supply, aquatic plant management, and natural...

Trust, Isolation, and Presence: The Virtual Work Environment and Acceptance of Deep Organizational Change

ERIC Educational Resources Information Center

Rose, Laurence Michael

2013-01-01

The primary focus of this research was to explore through the use of a grounded theory methodology if the human perceptions of trust, isolation, and presence affected the virtual workers ability to accept deep organizational change. The study found that the virtual workers in the sample defined their acceptance of deep organizational change by…

Self-calibrating multiplexer circuit

DOEpatents

Wahl, Chris P.

1997-01-01

A time domain multiplexer system with automatic determination of acceptable multiplexer output limits, error determination, or correction is comprised of a time domain multiplexer, a computer, a constant current source capable of at least three distinct current levels, and two series resistances employed for calibration and testing. A two point linear calibration curve defining acceptable multiplexer voltage limits may be defined by the computer by determining the voltage output of the multiplexer to very accurately known input signals developed from predetermined current levels across the series resistances. Drift in the multiplexer may be detected by the computer when the output voltage limits, expected during normal operation, are exceeded, or the relationship defined by the calibration curve is invalidated.

'Nursing research culture' in the context of clinical nursing practice: addressing a conceptual problem.

PubMed

Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi

2017-05-01

To report an analysis of the concept of nursing research culture in the context of clinical nursing practice. Nursing research culture should be valued for its contribution to improving patient care and should be considered as a routine hospital activity. However, the demand for efficiency, nurses' barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Concept analysis. Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Walker and Avant's eight-step framework for concept analysis. Five defining attributes of nursing research culture in the context of clinical nursing practice were identified: strong monodisciplinary nursing professionalism, academic thinking and socialization, research use as a part of daily nursing practice, acceptance by colleagues and management and facilitation of resources from management and organization. Although the method of concept analysis has been criticized and heavily debated, the development of nursing research cultures based on the defining attributes and antecedents of the concept will be important to emphasize evidence-based clinical nursing care. Further research should support the development and the implementation of nursing research culture in clinical nursing practice. © 2016 John Wiley & Sons Ltd.

Management of radioactive waste in Belgium: ONDRAF/NIRAS and Belgoprocess as major actors of the waste acceptance system

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

Zaelen, Gunter van; Verheyen, Annick

2007-07-01

The management of radioactive waste in Belgium is undertaken by the national agency for radioactive waste and enriched fissile materials, ONDRAF/NIRAS, and its industrial partner Belgoprocess. ONDRAF/NIRAS has set up a management system designed to guarantee that the general public and the environment are protected against the potential hazards arising from radioactive waste. Belgoprocess is a private company, founded in 1984 and located in Dessel, Belgium. It is a subsidiary of ONDRAF/NIRAS and its activities focus on the safe processing and storage of radioactive waste. The management system of ONDRAF/NIRAS includes two aspects: a) an integrated system and b) anmore » acceptance system. The integrated system covers all aspects of management ranging from the origin of waste to its transport, processing, interim storage and long-term management. The safety of radioactive waste management not only depends on the quality of the design and construction of the processing, temporary storage or disposal infrastructure, but also on the quality of the waste accepted by ONDRAF/NIRAS. In order to be manage d safely, both in the short and the long term, the waste transferred to ONDRAF/NIRAS must meet certain specific requirements. To that end, ONDRAF/NIRAS has developed an acceptance system. (authors)« less

Sinus pericranii: diagnosis and management in 21 pediatric patients.

PubMed

Pavanello, Marco; Melloni, Ilaria; Antichi, Eleonora; Severino, Mariasavina; Ravegnani, Marcello; Piatelli, Gianluca; Cama, Armando; Rossi, Andrea; Gandolfo, Carlo

2015-01-01

Sinus pericranii (SP) is a rare venous anomaly abnormally connecting the intracranial dural sinuses with the epicranial veins. In the present study the authors aimed to clarify this clinicoradiological entity, define the role of angiography in its preoperative assessment, and suggest a diagnostic-therapeutic flow chart for management purposes. The authors retrospectively reviewed the clinical charts and neuroimages of 21 patients with SP. All patients underwent brain MRI, MR venography, and craniocerebral CT. Diagnostic digital subtraction angiography was performed in 19 of 21 patients, and the SPs were categorized as dominant (draining the majority of the intracranial venous outflow) or accessory (draining only a minority of the intracranial venous outflow). SP was median or paramedian in 20 patients and lateral in 1 patient. There were 5 dominant and 14 accessory SPs. The dominant SPs were not treated. Among the patients with accessory SP, 4 were not treated, 2 underwent surgical ligature, and 8 were treated endovascularly (with either transvenous or percutaneous embolization). No complications were observed, and symptoms disappeared after treatment in all cases. Accepted guidelines or recommendations concerning the management, diagnosis, and treatment of SP are still lacking. The authors define here a diagnostic-therapeutic flow chart, in which angiography plays a crucial role in the classification of SP and choice of the optimal treatment. Only accessory SP is amenable to treatment, whereas dominant SP must be preserved. The endovascular approach is becoming increasingly relevant and has proven to be safe and effective.

Development of an effective risk management system in a teaching hospital.

PubMed

Adibi, Hossein; Khalesi, Nader; Ravaghi, Hamid; Jafari, Mahdi; Jeddian, Ali Reza

2012-09-21

Unsafe health care provision is a main cause of increased mortality rate amongst hospitalized patients all over the world. A system approach to medical error and its reduction is crucial that is defined by clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury. The aim of this study was to develop and implement a risk management system in a large teaching hospital in Iran, especially of the basis of WHO guidelines and patient safety context. WHO draft guideline and patient safety reports from different countries were reviewed for defining acceptable framework of risk management system. Also current situation of mentioned hospital in safety matter and dimensions of patient safety culture was evaluated using HSOPSC questionnaire of AHRQ. With adjustment of guidelines and hospital status, the conceptual framework was developed and next it was validated in expert panel. The members of expert panel were selected according to their role and functions and also their experiences in risk management and patient safety issues. The validated framework consisted of designating a leader and coordinator core, defining communications, and preparing the infrastructure for patient safety education and culture-building. That was developed on the basis of some values and commitments and included reactive and proactive approaches. The findings of reporting activities demonstrated that at least 3.6 percent of hospitalized patients have experienced adverse events and 5.3 percent of all deaths in the hospital related with patient safety problems. Beside the average score of 12 dimensions of patient safety culture was 46.2 percent that was considerably low. The "non-punitive responses to error" had lowest positive score with 21.2 percent. It is of paramount importance for all health organizations to lay necessary foundations in order to identify safety risks and improve the quality of care. Inadequate participation of staff in education, reporting and analyzing, underreporting and uselessness of aggregated data, limitation of human and financial resources, punitive directions and management challenges for solutions were the main executive problems which could affect the effectiveness of system.

Motivational and behavioural models of change: A longitudinal analysis of change among men with chronic haemophilia-related joint pain.

PubMed

Elander, J; Richardson, C; Morris, J; Robinson, G; Schofield, M B

2017-09-01

Motivational and behavioural models of adjustment to chronic pain make different predictions about change processes, which can be tested in longitudinal analyses. We examined changes in motivation, coping and acceptance among 78 men with chronic haemophilia-related joint pain. Using cross-lagged regression analyses of changes from baseline to 6 months as predictors of changes from 6 to 12 months, with supplementary structural equation modelling, we tested two models in which motivational changes influence behavioural changes, and one in which behavioural changes influence motivational changes. Changes in motivation to self-manage pain influenced later changes in pain coping, consistent with the motivational model of pain self-management, and also influenced later changes in activity engagement, the behavioural component of pain acceptance. Changes in activity engagement influenced later changes in pain willingness, consistent with the behavioural model of pain acceptance. Based on the findings, a combined model of changes in pain self-management and acceptance is proposed, which could guide combined interventions based on theories of motivation, coping and acceptance in chronic pain. This study adds longitudinal evidence about sequential change processes; a test of the motivational model of pain self-management; and tests of behavioural versus motivational models of pain acceptance. © 2017 European Pain Federation - EFIC®.

Enabling the sharing of neuroimaging data through well-defined intermediate levels of visibility.

PubMed

Smith, Kenneth; Jajodia, Sushil; Swarup, Vipin; Hoyt, Jeffrey; Hamilton, Gail; Faatz, Donald; Cornett, Todd

2004-08-01

The sharing of neuroimagery data offers great benefits to science, however, data owners sharing their data face substantial custodial responsibilities, such as ensuring data sets are correctly interpreted in their new shared context, protecting the identity and privacy of human research participants, and safeguarding the understood order of use. Given choices of sharing widely or not at all, the result will often be no sharing, due to the inability of data owners to control their exposure to the risks associated with data sharing. In this context, data sharing is enabled by providing data owners with well-defined intermediate levels of data visibility, progressing incrementally toward public visibility. In this paper, we define a novel and general data sharing model, Structured Sharing Communities (SSC), meeting this requirement. Arbitrary visibility levels representing collaborative agreements, consortium memberships, research organizations, and other affiliations are structured into a policy space through explicit paths of permissible information flow. Operations enable users and applications to manage the visibility of data and enforce access permissions and restrictions. We show how a policy space can be implemented in realistic neuroinformatic architectures with acceptable assurance of correctness, and briefly describe an open source implementation effort.

Potential Acceptability of a Pediatric Ventilator Management Computer Protocol.

PubMed

Sward, Katherine A; Newth, Christopher J L; Khemani, Robinder G; Page, Kent; Meert, Kathleen L; Carcillo, Joseph A; Shanley, Thomas P; Moler, Frank W; Pollack, Murray M; Dalton, Heidi J; Wessel, David L; Berger, John T; Berg, Robert A; Harrison, Rick E; Doctor, Allan; Dean, J Michael; Holobkov, Richard; Jenkins, Tammara L; Nicholson, Carol E

2017-11-01

To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome. Survey/questionnaire. The eight PICUs in the Collaborative Pediatric Critical Care Research Network. One hundred twenty-two physicians (attendings and fellows). None. We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for FIO2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables. Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.

Finnish policy approach and measures for the promotion of sustainability in contaminated land management.

PubMed

Reinikainen, Jussi; Sorvari, Jaana; Tikkanen, Sarianne

2016-12-15

The importance of sustainability considerations in contaminated land management (CLM) is highlighted in policy frameworks all around the world. It means that while the reduction of risks to human health and the environment remains the main goal of CLM, a variety of other environmental factors as well as economic and social aspects have an increasing role in decision making. The success of finding the right balance between these considerations and incorporating them in the risk management approach defines the overall sustainability of the outcome. Although the concept and principles of sustainable CLM are already widely accepted, they have not been fully realized in national procedures. According to several studies this often results from the lack of explicit policy measures. A sound policy framework in conjunction with functional policy instruments is therefore a prerequisite for the attainment of sustainable practices. In Finland, the environmental administration along with other key stakeholder groups, including regional authorities, landowners, consultants, industries, research institutes and academia, has developed a national strategy and associated policy measures in order to promote sustainable CLM. Copyright © 2016 Elsevier Ltd. All rights reserved.

48 CFR 2446.502 - Responsibility for acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Responsibility for acceptance. 2446.502 Section 2446.502 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 2446.502 Responsibility for acceptance. ...

Between Oais and Agile a Dynamic Data Management Approach

NASA Astrophysics Data System (ADS)

Bennett, V. L.; Conway, E. A.; Waterfall, A. M.; Pepler, S.

2015-12-01

In this paper we decribe an approach to the integration of existing archival activities which lies between compliance with the more rigid OAIS/TRAC standards and a more flexible "Agile" approach to the curation and preservation of Earth Observation data. We provide a high level overview of existing practice and discuss how these procedures can be extended and supported through the description of preservation state. The aim of which is to facilitate the dynamic controlled management of scientific data through its lifecycle. While processes are considered they are not statically defined but rather driven by human interactions in the form of risk management/review procedure that produce actionable plans, which are responsive to change. We then proceed by describing the feasibility testing of extended risk management and planning procedures which integrate current practices. This was done through the CEDA Archival Format Audit which inspected British Atmospheric Data Centre and NERC Earth Observation Data Centre Archival holdings. These holdings are extensive, comprising of around 2 Petabytes of data and 137 million individual files, which were analysed and characterised in terms of format, based risk. We are then able to present an overview of the format based risk burden faced by a large scale archive attempting to maintain the usability of heterogeneous environmental data sets We continue by presenting a dynamic data management information model and provide discussion of the following core model entities and their relationships: Aspirational entities, which include Data Entity definitions and their associated Preservation Objectives. Risk entities, which act as drivers for change within the data lifecycle. These include Acquisitional Risks, Technical Risks, Strategic Risks and External Risks Plan entities, which detail the actions to bring about change within an archive. These include Acquisition Plans, Preservation Plans and Monitoring plans which support responsive interactions with the community. The Result entities describe the outcomes of the plans. This includes Acquisitions. Mitigations and Accepted Risks. With risk acceptance permitting imperfect but functional solutions that can be realistically supported within an archives resource levels

Improving Estimates of Acceptable Growiing Stock in Young Upland Oak Forests in the Missouri Ozarks

Treesearch

Daniel C. Dey; Paul S. Johnson; H.E. Garrett

1998-01-01

Estimates of regeneration or growing stock in young oak forests may be too high unless criteria are established that define explicitly acceptable growing stock. In young hardwood stands, crown class can be used to identify acceptable growing stock because it is related to the future growth and survival of reproduction. A method is presented for assigning crown class...

Accepting managed aquifer recharge of urban storm water reuse: The role of policy-related factors

NASA Astrophysics Data System (ADS)

Mankad, Aditi; Walton, Andrea

2015-12-01

A between-groups experimental design examined public acceptance for managed aquifer recharge of storm water for indirect potable and nonpotable reuse; acceptance was based on five policy-related variables (fairness, effectiveness, trust, importance of safety assurances, and importance of communication activities). Results showed that public acceptance (N = 408) for managed aquifer recharge of storm water was higher for nonpotable applications, as was the importance of safety assurances. Analyses of variance also showed that perceptions of fairness and effectiveness were higher for a nonpotable scheme, but not trust. A three-step hierarchical regression (Step 1: age, gender, education, and income; Step 2: type of use; Step 3: fairness, effectiveness, trust, safety assurance, and communication activities) demonstrated that type of storm water use and the policy-related factors accounted for 73% of the variance in acceptance of storm water (R2 = 0.74, adjusted R2 = 0.74, F (10, 397) = 113.919, p < 0.001). Age, type of use, and three of the five policy-related factors were also significant individual predictors of acceptance. The most important predictors were perceptions of trust in water authorities, perceptions of effectiveness, and perceptions of fairness. Interestingly, while safety assurance was important in attitudinal acceptance of managed aquifer recharge based on type of use, safety assurance was not found to be significant predictor of acceptance. This research suggests that policy-makers should look to address matters of greater public importance and drive such as fairness, trust, and effectiveness of storm water programs and advocate these at the forefront of their policies, rather than solely on education campaigns.

Research notes : transportation planning performance measures.

DOT National Transportation Integrated Search

2006-06-01

Performance measurement can be defined as an assessment of progress toward goals. In transportation planning a good measure is clearly defined, is acceptable to stakeholders, allows for economical data collection and analysis, shows how well th...

Design of the Endobronchial Valve for Emphysema Palliation Trial (VENT): a non-surgical method of lung volume reduction.

PubMed

Strange, Charlie; Herth, Felix J F; Kovitz, Kevin L; McLennan, Geoffrey; Ernst, Armin; Goldin, Jonathan; Noppen, Marc; Criner, Gerard J; Sciurba, Frank C

2007-07-03

Lung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently, less invasive bronchoscopic approaches have been designed to utilize these principles while avoiding the associated perioperative risks. The Endobronchial Valve for Emphysema PalliatioN Trial (VENT) posits that occlusion of a single pulmonary lobe through bronchoscopically placed Zephyr endobronchial valves will effect significant improvements in lung function and exercise tolerance with an acceptable risk profile in advanced emphysema. The trial design posted on Clinical trials.gov, on August 10, 2005 proposed an enrollment of 270 subjects. Inclusion criteria included: diagnosis of emphysema with forced expiratory volume in one second (FEV1) < 45% of predicted, hyperinflation (total lung capacity measured by body plethysmography > 100%; residual volume > 150% predicted), and heterogeneous emphysema defined using a quantitative chest computed tomography algorithm. Following standardized pulmonary rehabilitation, patients were randomized 2:1 to receive unilateral lobar placement of endobronchial valves plus optimal medical management or optimal medical management alone. The co-primary endpoint was the mean percent change in FEV1 and six minute walk distance at 180 days. Secondary end-points included mean percent change in St. George's Respiratory Questionnaire score and the mean absolute changes in the maximal work load measured by cycle ergometry, dyspnea (mMRC) score, and total oxygen use per day. Per patient response rates in clinically significant improvement/maintenance of FEV1 and six minute walk distance and technical success rates of valve placement were recorded. Apriori response predictors based on quantitative CT and lung physiology were defined. If endobronchial valves improve FEV1 and health status with an acceptable safety profile in advanced emphysema, they would offer a novel intervention for this progressive and debilitating disease. ClinicalTrials.gov: NCT00129584.

Space Life Sciences at NASA: Spaceflight Health Policy and Standards

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.; House, Nancy G.

2006-01-01

In January 2005, the President proposed a new initiative, the Vision for Space Exploration. To accomplish the goals within the vision for space exploration, physicians and researchers at Johnson Space Center are establishing spaceflight health standards. These standards include fitness for duty criteria (FFD), permissible exposure limits (PELs), and permissible outcome limits (POLs). POLs delineate an acceptable maximum decrement or change in a physiological or behavioral parameter, as the result of exposure to the space environment. For example cardiovascular fitness for duty standards might be a measurable clinical parameter minimum that allows successful performance of all required duties. An example of a permissible exposure limit for radiation might be the quantifiable limit of exposure over a given length of time (e.g. life time radiation exposure). An example of a permissible outcome limit might be the length of microgravity exposure that would minimize bone loss. The purpose of spaceflight health standards is to promote operational and vehicle design requirements, aid in medical decision making during space missions, and guide the development of countermeasures. Standards will be based on scientific and clinical evidence including research findings, lessons learned from previous space missions, studies conducted in space analog environments, current standards of medical practices, risk management data, and expert recommendations. To focus the research community on the needs for exploration missions, NASA has developed the Bioastronautics Roadmap. The Bioastronautics Roadmap, NASA's approach to identification of risks to human space flight, revised baseline was released in February 2005. This document was reviewed by the Institute of Medicine in November 2004 and the final report was received in October 2005. The roadmap defines the most important research and operational needs that will be used to set policy, standards (define acceptable risk), and implement an overall Risk Management and Analysis process. Currently NASA is drafting spaceflight health standards for neurosensory alterations, space radiation exposure, behavioral health, muscle atrophy, cardiovascular fitness, immunological compromise, bone demineralization, and nutrition.

Managing authenticity: the paradox of great leadership.

PubMed

Goffee, Rob; Jones, Gareth

2005-12-01

Leaders and followers both associate authenticity with sincerity, honesty, and integrity. It's the real thing--the attribute that uniquely defines great managers. But while the expression of a genuine self is necessary for great leadership, the concept of authenticity is often misunderstood, not least by leaders themselves. They often assume that authenticity is an innate quality--that a person is either genuine or not. In fact, the authors say, authenticity is largely defined by what other people see in you and, as such, can to a great extent be controlled by you. In this article, the authors explore the qualities of authentic leadership. To illustrate their points, they recount the experiences of some of the authentic leaders they have known and studied, including the BBC's Greg Dyke, Nestlé's Peter Brabeck-Letmathe, and Marks & Spencer's Jean Tomlin. Establishing your authenticity as a leader is a two-part challenge. You have to consistently match your words and deeds; otherwise, followers will never accept you as authentic. But it is not enough just to practice what you preach. To get people to follow you, you also have to get them to relate to you. This means presenting different faces to different audiences--a requirement that many people find hard to square with authenticity. But authenticity is not the product of manipulation. It accurately reflects aspects of the leader's inner self, so it can't be an act. Authentic leaders seem to know which personality traits they should reveal to whom, and when. Highly attuned to their environments, authentic leaders rely on an intuition born of formative, sometimes harsh experiences to understand the expectations and concerns of the people they seek to influence. They retain their distinctiveness as individuals, yet they know how to win acceptance in strong corporate and social cultures and how to use elements of those cultures as a basis for radical change.

Limiting Magnitude, τ, t eff, and Image Quality in DES Year 1

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

H. Neilsen, Jr.; Bernstein, Gary; Gruendl, Robert

The Dark Energy Survey (DES) is an astronomical imaging survey being completed with the DECam imager on the Blanco telescope at CTIO. After each night of observing, the DES data management (DM) group performs an initial processing of that night's data, and uses the results to determine which exposures are of acceptable quality, and which need to be repeated. The primary measure by which we declare an image of acceptable quality ismore » $$\\tau$$, a scaling of the exposure time. This is the scale factor that needs to be applied to the open shutter time to reach the same photometric signal to noise ratio for faint point sources under a set of canonical good conditions. These conditions are defined to be seeing resulting in a PSF full width at half maximum (FWHM) of 0.9" and a pre-defined sky brightness which approximates the zenith sky brightness under fully dark conditions. Point source limiting magnitude and signal to noise should therefore vary with t in the same way they vary with exposure time. Measurements of point sources and $$\\tau$$ in the first year of DES data confirm that they do. In the context of DES, the symbol $$t_{eff}$$ and the expression "effective exposure time" usually refer to the scaling factor, $$\\tau$$, rather than the actual effective exposure time; the "effective exposure time" in this case refers to the effective duration of one second, rather than the effective duration of an exposure.« less

Assessing climate change-robustness of protected area management plans-The case of Germany.

PubMed

Geyer, Juliane; Kreft, Stefan; Jeltsch, Florian; Ibisch, Pierre L

2017-01-01

Protected areas are arguably the most important instrument of biodiversity conservation. To keep them fit under climate change, their management needs to be adapted to address related direct and indirect changes. In our study we focus on the adaptation of conservation management planning, evaluating management plans of 60 protected areas throughout Germany with regard to their climate change-robustness. First, climate change-robust conservation management was defined using 11 principles and 44 criteria, which followed an approach similar to sustainability standards. We then evaluated the performance of individual management plans concerning the climate change-robustness framework. We found that climate change-robustness of protected areas hardly exceeded 50 percent of the potential performance, with most plans ranking in the lower quarter. Most Natura 2000 protected areas, established under conservation legislation of the European Union, belong to the sites with especially poor performance, with lower values in smaller areas. In general, the individual principles showed very different rates of accordance with our principles, but similarly low intensity. Principles with generally higher performance values included holistic knowledge management, public accountability and acceptance as well as systemic and strategic coherence. Deficiencies were connected to dealing with the future and uncertainty. Lastly, we recommended the presented principles and criteria as essential guideposts that can be used as a checklist for working towards more climate change-robust planning.

Assessing climate change-robustness of protected area management plans—The case of Germany

PubMed Central

Geyer, Juliane; Kreft, Stefan; Jeltsch, Florian; Ibisch, Pierre L.

2017-01-01

Protected areas are arguably the most important instrument of biodiversity conservation. To keep them fit under climate change, their management needs to be adapted to address related direct and indirect changes. In our study we focus on the adaptation of conservation management planning, evaluating management plans of 60 protected areas throughout Germany with regard to their climate change-robustness. First, climate change-robust conservation management was defined using 11 principles and 44 criteria, which followed an approach similar to sustainability standards. We then evaluated the performance of individual management plans concerning the climate change-robustness framework. We found that climate change-robustness of protected areas hardly exceeded 50 percent of the potential performance, with most plans ranking in the lower quarter. Most Natura 2000 protected areas, established under conservation legislation of the European Union, belong to the sites with especially poor performance, with lower values in smaller areas. In general, the individual principles showed very different rates of accordance with our principles, but similarly low intensity. Principles with generally higher performance values included holistic knowledge management, public accountability and acceptance as well as systemic and strategic coherence. Deficiencies were connected to dealing with the future and uncertainty. Lastly, we recommended the presented principles and criteria as essential guideposts that can be used as a checklist for working towards more climate change-robust planning. PMID:28982187

Quality of care and economic considerations of active surveillance of men with prostate cancer

PubMed Central

2018-01-01

The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted. PMID:29732278

Quality of care and economic considerations of active surveillance of men with prostate cancer.

PubMed

Filson, Christopher P

2018-04-01

The current health care climate mandates the delivery of high-value care for patients considering active surveillance for newly-diagnosed prostate cancer. Value is defined by increasing benefits (e.g., quality) for acceptable costs. This review discusses quality of care considerations for men contemplating active surveillance, and highlights cost implications at the patient, health-system, and societal level related to pursuit of non-interventional management of men diagnosed with localized prostate cancer. In general, most quality measures are focused on prostate cancer care in general, rather that active surveillance patients specifically. However, most prostate cancer quality measures are pertinent to men seeking close observation of their prostate tumors with active surveillance. These include accurate documentation of clinical stage, informed discussion of all treatment options, and appropriate use of imaging for less-aggressive prostate cancer. Furthermore, interventions that may help improve the quality of care for active surveillance patients are reviewed (e.g., quality collaboratives, judicious antibiotic use, etc.). Finally, the potential economic impact and benefits of broad acceptance of active surveillance strategies are highlighted.

Improving Diabetes Self-Management through Acceptance, Mindfulness, and Values: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Gregg, Jennifer A.; Callaghan, Glenn M.; Hayes, Steven C.; Glenn-Lawson, June L.

2007-01-01

Patients in a low-income community health center with Type 2 diabetes (N = 81) taking a one-day education workshop as part of their diabetes medical management were randomly assigned either to education alone or to a combination of education and acceptance and commitment therapy (ACT). Both groups were taught how to manage their diabetes, but…

Public acceptance of management methods under different human-wildlife conflict scenarios.

PubMed

Liordos, Vasilios; Kontsiotis, Vasileios J; Georgari, Marina; Baltzi, Kerasia; Baltzi, Ioanna

2017-02-01

Wildlife management seeks to minimise public controversy for successful application of wildlife control methods. Human dimensions research in wildlife seeks a better understanding of public preferences for effective human-wildlife conflict resolution. In face to face interviews, 630 adults in Greece were asked to rate on a 5-point Likert-like scale their acceptance of 3 management methods, i.e., do nothing, non-lethal control, and lethal control, in the context of 5 human-wildlife conflict scenarios: 1) corvids damage crops; 2) starlings damage crops; 3) starlings foul urban structures; 4) coypus damage crops; and 5) coypus transfer disease. Univariate GLMs determined occupation, hunting membership and their interaction as the stronger predictors of public acceptance, generating 4 stakeholder groups: the general public, farmers, hunters, and farmers-hunters. Differences in acceptance and consensus among stakeholder groups were assessed using the Potential for Conflict Index 2 (PCI 2 ). All 4 stakeholder groups agreed that doing nothing was unacceptable and non-lethal control acceptable in all 5 scenarios, with generally high consensus within and between groups. The lethal control method was more controversial and became increasingly more acceptable as the severity of scenarios was increased and between non-native and native species. Lethal control was unacceptable for the general public in all scenarios. Farmers accepted lethal methods in the corvids and starlings scenarios, were neutral in the coypus damage crops scenario, whereas they accepted lethal control when coypus transfer disease. Hunters' opinion was neutral in the corvids, starlings and coypus damage crops and starlings foul urban structures scenarios, but they accepted lethal methods in the coypus transfer disease scenario. Farmers-hunters considered lethal control acceptable in all 5 scenarios. Implications from this study could be used for designing a socio-ecological approach which incorporates wildlife management with public interests. The studied species have a wide distribution, therefore present findings might also prove useful elsewhere. Copyright © 2016 Elsevier B.V. All rights reserved.

48 CFR 1346.503 - Place of acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Place of acceptance. 1346.503 Section 1346.503 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 1346.503 Place of acceptance. Insert a clause substantially similar to 1352...

Acceptability of an mHealth App Intervention for Persons With Type 2 Diabetes and its Associations With Initial Self-Management: Randomized Controlled Trial.

PubMed

Torbjørnsen, Astrid; Småstuen, Milada Cvancarova; Jenum, Anne Karen; Årsand, Eirik; Ribu, Lis

2018-05-21

Mobile health interventions are increasingly used in health care. The level of acceptability may indicate whether and how such digital solutions will be used. This study aimed to explore associations between the level of acceptability of a mobile diabetes app and initial ability of self-management for patients with type 2 diabetes. Participants with type 2 diabetes were recruited from primary health care settings to a 3-armed randomized controlled trial in the Norwegian study in the RENEWING HEALTH project. At the 1-year follow-up, 75 out of 101 participants from the intervention groups completed an acceptability questionnaire (The Service User Technology Acceptability Questionnaire). In the randomized controlled trial, the 2 intervention groups (n=101 in total) received a mobile phone with a diabetes diary app, and one of the groups received additional health counseling given by telephone calls from a diabetes specialist nurse (n=50). At baseline, we collected clinical variables from medical records, whereas demographic data and self-management (The Health Education Impact Questionnaire) measures were self-reported. Log data from the use of the app by self-monitoring were registered continuously. Associations between initial ability to self-manage at baseline and acceptability of the diabetes diary app after 1 year were analyzed using linear regression. We found statistically significant associations between 5 of the 8 self-management domains and perceived benefit, one of the acceptability factors. However, when adjusting for age, gender, and frequency of use, only 1 domain, skill and technique acquisition, remained independently associated with perceived benefit. Frequency of use of the app was the factor that revealed the strongest association with the acceptability domain perceived benefit. Our findings indicate that persons with diabetes may accept the app, despite its perceived benefit being associated with only one of the 8 domains of their initial level of self-management. ClinicalTrials.gov NCT01315756; https://clinicaltrials.gov/show/NCT01315756 (Archived by WebCite at http://www.webcitation.org/6z46qPhWl). ©Astrid Torbjørnsen, Milada Cvancarova Småstuen, Anne Karen Jenum, Eirik Årsand, Lis Ribu. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 21.05.2018.

Waste certification program plan for Oak Ridge National Laboratory. Revision 1

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

Orrin, R.C.

1997-05-01

This document defines the waste certification program developed for implementation at Oak Ridge National Laboratory (ORNL). The document describes the program structure, logic, and methodology for certification of ORNL wastes. The purpose of the waste certification program is to provide assurance that wastes are properly characterized and that the Waste Acceptance Criteria (WAC) for receiving facilities are met. The program meets the waste certification requirements outlined in US Department of Energy (DOE) Order 5820.2A, Radioactive Waste Management, and ensures that 40 CFR documentation requirements for waste characterization are met for mixed (both radioactive and hazardous) and hazardous (including polychlorinated biphenyls)more » waste. Program activities will be conducted according to ORNL Level 1 document requirements.« less

Systems Security Engineering Capability Maturity Model SSE-CMM Model Description Document

DTIC Science & Technology

1999-04-01

management is the process of accessing and quantifying risk , and establishing an acceptable level of risk for the organization. Managing risk is an...Process of assessing and quantifying risk and establishing acceptable level of risk for the organization. [IEEE 13335-1:1996] Security Engineering

The influence of fatalistic beliefs on health beliefs among diabetics in Khartoum, Sudan: a comparison between Coptic Christians and Sunni Muslims.

PubMed

Hag Hamed, Dana; Daniel, Marguerite

2017-07-01

Although there are many studies assessing the influence of religious beliefs on health they do not agree on whether the impact is positive or negative. More so, there is no consensus in the available literature on the definition of fatalism and what it means to individuals. In this phenomenological study we attempt to define what religious fatalism means to people living with diabetes in Khartoum, and how it affects their health beliefs, and how those beliefs affect their sense of coherence and generalized resistance resources, since salutogenesis is the guiding theory in this study. Three Copts and five Sunnis living with diabetes were interviewed, as well as a Coptic clergyman and a Sunni scholar. The semi-structured interviews were recorded and transcribed verbatim for analysis. Thematic network analysis was used to code salient concepts into basic themes, organizing themes and global themes. The empirical findings are thus structured as the three global themes: (1) fatalism and free will; (2) health responsibility; (3) acceptance and coping. Fatalism was defined as events beyond an individual's control where it is then the individual's free will to seek healthy behavior. Thus health responsibility was stressed upon by the participants in this study as well as the clergyman and scholar. There is also the concept of 'God doesn't give one what one cannot handle' that the participants relate to coping and acceptance. This study finds that the meaning of religious fatalism held by participants and religious clergy is not disempowering. The participants believe that they are responsible for their health. The meaning derived from fatalism is related to how they can accept what is beyond their control and cope with their health condition. Religious fatalism contributed to comprehensibility, manageability and meaningfulness in our participants' response to diabetes.

Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force.

PubMed

Strehl, Cindy; Bijlsma, Johannes W J; de Wit, Maarten; Boers, Maarten; Caeyers, Nele; Cutolo, Maurizio; Dasgupta, Bhaskar; Dixon, William G; Geenen, Rinie; Huizinga, Tom W J; Kent, Alison; de Thurah, Annette Ladefoged; Listing, Joachim; Mariette, Xavier; Ray, David W; Scherer, Hans U; Seror, Raphaèle; Spies, Cornelia M; Tarp, Simon; Wiek, Dieter; Winthrop, Kevin L; Buttgereit, Frank

2016-06-01

There is convincing evidence for the known and unambiguously accepted beneficial effects of glucocorticoids at low dosages. However, the implementation of existing recommendations and guidelines on the management of glucocorticoid therapy in rheumatic diseases is lagging behind. As a first step to improve implementation, we aimed at defining conditions under which long-term glucocorticoid therapy may have an acceptably low level of harm. A multidisciplinary European League Against Rheumatism task force group of experts including patients with rheumatic diseases was assembled. After a systematic literature search, breakout groups critically reviewed the evidence on the four most worrisome adverse effects of glucocorticoid therapy (osteoporosis, hyperglycaemia/diabetes mellitus, cardiovascular diseases and infections) and presented their results to the other group members following a structured questionnaire for final discussion and consensus finding. Robust evidence on the risk of harm of long-term glucocorticoid therapy was often lacking since relevant study results were often either missing, contradictory or carried a high risk of bias. The group agreed that the risk of harm is low for the majority of patients at long-term dosages of ≤5 mg prednisone equivalent per day, whereas at dosages of >10 mg/day the risk of harm is elevated. At dosages between >5 and ≤10 mg/day, patient-specific characteristics (protective and risk factors) determine the risk of harm. The level of harm of glucocorticoids depends on both dose and patient-specific parameters. General and glucocorticoid-associated risk factors and protective factors such as a healthy lifestyle should be taken into account when evaluating the actual and future risk. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Preventing Disruptive Behavior via Classroom Management: Validating the Color Wheel System in Kindergarten Classrooms.

PubMed

Watson, Tiffany L; Skinner, Christopher H; Skinner, Amy L; Cazzell, Samantha; Aspiranti, Kathleen B; Moore, Tara; Coleman, MariBeth

2016-07-01

Evidence suggests that installing a classroom management system known as the Color Wheel reduced inappropriate behaviors and increased on-task behavior in second- and fourth-grade classrooms; however, no systematic studies of the Color Wheel had been disseminated targeting pre-school or kindergarten participants. To enhance our understanding of the Color Wheel System (CWS) as a prevention system, a multiple-baseline design was used to evaluate the effects of the Color Wheel on inappropriate vocalizations (IVs) in three general education kindergarten classrooms. Partial-interval time-sampling was used to record classwide IVs, which were operationally defined as any comment or vocal noise that was not solicited by the teacher. Time series graphs and effect size calculations suggest that the CWS caused immediate, large, and sustained decreases in IVs across the three classrooms. Teacher acceptability and interview data also supported the CWS. Implications related to prevention are discussed and directions for future research are provided. © The Author(s) 2016.

Treat-to-target trials in diabetes.

PubMed

Wangnoo, Subhash K; Sethi, Bipin; Sahay, Rakesh K; John, Mathew; Ghosal, Samit; Sharma, Surendra K

2014-03-01

Treat-to-target is a therapeutic concept that considers well defined and specific physiologic targets as aims in controlling the pathophysiology of the disease. It has been widely used in diseases that pathophysiology includes, chronic metabolic and physiological disturbances, namely rheumatic conditions, vascular medicine and diabetes. In diabetes, the availability of "gold-standard" quantitative measures like fasting plasma glucose and glycated hemoglobin make the application of treat-to-target trials especially pertinent. Treatment modalities which have used single therapeutic agents or combinations or in combination with a variety of titration algorithms and implementation protocols have broadened our understanding of diabetes management with specific reference to insulin initiation and maintenance. Treat-to-target trials have been used to investigate a wide variety of questions including efficacy, safety, effect of treatment on comorbidities and patient satisfaction, ideal mechanisms to implement insulin initiation etc. A more generalized acceptance and implementation of treat-to-target trials may finally revolutionize diabetes management by combining aspects of individual care with standard treatment protocols.

Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the design and operation of multi-center clinical trials: a qualitative research study.

PubMed

Eisenstein, Eric L; Diener, Lawrence W; Nahm, Meredith; Weinfurt, Kevin P

2011-12-01

New technologies may be required to integrate the National Institutes of Health's Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators fell into two categories: acceptance by key regulators and the scientific community, and usability for researchers and clinicians. Issues reported by the coordinating center, participating sites, and study subjects were those faced when integrating new technologies into existing clinical trial systems. We then defined elements of a PROMIS Tool Kit required for integrating PROMIS into a multi-center clinical trial environment. The requirements identified in this study serve as a framework for future investigators in the design, development, implementation, and operation of PROMIS Tool Kit technologies.

Impact of the Patient-Reported Outcomes Management Information System (PROMIS) upon the Design and Operation of Multi-center Clinical Trials: a Qualitative Research Study

PubMed Central

Diener, Lawrence W.; Nahm, Meredith; Weinfurt, Kevin P.

2013-01-01

New technologies may be required to integrate the National Institutes of Health’s Patient Reported Outcome Management Information System (PROMIS) into multi-center clinical trials. To better understand this need, we identified likely PROMIS reporting formats, developed a multi-center clinical trial process model, and identified gaps between current capabilities and those necessary for PROMIS. These results were evaluated by key trial constituencies. Issues reported by principal investigators fell into two categories: acceptance by key regulators and the scientific community, and usability for researchers and clinicians. Issues reported by the coordinating center, participating sites, and study subjects were those faced when integrating new technologies into existing clinical trial systems. We then defined elements of a PROMIS Tool Kit required for integrating PROMIS into a multi-center clinical trial environment. The requirements identified in this study serve as a framework for future investigators in the design, development, implementation, and operation of PROMIS Tool Kit technologies. PMID:20703765

A pilot study of yoga as self-care for arthritis in minority communities

PubMed Central

2013-01-01

Background While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis. Methods/design In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months. Discussion There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis. Trial registration ClinicalTrials.gov: NCT01617421 PMID:23548052

A pilot study of yoga as self-care for arthritis in minority communities.

PubMed

Middleton, Kimberly R; Ward, Michael M; Haaz, Steffany; Velummylum, Sinthujah; Fike, Alice; Acevedo, Ana T; Tataw-Ayuketah, Gladys; Dietz, Laura; Mittleman, Barbara B; Wallen, Gwenyth R

2013-04-02

While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis. In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months. There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis. ClinicalTrials.gov: NCT01617421.

30 CFR 227.200 - What are a State's general responsibilities if it accepts a delegation?

Code of Federal Regulations, 2010 CFR

2010-07-01

... it accepts a delegation? 227.200 Section 227.200 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT DELEGATION TO STATES States' Responsibilities to... delegation? For each delegated function you perform, you must: (a) Operate in compliance with all Federal...

Using Financial Information in Continuing Education. Accepted Methods and New Approaches.

ERIC Educational Resources Information Center

Matkin, Gary W.

This book, which is intended as a resource/reference guide for experienced financial managers and course planners, examines accepted methods and new approaches for using financial information in continuing education. The introduction reviews theory and practice, traditional and new methods, planning and organizational management, and technology.…

77 FR 37803 - Customer Clearing Documentation, Timing of Acceptance for Clearing, and Clearing Member Risk...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-25

... COMMODITY FUTURES TRADING COMMISSION 17 CFR Part 38 RIN 3038-0092, -0094 Customer Clearing Documentation, Timing of Acceptance for Clearing, and Clearing Member Risk Management; Core Principles and Other... for Clearing, and Clearing Member Risk Management, and Core Principles and Other Requirements for...

Financial Management: Independent Examination of the Rights to U.S. Army Corps of Engineers Buildings and Other Structures

DTIC Science & Technology

2005-03-25

of Defense Financial Management Regulation DoD IG Department of Defense Inspector General FAS Financial Accounting Standards GAAP Generally Accepted...Sheet. The net book value represents the difference between the historical acquisition (book) cost and the associated accumulated depreciation of the...not corrected. Criteria Generally Accepted Accounting Principles ( GAAP ). GAAP describes assertions as representations by management that are

On Chinese Culture Curriculum Planning

ERIC Educational Resources Information Center

Wang, Catherine

2006-01-01

The importance of cultural elements in foreign language teaching has been widely accepted in recent years. This applies particularly to the teaching of Chinese as a foreign language (TCFL) to non-native Chinese speakers at tertiary level in mainland China. However, there is no commonly accepted blueprint that defines the parts of Chinese culture…

Quality Assurance in Ontario's Postsecondary Education Sector

ERIC Educational Resources Information Center

Klassen, Tim

2012-01-01

It is generally accepted that Canadian postsecondary education enjoys an international reputation for quality. However, Canada does not have an accepted, national framework to understand, measure, or clearly define the actual quality of the postsecondary education sector. In this, Canada is seen as unique when compared with other developed…

48 CFR 1403.101-3 - Agency regulations.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., officials who participate personally and substantially in DOI procurements (as defined in FAR 3.104-3), may not solicit or accept any gift, gratuity, favor, entertainment, loan or anything of monetary value from a competing contractor during the conduct of a procurement. (b)(1) Officials may not accept or...

46 CFR 11.309 - Coast Guard-accepted training other than approved courses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Coast Guard-accepted training other than approved courses. (a) When the training and assessment of... qualify to hold an STCW endorsement, such training and assessment must meet the following requirements: (1) The training and assessment must have written, clearly defined objectives that emphasize specific...

46 CFR 12.03-1 - Coast Guard-accepted training other than approved courses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Guard-accepted training other than approved courses. (a) When the training and assessment of competence... assessment must meet the following requirements: (1) The training and assessment must have written, clearly defined objectives that emphasize specific knowledge, skills, and abilities, and that include criteria to...

Process Improvements in Training Device Acceptance Testing: A Study in Total Quality Management

DTIC Science & Technology

1990-12-12

Quality Management , a small group of Government and industry specialists examined the existing training device acceptance test process for potential improvements. The agreed-to mission of the Air Force/Industry partnership was to continuously identify and promote implementable approaches to minimize the cost and time required for acceptance testing while ensuring that validated performance supports the user training requirements. Application of a Total Quality process improvement model focused on the customers and their requirements, analyzed how work was accomplished, and

Earth observation technologies in service to the cultural landscape of Cyprus: risk identification and assessment

NASA Astrophysics Data System (ADS)

Cuca, Branka; Tzouvaras, Marios; Agapiou, Athos; Lysandrou, Vasiliki; Themistocleous, Kyriacos; Nisantzi, Argyro; Hadjimitsis, Diofantos G.

2016-08-01

The Cultural landscapes are witnesses of "the creative genius, social development and the imaginative and spiritual vitality of humanity. They are part of our collective identity", as it is internationally defined and accepted (ICOMOSUNESCO). The need for their protection, management and inclusion in the territorial policies has already been widely accepted and pursued. There is a great number of risks to which the cultural landscapes are exposed, arising mainly from natural (both due to slow geo-physical phenomena as well as hazards) and anthropogenic causes (e.g. urbanisation pressure, agriculture, landscape fragmentation etc.). This paper explores to what extent Earth Observation (EO) technologies can contribute to identify and evaluate the risks to which Cultural Landscapes of Cyprus are exposed, taking into consideration specific phenomena, such as land movements and soil erosion. The research of the paper is illustrated as part of the activities carried out in the CLIMA project - "Cultural Landscape risk Identification, Management and Assessment". It aims to combine the fields of remote sensing technologies, including Sentinel data, and monitoring of cultural landscape for its improved protection and management. Part of this approach will be based on the use of InSAR techniques in order to monitor the temporal evolution of deformations through the detection and measurement of the effects of surface movements caused by various factors. The case study selected for Cyprus is the Nea Paphos archeological site and historical center of Paphos, which are listed as UNESCO World Heritage sites. The interdisciplinary approach adopted in this research was useful to identify major risks affecting the landscape of Cyprus and to classify the most suitable EO methods to assess and map such risks.

"You've got to walk before you run": positive evaluations of a walking program as part of a gender-sensitized, weight-management program delivered to men through professional football clubs.

PubMed

Hunt, Kate; McCann, Claire; Gray, Cindy M; Mutrie, Nanette; Wyke, Sally

2013-01-01

To explore men's views of a pedometer-based walking program, part of a weight-management intervention delivered through Scottish Premier League football clubs, and the congruence or challenge this poses to masculine identities. Semistructured telephone interviews with a sample of participants in a gender-sensitized, group weight-management program. Interviewing continued until data saturation was reached (n = 29). All men were positive about the context, style of delivery, and content of the broader intervention. These things encouraged men to increase their physical activity (and adopt other behavioral changes) that they may not otherwise have found appealing. The success and acceptability of the walking program resided in three interrelated factors: (a) the utility of pedometers as a technology for motivation, self-monitoring and surveillance, and target setting; (b) the speed with which fitness was regained and weight reduced (enabling men to begin to do more desired forms of physical activity, and so regain visceral, experiential, and pragmatic masculine capital); and (c) bolstering their masculine identities through the receipt of the program in a valued, masculinised context. These data suggest that men will enthusiastically embrace a graduated walking program when the presentation is gender sensitive in context, content, and delivery. Pedometers were viewed as a valuable, reliable technological aid which motivated men and empowered them in self-monitoring of progress toward self-defined goals. Many men experienced the walking program as a means of regaining fitness, thereby enabling them to also regain valued masculine identities and activities, and a step toward regaining a more acceptable masculine body. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Integrating practical, regulatory and ethical strategies for enhancing farm animal welfare.

PubMed

Mellor, D J; Stafford, K J

2001-11-01

To provide an integrated view of relationships between assessment of animal welfare. societal expectations regarding animal welfare standards, the need for regulation, and two ethical strategies for promoting animal welfare, emphasising farm animals. Ideas in relevant papers and key insights were outlined and illustrated, where appropriate, by New Zealand experience with different facets of the welfare management of farm animals. An animal's welfare is good when its nutritional, environmental, health, behavioural and mental needs are met. Compromise may occur in one or more of these areas and is assessed by scientifically-informed best judgement using parameters validated by directed research and objective analysis in clinical and practical settings. There is a wide range of perceptions of what constitutes good and bad welfare in society, so that animal welfare standards cannot be left to individual preferences to determine. Rather, the promotion of animal welfare is seen as requiring central regulation, but managed in a way that allows for adjustments based on new scientific knowledge of animals' needs and changing societal perceptions of what is acceptable and unacceptable treatment of animals. Concepts of 'minimal welfare', representing the threshold of cruelty, and 'acceptable welfare', representing higher, more acceptable standards than those that merely avoid cruelty, are outlined. They are relevant to economic analyses, which deal with determinants of animal welfare standards based on financial costs and the desire of the public to feel broadly comfortable about the treatment of the animals that are used to serve their needs. Ethical strategies for promoting animal welfare can be divided broadly into the 'gold standard' approach and the 'incremental improvement' approach. The first defines the ideal that is to be required in a particular situation and will accept nothing less than that ideal, whereas the second aims to improve welfare in a step-wise fashion by setting a series of achievable goals, seeing each small advance as worthwhile progress towards the same ideal. 'Incremental improvement' is preferred. This also has application in veterinary practice where the professional commitment to maintain good welfare standards may at times conflict with financial constraints experienced by clients.

Impact of location on outcome after penetrating colon injuries.

PubMed

Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Zarzaur, Ben L; Shahan, Charles P; Parks, Nancy A; Fabian, Timothy C; Croce, Martin A

2012-12-01

Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries. Consecutive patients with full thickness penetrating colon injuries for 13 years were stratified by age, injury location and mechanism, and severity of shock. According to the algorithm, patients with nondestructive injuries underwent primary repair. Destructive wounds underwent resection plus anastomosis in the absence of comorbidities or large preoperative or intraoperative transfusion requirements (>6 U of packed red blood cells); otherwise, they were diverted. Injury location was defined as ascending, transverse, descending (including splenic flexure), and sigmoid. Multivariable logistic regression was performed to determine whether injury location was an independent predictor of either morbidity or mortality. Four hundred sixty-nine patients were identified: 314 (67%) underwent primary repair and 155 (33%) underwent resection. Most injuries involved the transverse colon (39%), followed by the ascending colon (26%), the descending colon (21%), and the sigmoid colon (14%). Overall, there were 13 suture line failures (3%) and 72 abscesses (15%). Most suture line failures involved injuries to the descending colon (p = 0.06), whereas most abscesses followed injuries to the ascending colon (p = 0.37). Multivariable logistic regression failed to identify injury location as an independent predictor of either morbidity or mortality after adjusting for 24-hour transfusions, base excess, shock index, injury mechanism, and operative management. Injury location did not affect morbidity or mortality after penetrating colon injuries. Nondestructive injuries should be primarily repaired. For destructive injuries, operative decisions based on a defined algorithm rather than injury location achieves an acceptably low morbidity and mortality rate and simplifies management. Prognostic study, level III.

Accreditation of medical laboratories in Croatia--experiences of the Institute of Clinical Chemistry, University Hospital "Merkur", Zagreb.

PubMed

Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Kardum-Paro, Mirjana Mariana; Siftar, Zoran; Sikirica, Mirjana; Sokolić, Ivica; Ozvald, Ivan; Vidas, Zeljko

2010-03-01

Since 2003 when the international norm for implementation of quality management in medical laboratories (EN ISO 15189, Medical laboratories--Particular requirements for quality and competence) was established and accepted, accreditation has become practical, generally accepted method of quality management and confirmation of technical competence of medical laboratories in the whole world. This norm has been translated into Croatian and accepted by the Croatian Institute for Norms as Croatian norm. Accreditation is carried out on voluntary basis by the Croatian Accreditation Agency that has up to now accredited two clinical medical biochemical laboratories in the Republic of Croatia. Advantages of accredited laboratory lie in its documented management system, constant improvement and training, reliability of test results, establishing users' trust in laboratory services, test results comparability and interlaboratory (international) test results acceptance by adopting the concept of metrological traceability in laboratory medicine.

Public acceptance for centralized storage and repositories of low-level waste session (Panel)

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

Lutz, H.R.

1995-12-31

Participants from various parts of the world will provide a summary of their particular country`s approach to low-level waste management and the cost of public acceptance for low-level waste management facilities. Participants will discuss the number, geographic location, and type of low-level waste repositories and centralized storage facilities located in their countries. Each will discuss the amount, distribution, and duration of funds to gain public acceptance of these facilities. Participants will provide an estimated $/meter for centralized storage facilities and repositories. The panel will include a brief discussion about the ethical aspects of public acceptance costs, approaches for negotiating acceptance,more » and lessons learned in each country. The audience is invited to participate in the discussion.« less

Pain management: a fundamental human right.

PubMed

Brennan, Frank; Carr, Daniel B; Cousins, Michael

2007-07-01

This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right. This concept recently gained momentum with the 2004 European Federation of International Association for the Study of Pain (IASP) Chapters-, International Association for the Study of Pain- and World Health Organization-sponsored "Global Day Against Pain," where it was adopted as a central theme. We survey the scope of the problem of unrelieved pain in three areas, acute pain, chronic noncancer pain, and cancer pain, and outline the adverse physical and psychological effects and social and economic costs of untreated pain. Reasons for deficiencies in pain management include cultural, societal, religious, and political attitudes, including acceptance of torture. The biomedical model of disease, focused on pathophysiology rather than quality of life, reinforces entrenched attitudes that marginalize pain management as a priority. Strategies currently applied for improvement include framing pain management as an ethical issue; promoting pain management as a legal right, providing constitutional guarantees and statutory regulations that span negligence law, criminal law, and elder abuse; defining pain management as a fundamental human right, categorizing failure to provide pain management as professional misconduct, and issuing guidelines and standards of practice by professional bodies. The role of the World Health Organization is discussed, particularly with respect to opioid availability for pain management. We conclude that, because pain management is the subject of many initiatives within the disciplines of medicine, ethics and law, we are at an "inflection point" in which unreasonable failure to treat pain is viewed worldwide as poor medicine, unethical practice, and an abrogation of a fundamental human right.

Feasibility, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology Supported Self-Management Intervention for Older Adults with Serious Mental Illness.

PubMed

Fortuna, Karen L; DiMilia, Peter R; Lohman, Matthew C; Bruce, Martha L; Zubritsky, Cynthia D; Halaby, Mitch R; Walker, Robert M; Brooks, Jessica M; Bartels, Stephen J

2018-06-01

To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention ("PeerTECH") was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.

75 FR 28647 - Filing of Plats of Survey: Oregon/Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

...] Filing of Plats of Survey: Oregon/Washington AGENCY: Bureau of Land Management, Interior. ACTION: Notice... Bureau of Land Management Oregon/Washington State Office, Portland, Oregon, 30 days from the date of this publication. Willamette Meridian Oregon T. 7 S., R. 9 W., accepted April 12, 2010 T. 39 S., R. 2 E., accepted...

77 FR 57111 - Filing of Plats of Survey: Oregon/Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-17

...] Filing of Plats of Survey: Oregon/Washington AGENCY: Bureau of Land Management, Interior. ACTION: Notice... Bureau of Land Management Oregon/Washington State Office, Portland, Oregon, 30 days from the date of this publication. Willamette Meridian Oregon T. 5 S., 14 E., accepted August 21, 2012 T. 26 S., R. 2 W., accepted...

77 FR 47435 - Filing of Plats of Survey: Oregon/Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

...] Filing of Plats of Survey: Oregon/Washington AGENCY: Bureau of Land Management, Interior. ACTION: Notice... Bureau of Land Management Oregon/Washington State Office, Portland, Oregon, 30 days from the date of this publication. Willamette Meridian Oregon T. 9 S., 19 E., accepted July 23, 2012 T. 18 S., R. 1 W., accepted...

75 FR 49944 - Filing of Plats of Survey: Oregon/Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

...] Filing of Plats of Survey: Oregon/Washington AGENCY: Bureau of Land Management, Interior. ACTION: Notice... Bureau of Land Management Oregon/Washington State Office, Portland, Oregon, 30 days from the date of this publication. Willamette Meridian Oregon T. 41 S., R. 4 W., accepted June 29, 2010 T. 39 S., R. 1 W., accepted...

76 FR 17669 - Filing of Plats of Survey: Oregon/Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

...] Filing of Plats of Survey: Oregon/Washington AGENCY: Bureau of Land Management, Interior. ACTION: Notice... Bureau of Land Management Oregon/Washington State Office, Portland, Oregon, 30 days from the date of this publication. Willamette Meridian Oregon T. 20 S., R. 4 W., accepted March 1, 2011. T. 19 S., R. 1 E., accepted...

Postgraduate Clinical Psychology Students' Perceptions of an Acceptance and Commitment Therapy Stress Management Intervention and Clinical Training

ERIC Educational Resources Information Center

Pakenham, Kenneth I.; Stafford-Brown, Johanna

2013-01-01

Background: Research into stress management interventions for clinical psychology trainees (CPTs) is limited, despite evidence indicating that these individuals are at risk for elevated stress, which can negatively impact personal and professional functioning. This study explored: (1) CPTs' perceptions of a previously evaluated Acceptance and…

ACT for Leadership: Using Acceptance and Commitment Training to Develop Crisis-Resilient Change Managers

ERIC Educational Resources Information Center

Moran, Daniel J.; Consulting, Pickslyde

2010-01-01

The evidence-based executive coaching movement suggests translating empirical research into practical methods to help leaders develop a repertoire of crisis resiliency and value-directed change management skills. Acceptance and Commitment Therapy (ACT) is an evidence-based modern cognitive-behavior therapy approach that has been and applied to…

75 FR 41875 - Technical Processing Requirements for Multifamily Project Mortgage Insurance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... submitted to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction... principals are acceptable and have the insurance for new or rehabilitated housing. The information collected is used to determine if key principals are acceptable and have the ability to manage the development...

Managing Problems of Acceptability through High Rise-Fall Repetitions

ERIC Educational Resources Information Center

Benjamin, Trevor; Walker, Traci

2013-01-01

This article examines one of the ways in which matters of truth, appropriateness, and acceptability are raised and managed within the course of everyday conversation. Using the methodology of conversation analysis, we show that by repeating what another participant has said and doing so with a high rise-fall intonation contour, a speaker claims…

Definition of an Acceptable Glass composition Region (AGCR) via an Index System and a Partitioning Function

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

Peeler, D. K.; Taylor, A. S.; Edwards, T.B.

2005-06-26

The objective of this investigation was to appeal to the available ComPro{trademark} database of glass compositions and measured PCTs that have been generated in the study of High Level Waste (HLW)/Low Activity Waste (LAW) glasses to define an Acceptable Glass Composition Region (AGCR). The term AGCR refers to a glass composition region in which the durability response (as defined by the Product Consistency Test (PCT)) is less than some pre-defined, acceptable value that satisfies the Waste Acceptance Product Specifications (WAPS)--a value of 10 g/L was selected for this study. To assess the effectiveness of a specific classification or index systemmore » to differentiate between acceptable and unacceptable glasses, two types of errors (Type I and Type II errors) were monitored. A Type I error reflects that a glass with an acceptable durability response (i.e., a measured NL [B] < 10 g/L) is classified as unacceptable by the system of composition-based constraints. A Type II error occurs when a glass with an unacceptable durability response is classified as acceptable by the system of constraints. Over the course of the efforts to meet this objective, two approaches were assessed. The first (referred to as the ''Index System'') was based on the use of an evolving system of compositional constraints which were used to explore the possibility of defining an AGCR. This approach was primarily based on ''glass science'' insight to establish the compositional constraints. Assessments of the Brewer and Taylor Index Systems did not result in the definition of an AGCR. Although the Taylor Index System minimized Type I errors which allowed access to composition regions of interest to improve melt rate or increase waste loadings for DWPF as compared to the current durability model, Type II errors were also committed. In the context of the application of a particular classification system in the process control system, Type II errors are much more serious than Type I errors. A Type I error only reflects that the particular constraint system being used is overly conservative (i.e., its application restricts access to glasses that have an acceptable measured durability response). A Type II error results in a more serious misclassification that could result in allowing the transfer of a Slurry Mix Evaporator (SME) batch to the melter, which is predicted to produce a durable product based on the specific system applied but in reality does not meet the defined ''acceptability'' criteria. More specifically, a nondurable product could be produced in DWPF. Given the presence of Type II errors, the Index System approach was deemed inadequate for further implementation consideration at the DWPF. The second approach (the JMP partitioning process) was purely data driven and empirically derived--glass science was not a factor. In this approach, the collection of composition--durability data in ComPro was sequentially partitioned or split based on the best available specific criteria and variables. More specifically, the JMP software chose the oxide (Al{sub 2}O{sub 3} for this dataset) that most effectively partitions the PCT responses (NL [B]'s)--perhaps not 100% effective based on a single oxide. Based on this initial split, a second request was made to split a particular set of the ''Y'' values (good or bad PCTs based on the 10 g/L limit) based on the next most critical ''X'' variable. This ''splitting'' or ''partitioning'' process was repeated until an AGCR was defined based on the use of only 3 oxides (Al{sub 2}O{sub 3}, CaO, and MgO) and critical values of > 3.75 wt% Al{sub 2}O{sub 3}, {ge} 0.616 wt% CaO, and < 3.521 wt% MgO. Using this set of criteria, the ComPro database was partitioned in which no Type II errors were committed. The automated partitioning function screened or removed 978 of the 2406 ComPro glasses which did cause some initial concerns regarding excessive conservatism regardless of its ability to identify an AGCR. However, a preliminary review of glasses within the 1428 ''acceptable'' glasses defining the ACGR includes glass systems of interest to support the accelerated mission.« less

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

Not Available

The Office of Civilian Radioactive Waste Management Systems Engineering Management Plan (OCRWM SEMP) specifies the technical management approach for the development of the waste management system, and specifies the approach for the development of each of the system elements -- the waste acceptance system, the transportation system, the Monitored Retrievable Storage (MRS) facility, and the mined geologic disposal system, which includes site characterization activity. The SEMP also delineates how systems engineering will be used by OCRWM to describe the system development process; it identifies responsibilities for its implementation, and specifies the minimum requirements for systems engineering. It also identifies themore » close interrelationship of system engineering and licensing processes. This SEMP, which is a combined OCRWM and M&O SEMP, is part of the top-level program documentation and is prepared in accordance with the direction provided in the Program Management System Manual (PMSM). The relationship of this document to other top level documents in the CRWMS document hierarchy is defined in the PMSM. A systems engineering management plan for each project, which specifies the actions to be taken in implementing systems engineering at the project level, shall be prepared by the respective project managers. [``Program`` refers to the CRWMS-wide activity and ``project`` refers to that level responsible for accomplishing the specific activities of that segment of the program.] The requirements for the project level SEMPs are addressed in Section 4.2.2.2. They represent the minimum set of requirements, and do not preclude the broadening of systems engineering activities to meet the specific needs of each project.« less

Acceptance and Utilization of Technology (UTAUT) as a Method of Technology Acceptance Model of Mitigation Disaster Website

NASA Astrophysics Data System (ADS)

Siswanto, T.; Shofiati, R.; Hartini, H.

2018-01-01

www.mitigasi-bencana.com as a knowledge management website created based on survey results in April-July 2014 in East Java and Central Java provinces, indicates a gap between the expectations and reality that exist in the services provided by the regional disaster management agency. Based on condition analysis, the gaps that occur can be reduced if the community has the understanding and knowledge of adequate disaster mitigation. The problem that arises later is whether the chosen technology solution is appropriate and acceptable to the public? The methodology used in this study using the Technology Acceptance Model development is the Unified Theory of Acceptance and Utilization of Technology (UTAUT). Feedback obtained from respondents KarangTaruna youth SelogedongBantul, www.mitigasi-bencana.com can be accepted by the respondents, but from processed data is obtained only UTAUT hypotheses on the relationship dimension eligible for Social Expectancy on the Attitude toward technology, which means the higher the perception of the Social Expectancy, the higher the perception of the Attitude toward technology. Because www.mitigasi-bencana.com is new socialized so that society still need time to explore content information and knowledge contained therein. To be accepted by user, a knowledge management application must prepare various aspects of Performance Expectancy, Effort Expectancy, Social Factors, Facilitating Conditions and Attitude.

Influence of UAS Pilot Communication and Execution Delay on Controller's Acceptability Ratings of UAS-ATC Interactions

NASA Technical Reports Server (NTRS)

Vu, Kim-Phuong L.; Morales, Gregory; Chiappe, Dan; Strybel, Thomas Z.; Battiste, Vernol; Shively, Jay; Buker, Timothy J

2013-01-01

Successful integration of UAS in the NAS will require that UAS interactions with the air traffic management system be similar to interactions between manned aircraft and air traffic management. For example, UAS response times to air traffic controller (ATCo) clearances should be equivalent to those that are currently found to be acceptable with manned aircraft. Prior studies have examined communication delays with manned aircraft. Unfortunately, there is no analogous body of research for UAS. The goal of the present study was to determine how UAS pilot communication and execution delays affect ATCos' acceptability ratings of UAS pilot responses when the UAS is operating in the NAS. Eight radar-certified controllers managed traffic in a modified ZLA sector with one UAS flying in it. In separate scenarios, the UAS pilot verbal communication and execution delays were either short (1.5 s) or long (5 s) and either constant or variable. The ATCo acceptability of UAS pilot communication and execution delays were measured subjectively via post trial ratings. UAS verbal pilot communication delay, were rated as acceptable 92% of the time when the delay was short. This acceptability level decreased to 64% when the delay was long. UAS pilot execution delay had less of an influence on ATCo acceptability ratings in the present stimulation. Implications of these findings for UAS in the NAS integration are discussed.

The stakeholder preference for best management practices in the Three Gorges Reservoir Region.

PubMed

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived (P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

The Stakeholder Preference for Best Management Practices in the Three Gorges Reservoir Region

NASA Astrophysics Data System (ADS)

Qiu, Jiali; Shen, Zhenyao; Chen, Lei; Xie, Hui; Sun, Chengchun; Huang, Qin

2014-11-01

A qualitative analysis of in-depth interviews with 92 farmers and 42 policy managers in Wuxi County, the Three Gorges Reservoir Region, was conducted to identify stakeholder preferences for alternative best management practices (BMPs) and to determine the factors that affect their acceptance. Policy manager support for most of the practices was relatively stronger than support by farmers, except for the grade stabilization structure (GSS), hillside ditch (HD) and constructed wetland alternative, owing to their perceptions of soil benefits, economic advantages and environmental advantages. Farmers opposed those practices that occupied cultivated lands or changed the conventional planting methods, such as field border, conservation tillage (CT) and contour buffer strips. They tended to accept the BMPs with off-farm pollution reduction, such as GSS, riparian forest buffer and HD, and the BMPs associated with soil benefits, such as nutrient management and Terrace. The result that almost all respondents did not accept CT differed from reports in the existing literature. There is a significant correlation between the acceptance of some BMPs and the townships where the farmers lived ( P ≤ 0.05). The environmental conditions and social factors would affect farmer support for BMPs, including local soil conditions, farming methods, economic income, education level and age. The economic advantages of the BMPs were the main motivation for farmers to accept the practices. Furthermore, intensive education efforts, financial incentives or economic subsidies may promote the adoption of the BMPs in our study area.

Model depicting aspects of audit and feedback that impact physicians' acceptance of clinical performance feedback.

PubMed

Payne, Velma L; Hysong, Sylvia J

2016-07-13

Audit and feedback (A&F) is a strategy that has been used in various disciplines for performance and quality improvement. There is limited research regarding medical professionals' acceptance of clinical-performance feedback and whether feedback impacts clinical practice. The objectives of our research were to (1) investigate aspects of A&F that impact physicians' acceptance of performance feedback; (2) determine actions physicians take when receiving feedback; and (3) determine if feedback impacts physicians' patient-management behavior. In this qualitative study, we employed grounded theory methods to perform a secondary analysis of semi-structured interviews with 12 VA primary care physicians. We analyzed a subset of interview questions from the primary study, which aimed to determine how providers of high, low and moderately performing VA medical centers use performance feedback to maintain and improve quality of care, and determine perceived utility of performance feedback. Based on the themes emergent from our analysis and their observed relationships, we developed a model depicting aspects of the A&F process that impact feedback acceptance and physicians' patient-management behavior. The model is comprised of three core components - Reaction, Action and Impact - and depicts elements associated with feedback recipients' reaction to feedback, action taken when feedback is received, and physicians modifying their patient-management behavior. Feedback characteristics, the environment, external locus-of-control components, core values, emotion and the assessment process induce or deter reaction, action and impact. Feedback characteristics (content and timeliness), and the procedural justice of the assessment process (unjust penalties) impact feedback acceptance. External locus-of-control elements (financial incentives, competition), the environment (patient volume, time constraints) and emotion impact patient-management behavior. Receiving feedback generated intense emotion within physicians. The underlying source of the emotion was the assessment process, not the feedback. The emotional response impacted acceptance, impelled action or inaction, and impacted patient-management behavior. Emotion intensity was associated with type of action taken (defensive, proactive, retroactive). Feedback acceptance and impact have as much to do with the performance assessment process as it does the feedback. In order to enhance feedback acceptance and the impact of feedback, developers of clinical performance systems and feedback interventions should consider multiple design elements.

Parental acceptance of behaviour-management techniques used in paediatric dentistry and its relation to parental dental anxiety and experience.

PubMed

Boka, V; Arapostathis, K; Vretos, N; Kotsanos, N

2014-10-01

The aim of this study was to examine the acceptance by Greek parents of nine behaviour-management techniques and its association with several possible confounding factors. Following ethical approval, 106 parents whose 3- to 12-year-old children had been receiving treatment in a university postgraduate paediatric dental clinic, and 123 parents of children from a private paediatric dental practice agreed to participate. After being shown a video with nine behaviour-management techniques, parents rated the acceptance of each technique on a 0-10 scale. They were then asked to complete a questionnaire about demographics, their previous dental experience and dental anxiety (modified Corah dental anxiety scale). The best accepted technique was tell-show-do (9.76 ± 0.69), followed by parental presence/absence (PPA) technique (7.83 ± 3.06) and nitrous oxide inhalation sedation (7.09 ± 3.02). The least accepted techniques were passive restraint (4.21 ± 3.84) and general anaesthesia (4.21 ± 4.02). No correlations were found between acceptance of any individual management technique and parental age, gender, income, education, dental experience and dental anxiety or the child's age, gender and dental experience. Parents whose children had been treated at the University clinic had lower income and educational levels, and rated passive restraint, oral sedation and general anaesthesia higher than those from the private practice. When the parents were specifically asked to choose between general anaesthesia over any of the active or passive restraint, hand-over-mouth and voice control techniques, 10% preferred general anaesthesia, and these parents reported statistically significant more negative dental experience but not higher dental anxiety. Statistical significance of differences was explored using the Tukey-Kramer method. There was no correlation between parental dental experience and dental anxiety and the acceptance of any specific behaviour-management technique. However, parents with negative dental experience would prefer general anaesthesia over any of active or passive restraint, hand-over-mouth and voice control techniques. PPA is a highly acceptable technique for Greek parents.

Hanford Site Solid Waste Acceptance Criteria

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

Not Available

1993-11-17

This manual defines the Hanford Site radioactive, hazardous, and sanitary solid waste acceptance criteria. Criteria in the manual represent a guide for meeting state and federal regulations; DOE Orders; Hanford Site requirements; and other rules, regulations, guidelines, and standards as they apply to acceptance of radioactive and hazardous solid waste at the Hanford Site. It is not the intent of this manual to be all inclusive of the regulations; rather, it is intended that the manual provide the waste generator with only the requirements that waste must meet in order to be accepted at Hanford Site TSD facilities.

The feasibility of e-learning as a quality improvement tool.

PubMed

Kobewka, Daniel; Backman, Chantal; Hendry, Paul; Hamstra, Stanley J; Suh, Kathryn N; Code, Catherine; Forster, Alan J

2014-10-01

Many quality problems exist in health care. We aim to investigate the feasibility and acceptability of using e-learning (defined as computer-based learning modules) to address gaps in quality of care. We performed a qualitative evaluation of participants in a pilot e-learning program. Physician members of six medical teaching units (MTUs) at a multi-site tertiary care teaching hospital were asked to complete two e-learning modules addressing hand hygiene practices and management of community-acquired pneumonia (CAP). An e-learning design team created online modules that were made available to members of the six MTUs for 4 weeks using a password secured website. Use of the modules was voluntary. Participants' perceptions of module content, mode of delivery, and suggestions for improvement were determined through focus groups. We then performed content analysis on the transcripts. We used system data to define patterns of module access. Out of 55 eligible users, 30 (55%) logged onto the system at least once. Residents (14/30, 47%) were less likely to use the system than medical students (9/14, 64%) and attending staff (7/11, 64%). Learners at all levels thought the modules were easy to use. Participants liked the knowledge-based material in the CAP module because it directly applied to their work. There were less favourable opinions of the hand hygiene module Generating e-learning modules targeted at gaps in quality of care is feasible and acceptable to learners. Future studies should assess whether these approaches lead to desired changes in behavior. © 2014 John Wiley & Sons, Ltd.

[Effect of an educational intervention on the attitudes of the nurses of primary care on depression].

PubMed

López-Cortacans, Germán; Aragonès Benaiges, Enric; Caballero Alías, Antonia; Piñol Moreso, Josep Lluís

2015-01-01

To describe nurse attitudes toward depression, using a standardized questionnaire and to evaluate how a training workshop can modify or influence these attitudes. A prospective study based on the application of the Depression Attitude Questionnaire, before and six months after, participating in a training day on the nursing role in the management of depression in Primary Care. The sample consisted of 40 Primary Care nurses from 10 health centers in the province of Tarragona. Nurses are in a neutral position when considering the management of depressed patients as a difficult task, or to feel comfortable in this task, but there is a high degree of acceptance of the claim that the time spent caring for depressed patients is rewarding. In general, there was little significant difference in the mean scores for the different items of the Depression Attitude Questionnaire, before and six months, after the training intervention. The attitude towards the management of depression in Primary Care and to the role that nurses can play in this task is generally favorable. Fruitful training and organizational initiatives can be established in order to define and structure the nursing role in the management of depression in Primary Care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Designing medical foods for inherited metabolic disorders: why intact protein is superior to amino acids.

PubMed

Ney, Denise Marie; Etzel, Mark Raymond

2017-04-01

Phenylketonuria and tyrosinemia are inherited metabolic disorders characterized by high blood levels of phenylalanine (Phe) or tyrosine (Tyr), due to mutations in genes affecting Phe and Tyr metabolism, respectively. The primary management is a lifelong diet restricted in protein from natural foods in combination with medical foods comprised mixtures of synthetic amino acids. Compliance is often poor after childhood leading to neuropsychological sequela. Glycomacropeptide, an intact 64 amino acid glycophosphopeptide isolated from cheese whey, provides a new paradigm for the management of phenylketonuria and tyrosinemia because glycomacropeptide contains no Phe and Tyr in its pure form, and is also a prebiotic. Medical foods made from glycomacropeptide have been used successfully for the management of phenylketonuria and tyrosinemia. Preclinical and clinical studies demonstrate that intact protein from glycomacropeptide provides a more acceptable and physiologic source of defined protein compared to amino acids in medical foods. For example, harmful gut bacteria were reduced, beneficial short chain fatty acids increased, renal workload decreased, protein utilization increased, and bone fragility decreased using intact protein versus amino acids. Advances in biotechnology will propel the transition from synthetic amino acids to intact proteins for the management of inherited metabolic disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

X-PAT: a multiplatform patient referral data management system for small healthcare institution requirements.

PubMed

Masseroli, Marco; Marchente, Mario

2008-07-01

We present X-PAT, a platform-independent software prototype that is able to manage patient referral multimedia data in an intranet network scenario according to the specific control procedures of a healthcare institution. It is a self-developed storage framework based on a file system, implemented in eXtensible Markup Language (XML) and PHP Hypertext Preprocessor Language, and addressed to the requirements of limited-dimension healthcare entities (small hospitals, private medical centers, outpatient clinics, and laboratories). In X-PAT, healthcare data descriptions, stored in a novel Referral Base Management System (RBMS) according to Health Level 7 Clinical Document Architecture Release 2 (CDA R2) standard, can be easily applied to the specific data and organizational procedures of a particular healthcare working environment thanks also to the use of standard clinical terminology. Managed data, centralized on a server, are structured in the RBMS schema using a flexible patient record and CDA healthcare referral document structures based on XML technology. A novel search engine allows defining and performing queries on stored data, whose rapid execution is ensured by expandable RBMS indexing structures. Healthcare personnel can interface the X-PAT system, according to applied state-of-the-art privacy and security measures, through friendly and intuitive Web pages that facilitate user acceptance.

Managing multiple image stacks from confocal laser scanning microscopy

NASA Astrophysics Data System (ADS)

Zerbe, Joerg; Goetze, Christian H.; Zuschratter, Werner

1999-05-01

A major goal in neuroanatomy is to obtain precise information about the functional organization of neuronal assemblies and their interconnections. Therefore, the analysis of histological sections frequently requires high resolution images in combination with an overview about the structure. To overcome this conflict we have previously introduced a software for the automatic acquisition of multiple image stacks (3D-MISA) in confocal laser scanning microscopy. Here, we describe a Windows NT based software for fast and easy navigation through the multiple images stacks (MIS-browser), the visualization of individual channels and layers and the selection of user defined subregions. In addition, the MIS browser provides useful tools for the visualization and evaluation of the datavolume, as for instance brightness and contrast corrections of individual layers and channels. Moreover, it includes a maximum intensity projection, panning and zoom in/out functions within selected channels or focal planes (x/y) and tracking along the z-axis. The import module accepts any tiff-format and reconstructs the original image arrangement after the user has defined the sequence of images in x/y and z and the number of channels. The implemented export module allows storage of user defined subregions (new single image stacks) for further 3D-reconstruction and evaluation.

48 CFR 446.370 - Inspection and acceptance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Inspection and acceptance. 446.370 Section 446.370 Federal Acquisition Regulations System DEPARTMENT OF AGRICULTURE CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 446.370 Inspection and acceptance. The Contracting Officer...

A first-line nurse manager's goal-profile.

PubMed

Johansson, Gunilla; Pörn, Ingmar; Theorell, Töres; Gustafsson, Barbro

2007-01-01

The aim of this case study was to acquire understanding concerning the first-line nurse manager's goal-profile, i.e. prioritization of goals in her work as a first-line nurse manager, through use of an action-theoretic and confirmatory theory. The first-line nurse manager's pivotal role regarding quality of care and development in relation to on-going changes in the health care sector is stressed by many researchers and the transition from nurse to manager is described as a demanding challenge for the first-line nurse manager. The case study described in this paper concerns a first-line nurse manager in an actual working environment in care of older people. Data collection comprised interviews, observations, a job description and policy documents. A hermeneutic interpretation was used for data analysis. The results showed that the first-line nurse manager had three goals in her goal-profile, in the following order of priority: (i) a nurse goal that she had strongly accepted and in which she had excellent control, (ii) an administrator goal that she had accepted and in which she had control, (iii) a leadership goal that she had not accepted and in which she did not have control. Both the administrator and leadership goals were based on her job description, but the nurse goal was a personally chosen goal based on her own self-relation/goal-fulfillment. The first-line nurse manager's prioritized self-identity, based on successful realization of goals in her goal-profile, was decisive in the manifestation of her work. This study contributes to a new understanding of the first-line nurse manager's self-identity related to work in terms of goal acceptance and goal control of prioritized goals. This action-theoretic approach could be a valuable 'key' for understanding leadership (or lack of leadership) in clinical practice.

Ultra high performance connectors for power transmission applications

DOEpatents

Wang, Jy-An; Ren, Fei; Lee, Dominic F; Jiang, Hao

2014-03-04

Disclosed are several examples of an apparatus for connecting the free ends of two electrical power transmission lines having conductor strands disposed around a central, reinforcing core. The examples include an inner sleeve having a body defining an inner bore passing through an axially-extending, central axis, an outer rim surface disposed radially outward from the central bore, and one or more axially-extending grooves penetrating the body at the outer rim surface. Also included is an outer splice having a tubular shaped body with a bore passing coaxially through the central axis, the bore defining an inner rim surface for accepting the inner sleeve. The inner bore of the inner sleeve accepts the reinforcement cores of the two conductors, and the grooves accept the conductor strands in an overlapping configuration so that a majority of the electrical current flows between the overlapped conductor strands when the conductors are transmitting electrical current.

Animal experimentation.

PubMed

Kolar, Roman

2006-01-01

Millions of animals are used every year in often times extremely painful and distressing scientific procedures. Legislation of animal experimentation in modern societies is based on the supposition that this is ethically acceptable when certain more or less defined formal (e.g. logistical, technical) demands and ethical principles are met. The main parameters in this context correspond to the "3Rs" concept as defined by Russel and Burch in 1959, i.e. that all efforts to replace, reduce and refine experiments must be undertaken. The licensing of animal experiments normally requires an ethical evaluation process, often times undertaken by ethics committees. The serious problems in putting this idea into practice include inter alia unclear conditions and standards for ethical decisions, insufficient management of experiments undertaken for specific (e.g. regulatory) purposes, and conflicts of interest of ethics committees' members. There is an ongoing societal debate about ethical issues of animal use in science. Existing EU legislation on animal experimentation for cosmetics testing is an example of both the public will for setting clear limits to animal experiments and the need to further critically examine other fields and aspects of animal experimentation.

Toward the definition of specific protection goals for the environmental risk assessment of chemicals: A perspective on environmental regulation in Europe.

PubMed

Brown, A Ross; Whale, Graham; Jackson, Mathew; Marshall, Stuart; Hamer, Mick; Solga, Andreas; Kabouw, Patrick; Galay-Burgos, Malyka; Woods, Richard; Nadzialek, Stephanie; Maltby, Lorraine

2017-01-01

This critical review examines the definition and implementation of environmental protection goals for chemicals in current European Union (EU) legislation, guidelines, and international agreements to which EU countries are party. The European chemical industry is highly regulated, and prospective environmental risk assessments (ERAs) are tailored for different classes of chemical, according to their specific hazards, uses, and environmental exposure profiles. However, environmental protection goals are often highly generic, requiring the prevention of "unacceptable" or "adverse" impacts on "biodiversity" and "ecosystems" or the "environment as a whole." This review aims to highlight working examples, challenges, solutions, and best practices for defining specific protection goals (SPGs), which are seen to be essential for refining and improving ERA. Specific protection goals hinge on discerning acceptable versus unacceptable adverse effects on the key attributes of relevant, sensitive ecological entities (ranging from organisms to ecosystems). Some isolated examples of SPGs for terrestrial and aquatic biota can be found in prospective ERA guidance for plant protection products (PPPs). However, SPGs are generally limited to environmental or nature legislation that requires environmental monitoring and retrospective ERA. This limitation is due mainly to the availability of baselines, which define acceptable versus unacceptable environmental effects on the key attributes of sentinel species, populations and/or communities, such as reproductive status, abundance, or diversity. Nevertheless, very few regulatory case examples exist in which SPGs incorporate effect magnitude, spatial extent, and temporal duration. We conclude that more holistic approaches are needed for defining SPGs, particularly with respect to protecting population sustainability, ecosystem function, and integrity, which are implicit in generic protection goals and explicit in the International Programme for Chemical Safety (IPCS) definition of "adverse effect." A possible solution, which the chemical industry is currently assessing, is wider application of the ecosystem services approach proposed by the European Food Safety Authority (EFSA) for the risk assessment of PPPs. Integr Environ Assess Manag 2017;13:17-37. © 2016 SETAC. © 2016 SETAC.

Deans in German Universities: Goal Acceptance and Task Characteristics

ERIC Educational Resources Information Center

Scholkmann, Antonia

2011-01-01

This paper presents an empirical study which explored how deans at German universities accept their new role as manager, and which factors influence the acceptance of this role. Within a framework referring to Locke and Latham's goal setting theory, the acceptance of operative goals implemented in the faculties served as an indicator of how well…

Public acceptance of wildland fire and fuel management: panel responses in seven locations.

PubMed

Toman, Eric; Shindler, Bruce; McCaffrey, Sarah; Bennett, James

2014-09-01

Wildland fire affects both public and private resources throughout the United States. A century of fire suppression has contributed to changing ecological conditions and accumulated fuel loads. Managers have used a variety of approaches to address these conditions and reduce the likelihood of wildland fires that may result in adverse ecological impacts and threaten communities. Public acceptance is a critical component of developing and implementing successful management programs. This study examines the factors that influence citizen support for agency fuel reduction treatments over time-particularly prescribed fire and mechanical vegetation removal. This paper presents findings from a longitudinal study examining resident beliefs and attitudes regarding fire management and fuels treatments in seven states: Arizona, Colorado, Oregon, Utah, Michigan, Minnesota, and Wisconsin. The study was implemented in two phases over a 6-year period using mail surveys to residents of communities adjacent to federal lands in each location. Questions replicated measures from the original project as well as some new items to allow a more in-depth analysis of key concepts. The study design enables comparisons over time as well as between locations. We also assess the factors that influence acceptance of both prescribed fire and mechanical vegetation removal. Findings demonstrate a relative stability of attitudes toward fuels management approaches over time and suggest that this acceptance is strongly influenced by confidence in resource managers and beliefs that the treatments would result in positive outcomes.

A Web-Based Information System for Field Data Management

NASA Astrophysics Data System (ADS)

Weng, Y. H.; Sun, F. S.

2014-12-01

A web-based field data management system has been designed and developed to allow field geologists to store, organize, manage, and share field data online. System requirements were analyzed and clearly defined first regarding what data are to be stored, who the potential users are, and what system functions are needed in order to deliver the right data in the right way to the right user. A 3-tiered architecture was adopted to create this secure, scalable system that consists of a web browser at the front end while a database at the back end and a functional logic server in the middle. Specifically, HTML, CSS, and JavaScript were used to implement the user interface in the front-end tier, the Apache web server runs PHP scripts, and MySQL to server is used for the back-end database. The system accepts various types of field information, including image, audio, video, numeric, and text. It allows users to select data and populate them on either Google Earth or Google Maps for the examination of the spatial relations. It also makes the sharing of field data easy by converting them into XML format that is both human-readable and machine-readable, and thus ready for reuse.

[Autoimmune pancreatitis. Evidence based management guidelines of the Hungarian Pancreatic Study Group].

PubMed

Dubravcsik, Zsolt; Farkas, Gyula; Hegyi, Péter; Hritz, István; Kelemen, Dezső; Lásztity, Natália; Morvay, Zita; Oláh, Attila; Pap, Ákos; Párniczky, Andrea; Sahin-Tóth, Miklós; Szentkereszti, Zsolt; Szmola, Richárd; Takács, Tamás; Tiszlavicz, László; Szücs, Ákos; Czakó, László

2015-02-22

Autoimmune pancreatitis is a rare disease which can even mimic pancreatic tumor, however, unlike the latter, it requires not surgical but conservative management. Correct diagnosis and differential diagnosis of autoimmune pancreatitis and treatment of these patients requires up-to-date and evidence based management guidelines. The Hungarian Pancreatic Study Group proposed to prepare an evidence based guideline based on the available international guidelines and evidences. The preparatory and consultation task force appointed by the Hungarian Pancreatic Study Group translated and complemented and/or modified the international guidelines if it was necessary. 29 relevant clinical questions in 4 topics were defined (Basics; Diagnosis; Differential diagnostics; Therapy). Evidence was classified according to the UpToDate(®) grading system. The draft of the guidelines was presented and discussed at the consensus meeting on September 12, 2014. All clinial questions were accepted with almost total (more than 95%) agreement. The present guideline is the first evidence based autoimmune pancreatitis guideline in Hungary. The guideline may provide very important and helpful data for tuition of autoimmune pancreatitis, for everyday practice and for establishing proper finance. Therefore, the authors believe that these guidelines will widely become a basic reference in Hungary.

Reinventing The Design Process: Teams and Models

NASA Technical Reports Server (NTRS)

Wall, Stephen D.

1999-01-01

The future of space mission designing will be dramatically different from the past. Formerly, performance-driven paradigms emphasized data return with cost and schedule being secondary issues. Now and in the future, costs are capped and schedules fixed-these two variables must be treated as independent in the design process. Accordingly, JPL has redesigned its design process. At the conceptual level, design times have been reduced by properly defining the required design depth, improving the linkages between tools, and managing team dynamics. In implementation-phase design, system requirements will be held in crosscutting models, linked to subsystem design tools through a central database that captures the design and supplies needed configuration management and control. Mission goals will then be captured in timelining software that drives the models, testing their capability to execute the goals. Metrics are used to measure and control both processes and to ensure that design parameters converge through the design process within schedule constraints. This methodology manages margins controlled by acceptable risk levels. Thus, teams can evolve risk tolerance (and cost) as they would any engineering parameter. This new approach allows more design freedom for a longer time, which tends to encourage revolutionary and unexpected improvements in design.

Improved exposure estimation in soil screening and cleanup criteria for volatile organic chemicals.

PubMed

DeVaull, George E

2017-09-01

Soil cleanup criteria define acceptable concentrations of organic chemical constituents for exposed humans. These criteria sum the estimated soil exposure over multiple pathways. Assumptions for ingestion, dermal contact, and dust exposure generally presume a chemical persists in surface soils at a constant concentration level for the entire exposure duration. For volatile chemicals, this is an unrealistic assumption. A calculation method is presented for surficial soil criteria that include volatile depletion of chemical for these uptake pathways. The depletion estimates compare favorably with measured concentration profiles and with field measurements of soil concentration. Corresponding volatilization estimates compare favorably with measured data for a wide range of volatile and semivolatile chemicals, including instances with and without the presence of a mixed-chemical residual phase. Selected examples show application of the revised factors in estimating screening levels for benzene in surficial soils. Integr Environ Assess Manag 2017;13:861-869. © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC). © 2017 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

OTC polyethylene glycol 3350 and pharmacists' role in managing constipation.

PubMed

Horn, John R; Mantione, Maria Marzella; Johanson, John F

2012-01-01

To define constipation, assess the pharmacist's role in identifying and treating constipation, and review clinical evidence for the efficacy, safety, and tolerability of polyethylene glycol (PEG) 3350 (MiraLAX-Merck Consumer Care), an osmotic laxative now available over the counter (OTC), across a variety of patient populations routinely encountered in pharmacy settings. Systematic PubMed search of the primary literature for constipation treatment guidelines and clinical trial results for PEG 3350. Pharmacists have a unique role in assisting patients with identifying and managing constipation. Multiple controlled clinical trials have established the efficacy, safety, and tolerability of PEG 3350 at its recommended dose of 17 g once daily. On the basis of this evidence, various professional groups have recommended PEG 3350 for use in improving stool frequency and consistency in patients with constipation. PEG 3350 is approved for short-term use, including treatment of constipation caused by medications. Pharmacists can play an important role in managing constipation with OTC agents. Compared with other available OTC agents, PEG 3350 can be recommended to patients suffering from constipation on the basis of a large body of clinical evidence supporting its efficacy and safety, as well as the high patient acceptance shown for its palatability and once-daily dosing.

Assessment of environmental risks from toxic and nontoxic stressors; a proposed concept for a risk-based management tool for offshore drilling discharges.

PubMed

Smit, Mathijs G D; Jak, Robbert G; Rye, Henrik; Frost, Tone Karin; Singsaas, Ivar; Karman, Chris C

2008-04-01

In order to improve the ecological status of aquatic systems, both toxic (e.g., chemical) and nontoxic stressors (e.g., suspended particles) should be evaluated. This paper describes an approach to environmental risk assessment of drilling discharges to the sea. These discharges might lead to concentrations of toxic compounds and suspended clay particles in the water compartment and concentrations of toxic compounds, burial of biota, change in sediment structure, and oxygen depletion in marine sediments. The main challenges were to apply existing protocols for environmental risk assessment to nontoxic stressors and to combine risks arising from exposure to these stressors with risk from chemical exposure. The defined approach is based on species sensitivity distributions (SSDs). In addition, precautionary principles from the EU-Technical Guidance Document were incorporated to assure that the method is acceptable in a regulatory context. For all stressors a protocol was defined to construct an SSD for no observed effect concentrations (or levels; NOEC(L)-SSD) to allow for the calculation of the potentially affected fraction of species from predicted exposures. Depending on the availability of data, a NOEC-SSD for toxicants can either be directly based on available NOECs or constructed from the predicted no effect concentration and the variation in sensitivity among species. For nontoxic stressors a NOEL-SSD can be extrapolated from an SSD based on effect or field data. Potentially affected fractions of species at predicted exposures are combined into an overall risk estimate. The developed approach facilitates environmental management of drilling discharges and can be applied to define risk-mitigating measures for both toxic and nontoxic stress.

Cultural Variations in Mothers' Acceptance of and Intent to Use Behavioral Child Management Techniques

ERIC Educational Resources Information Center

Mah, Janet W. T.; Johnston, Charlotte

2012-01-01

We examined cultural differences in mothers' acceptance of and intent to use behavioral parenting techniques for managing disruptive child behavior, and the possible roles of parenting styles and implicit theories in explaining these cultural differences. A community sample of 117 Euro-Canadian and Chinese-immigrant mothers of boys aged 4- to…

75 FR 41881 - Filing of Plats of Survey: Oregon/Washington

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

...] Filing of Plats of Survey: Oregon/Washington AGENCY: Bureau of Land Management, Interior. ACTION: Notice... Bureau of Land Management Oregon/Washington State Office, Portland, Oregon, 30 days from the date of this publication. Willamette Meridian Oregon T. 3 S., R. 6 W., accepted May 7, 2010 T 2 S., R. 6 W., accepted May 7...

The Role of Peer Influence and Perceived Quality of Teaching in Faculty Acceptance of Web-Based Learning Management Systems

ERIC Educational Resources Information Center

Salajan, Florin D.; Welch, Anita G.; Ray, Chris M.; Peterson, Claudette

2015-01-01

This study's primary investigation is the impact of "peer influence" and "perceived quality of teaching" on faculty members' usage of web-based learning management systems within the Technology Acceptance Model (TAM) framework. These factors are entered into an extended TAM as external variables impacting on the core constructs…

Researching Instructional Use and the Technology Acceptation of Learning Management Systems by Secondary School Teachers

ERIC Educational Resources Information Center

De Smet, Cindy; Bourgonjon, Jeroen; De Wever, Bram; Schellens, Tammy; Valcke, Martin

2012-01-01

The aim of this large-scale study was to understand the technology acceptation of learning management systems (LMS) by secondary school teachers and to investigate the instructional use of LMS, distinguishing between informational use and communicational use. The predictive model further includes: perceived usefulness, perceived ease of use,…

Acceptability and perceived utility of drone technology among emergency medical service responders and incident commanders for mass casualty incident management.

PubMed

Hart, Alexander; Chai, Peter R; Griswold, Matthew K; Lai, Jeffrey T; Boyer, Edward W; Broach, John

2017-01-01

This study seeks to understand the acceptability and perceived utility of unmanned aerial vehicle (UAV) technology to Mass Casualty Incidents (MCI) scene management. Qualitative questionnaires regarding the ease of operation, perceived usefulness, and training time to operate UAVs were administered to Emergency Medical Technicians (n = 15). A Single Urban New England Academic Tertiary Care Medical Center. Front-line emergency medical service (EMS) providers and senior EMS personnel in Incident Commander roles. Data from this pilot study indicate that EMS responders are accepting to deploying and operating UAV technology in a disaster scenario. Additionally, they perceived UAV technology as easy to adopt yet impactful in improving MCI scene management.

Teaching Strategies to Increase Nursing Student Acceptance and Management of Unconscious Bias.

PubMed

Schultz, Paula L; Baker, Janet

2017-11-01

Medical providers' unconscious biases may contribute to health disparities. Awareness and self-reflection strategies commonly used to teach cultural competence in academic settings are generally ineffective in reducing unconscious bias or motivating change. This article describes the innovative teaching strategies implemented in a graduate setting (N = 75) to increase nursing learners' acceptance and management of unconscious bias. Strategies used guided the debriefing and feedback that incorporated implicit association testing, interactive audience polling, categorized management strategies, and perspective taking. Strategies resulted in positive learner feedback, including a high likelihood to learn more about unconscious bias, acceptance of unconscious bias influence on health disparities, and importance of using management strategies to address personal bias. Increasingly diverse patient populations require nurses who have the skills to understand, assess, and correct unconscious biases. To accomplish this goal, consistent exposure to unconscious bias curricula that includes focused debriefing, feedback, and management strategies is needed at all levels of nursing education. [J Nurs Educ. 2017;56(11):692-696.]. Copyright 2017, SLACK Incorporated.

Factors affecting home care patients' acceptance of a web-based interactive self-management technology

PubMed Central

Karsh, Ben-Tzion; Severtson, Dolores J; Burke, Laura J; Brown, Roger L; Brennan, Patricia Flatley

2010-01-01

Objective With the advent of personal health records and other patient-focused health technologies, there is a growing need to better understand factors that contribute to acceptance and use of such innovations. In this study, we employed the Unified Theory of Acceptance and Use of Technology as the basis for determining what predicts patients' acceptance (measured by behavioral intention) and perceived effective use of a web-based, interactive self-management innovation among home care patients. Design Cross-sectional secondary analysis of data from a randomized field study evaluating a technology-assisted home care nursing practice with adults with chronic cardiac disease. Measurement and analysis A questionnaire was designed based on validated measurement scales from prior research and was completed by 101 participants for measuring the acceptance constructs as part of the parent study protocol. Latent variable modeling with item parceling guided assessment of patients' acceptance. Results Perceived usefulness accounted for 53.9% of the variability in behavioral intention, the measure of acceptance. Together, perceived usefulness, health care knowledge, and behavioral intention accounted for 68.5% of the variance in perceived effective use. Perceived ease of use and subjective norm indirectly influenced behavioral intention, through perceived usefulness. Perceived ease of use and subjective norm explained 48% of the total variance in perceived usefulness. Conclusion The study demonstrates that perceived usefulness, perceived ease of use, subjective norm, and healthcare knowledge together predict most of the variance in patients' acceptance and self-reported use of the web-based self-management technology. PMID:21131605

12 CFR 621.3 - Application of generally accepted accounting principles.

Code of Federal Regulations, 2010 CFR

2010-01-01

... principles. 621.3 Section 621.3 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ACCOUNTING... reports to the Farm Credit Administration, in accordance with generally accepted accounting principles... management and the Farm Credit Administration, in accordance with generally accepted accounting principles...

'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain.

PubMed

Goldthorpe, J; Peters, S; Lovell, K; McGowan, L; Aggarwal, V

2016-05-13

Introduction Evidence suggests that psychosocial management may produce improved outcomes for patients suffering from chronic orofacial pain (COFP), when symptoms cannot be attributed to pathology. A complex intervention, based on cognitive behavioural therapy (CBT) was developed by a multi-disciplinary team, using evidence synthesis. An important element of developing and evaluating complex interventions is to establish acceptability to stakeholders; therefore qualitative interviews with patients were carried out.Objectives To explore levels of acceptability of a complex intervention to manage COFP.Method Semi-structured interviews were carried out with 17 participants who had been referred to the intervention. Thematic analysis was used to identify emerging issues and themes from the data.Results Themes relating to processes of engagement with the intervention emerged. Important processes were: identification with the intervention; feeling believed and understood; obtaining a plausible explanation for symptoms; degree of perceived effort required to engage; acceptance of having a long-term condition; and receiving demonstrative, positive feedback.Conclusion Patients presenting with unexplained COFP in a secondary care setting are able to accept a CBT based intervention to manage their condition. Findings may offer guidance for dentists who are not used to referring patients to psychosocial interventions and inform the way dentists communicate the nature of unexplained symptoms to patients.

Chronic urinary retention in men: how we define it, and how does it affect treatment outcome.

PubMed

Negro, Carlo L A; Muir, Gordon H

2012-12-01

What's known on the subject? and What does the study add? Chronic urinary retention (CUR) is a poorly defined entity, as the key element of definition, significant postvoid residual urine volume (PVR), has not a worldwide and moreover evidenced-based definition. There is no agreement on which is the threshold value to define a significant PVR and different society produced guidelines with different thresholds ranging from 300 mL to 1000 mL. Diagnosis is difficult, and management has not been defined yet. There is a lack of studies on the best management of these patients, as this group of patients has always been considered at high risk of failure. Only one study compares conservative with the surgical management but it is not a randomised controlled trail. This review offers a systematic appraisal of the most recent publications on CUR. It indicates the absence of a real worldwide agreed definition, as the two keys element of it are not satisfactorily defined yet: significant PVR, is suffering from a lack of evidenced-based definition, and percussable or palpable bladder is a very nebulous concept as it is not a criteria of certainty as different individual variables affect it. This has an important effect on management which is not structured. Most of the trials involving benign prostatic hyperplasia treatments (either medical or surgical) tend to exclude this group of patients, which is a clinically important group, comprising up to a quarter of men undergoing TURP in the UK. Urinary retention describes a bladder that does not empty completely or does not empty at all. Historically, urinary retention has been classified as either acute or chronic the latter is generally classified as high pressure or low pressure according to the bladder filling pressure on urodynamic. A MEDLINE® search for articles written in English and published before January 2010 was done using a list of terms related to urinary retention: 'urinary retention', 'chronic urinary retention' and 'PVR'. Chronic urinary retention (CUR) is defined by the International Continence Society as 'a non-painful bladder, which remains palpable or percussable after the patient has passed urine'. Abrams was the first to choose a residual urine volume >300 mL to define CUR as he considered it the minimum volume at which the bladder becomes palpable suprapubically. The UK National Institute for Health and Clinical Excellence lower urinary tract symptoms (LUTS) guidelines define CUR as a postvoid residual urine volume (PVR) of >1000 mL. No studies have specifically addressed the problem of quantifying the minimum amount of urine present in the bladder to define CUR. Nor did we find any publications objectively assessing at what amount of urine a bladder can be palpable. The ability to feel a bladder may rely on variables (i.e. medical skills and patient habitus). There is a marked variability of PVR, so the test should be repeated to improve precision. As defining CUR is difficult, structured management is challenging. Nearly all prospective trials exclude men with CUR from analysis, possibly anticipating a poor outcome and a high risk of complications. However, men with CUR are a clinically important group, comprising up to 25% of men undergoing transurethral resection of the prostate. Definition of CUR is imprecise and arbitrary. Most studies seem to describe the condition as either a PVR of >300 mL in men who are voiding, or >1000 mL in men who are unable to void. This confusion leads to an inability to design and interpret studies; indeed most prospective trials simply exclude these patients. There is a clear need for internationally accepted definitions of retention to allow both treatment and reporting of outcomes in men with LUTS, and for such definitions to be used by all investigators in future trials. © 2012 BJU INTERNATIONAL.

Development of quantitative risk acceptance criteria

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

Griesmeyer, J. M.; Okrent, D.

Some of the major considerations for effective management of risk are discussed, with particular emphasis on risks due to nuclear power plant operations. Although there are impacts associated with the rest of the fuel cycle, they are not addressed here. Several previously published proposals for quantitative risk criteria are reviewed. They range from a simple acceptance criterion on individual risk of death to a quantitative risk management framework. The final section discussed some of the problems in the establishment of a framework for the quantitative management of risk.

An Introduction to the Surveys of Applicants Who Accepted or Declined Admission to UMCP.

ERIC Educational Resources Information Center

Ott, Mary Diederich

Surveys of admitted students (N=309) at the University of Maryland College Park (UMCP) were conducted in order to obtain admitted applicants' views of the functioning of the Admission Office and to assess differences in responses of certain subgroups of applicants. The four classification variables defining the subgroups were: acceptance status…

Carrying capacity as "informed judgment": The values of science and the science of values

Treesearch

Robert E. Manning

2001-01-01

Contemporary carrying capacity frameworks, such as Limits of Acceptable Change and Visitor Experience and Resource Protection, rely on formulation of standards of quality, which are defined as minimum acceptable resource and social conditions in parks and wilderness. Formulation of standards of quality involves elements of both science and values, and both of these...

Hospital materials managers need to be aware of actions that constitute legal acceptance.

PubMed

Decker, R

1990-12-01

A hospital invited bids for building materials for a hospital construction project. A supplier submitted a bid which asked the hospital to sign and return a trade association form contract. The hospital didn't return the form but used the supplier's bid as part of the general contract for the entire project and notified the supplier and the general contractor. Later, the supplier submitted a higher bid for the same material contending that the hospital hadn't accepted the first bid as they hadn't followed the instructions. The hospital materials manager feels that the bid was properly accepted. In this dialogue, Dr. Decker reviews the legal issues involved in the different ways of accepting an offer.

Investigating the feasibility and acceptability of health psychology-informed obesity training for medical students.

PubMed

Chisholm, Anna; Hart, Jo; Mann, Karen; Perry, Mark; Duthie, Harriet; Rezvani, Leila; Peters, Sarah

2016-01-01

Health psychologists have succeeded in identifying theory-congruent behaviour change techniques (BCTs) to prevent and reduce lifestyle-related illnesses, such as cardiovascular disease, cancers and diabetes. Obesity management discussions between doctors and patients can be challenging and are often avoided. Despite a clear training need, it is unknown how best to tailor BCT research findings to inform obesity-management training for future healthcare professionals. The primary objective of this descriptive study was to gather information on the feasibility and acceptability of delivering and evaluating health psychology-informed obesity training to UK medical students. Medical students (n = 41) attended an obesity management session delivered by GP tutors. Sessions were audio-recorded to enable fidelity checks. Acceptability of training was explored qualitatively. Tutors consistently delivered training according to the intervention protocol; and students and tutors found the training highly acceptable. This psychology-informed training can be delivered successfully by GP tutors and further research is warranted to explore its efficacy.

7 CFR 1738.19 - Facilities financed.

Code of Federal Regulations, 2010 CFR

2010-01-01

... broadband loans to finance broadband facilities leased under the terms of a capital lease as defined in... under the terms of an operating lease as defined in generally accepted accounting principles. (c) RUS... applicant. (e) RUS will not make a broadband loan to finance the following items: (1) Customer terminal...

40 CFR 63.1414 - Test methods and emission estimation equations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (D) Design analysis based on accepted chemical engineering principles, measurable process parameters... paragraph (d)(5) of this section. Engineering assessment may be used to estimate organic HAP emissions from... defined in paragraph (d)(5) of this section; through engineering assessment, as defined in paragraph (d)(6...

40 CFR 63.1414 - Test methods and emission estimation equations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (D) Design analysis based on accepted chemical engineering principles, measurable process parameters... paragraph (d)(5) of this section. Engineering assessment may be used to estimate organic HAP emissions from... defined in paragraph (d)(5) of this section; through engineering assessment, as defined in paragraph (d)(6...

Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies.

PubMed

Jamieson, Nathan J; Hanson, Camilla S; Josephson, Michelle A; Gordon, Elisa J; Craig, Jonathan C; Halleck, Fabian; Budde, Klemens; Tong, Allison

2016-03-01

Kidney transplantation offers better outcomes compared to dialysis, but requires patients to adhere to an ongoing and complex self-management regimen. Medication nonadherence remains a leading cause of transplant loss, and inadequate self-management undermines transplantation and other health outcomes. We aimed to describe kidney transplant recipients' motivations, challenges, and attitudes toward self-management. Systematic review and thematic synthesis of qualitative studies. Kidney transplant recipients. MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to October 2014. Thematic synthesis. 50 studies involving 1,238 recipients aged 18 to 82 years across 19 countries were included. We identified 5 themes: empowerment through autonomy (achieving mastery, tracking against tangible targets, developing bodily intuition, routinizing and problem solving, and adaptive coping), prevailing fear of consequences (inescapable rejection anxiety, aversion to dialysis, minimizing future morbidity, trivialization and denial, and defining acceptable risks), burdensome treatment and responsibilities (frustrating ambiguities, inadvertent forgetfulness, intrusive side effects, reversing ingrained behaviors, and financial hardship), overmedicalizing life (dominating focus, evading patienthood, and succumbing to burnout), and social accountability and motivation (demonstrating gratitude toward medical team, indebtedness to donor, and peer learning). Non-English articles were excluded. Self-efficacy and social accountability are motivators for self-management, although adherence can be mentally and physically taxing. Multicomponent interventions incorporating personalized care planning, education, psychosocial support, decision aids, and self-monitoring tools may foster self-management capacity and improve transplantation outcomes. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Sinks as limited resources? A new indicator for evaluating anthropogenic material flows

PubMed Central

Kral, Ulrich; Brunner, Paul H.; Chen, Pi-Cheng; Chen, Sih-Rong

2014-01-01

Besides recyclables, the use of materials inevitably yields non-recyclable materials such as emissions and wastes for disposal. These flows must be directed to sinks in a way that no adverse effects arise for humans and the environment. The objective of this paper is to present a new indicator for the assessment of substance flows to sinks on a regional scale. The indicator quantifies the environmentally acceptable mass share of a substance in actual waste and emission flows, ranging from 0% as worst case to 100% as best case. This paper consists of three parts: first, the indicator is defined. Second, a methodology to determine the indicator score is presented, including (i) substance flows analysis and (ii) a distant-to-target approach based on an adaptation of the Ecological Scarcity Method 2006. Third, the metric developed is applied in three case studies including copper (Cu) and lead (Pb) in the city of Vienna, and perfluorooctane sulfonate (PFOS) in Switzerland. The following results were obtained: in Vienna, 99% of Cu flows to geogenic and anthropogenic sinks are acceptable when evaluated by the distant-to-target approach. However, the 0.7% of Cu entering urban soils and the 0.3% entering receiving waters are beyond the acceptable level. In the case of Pb, 92% of all flows into sinks prove to be acceptable, and 8% are disposed of in local landfills with limited capacity. For PFOS, 96% of all flows into sinks are acceptable. 4% cannot be evaluated due to a lack of normative criteria, despite posing a risk for human health and the environment. The examples demonstrate the need (i) for appropriate data of good quality to calculate the sink indicator and (ii) for standards, needed for the assessment of substance flows to urban soils and receiving waters. This study corroborates that the new indicator is well suited as a base for decisions regarding the control of hazardous substances in waste and environmental management. PMID:25368543

Experiencing limits of acceptable change: some thoughts after a decade of implementation

Treesearch

Stephen F. McCool; David N. Cole

1997-01-01

Wilderness managers and researchers have experienced implementation of the Limits of Acceptable Change planning system for over a decade. In a sense, implementation of LAC has been a broad scale experiment in planning, with the hypothesis being that LAC processes are more effective approaches to deal with questions of recreation management in protected areas than the...

Institutional barriers and opportunities in application of the limits of acceptable change

Treesearch

George H. Stankey

1997-01-01

Although the Limits of Acceptable Change (LAC) process has been in use since the mid-1980’s and has contributed to improved wilderness management, significant barriers and challenges remain. Formal and informal institutional barriers are the principal constraint to more effective implementation. Although grounded in a traditional management-by-objectives model, the LAC...

INPRO Assessment of an INS in the Area of Safety of Fuel Cycle Installations

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

Raj, B.; Busurin, Y.; Depisch, F.

2006-07-01

INPRO has defined requirements organized in a hierarchy of Basic Principles, User Requirements and Criteria (consisting of an indicator and an acceptance limit) to be met by innovative nuclear reactor systems (INS) in six areas, namely: economics, safety, waste management, environment, proliferation resistance, and infrastructure. If an INS meets all requirements in all areas it represents a sustainable system for the supply of energy, capable of making a significant contribution to meeting the energy needs of the 21. century. Draft manuals have been developed, for each INPRO area, to provide guidance for performing an assessment of whether an INS meetsmore » the INPRO requirements in a given area. The manuals set out the information that needs to be assembled to perform an assessment and provide guidance on selecting the acceptance limits and, for a given INS, for determining the value of the indicators for comparison with the associated acceptance limits. Each manual also includes an example of a specific assessment to illustrate the guidance. This paper discusses the manual for performing an INPRO assessment in the area of safety of fuel cycle installations. The example, chosen solely for the purpose of illustrating the INPRO methodology, describes an assessment of an MOX fuel fabrication plant based on sol-gel technology and illustrates an assessment performed for an INS at an early stage of development. The safety issues and the assessment steps are presented in detail in the paper. (authors)« less

Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study.

PubMed

Jeon, Yun-Hee; Conway, Jane; Chenoweth, Lynn; Weise, Janelle; Thomas, Tamsin Ht; Williams, Anna

2015-04-01

To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. A Delphi method. Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. © 2014 John Wiley & Sons Ltd.

Risk analysis of hematopoietic stem cell transplant process: failure mode, effect, and criticality analysis and hazard analysis critical control point methods integration based on guidelines to good manufacturing practice for medicinal product ANNEX 20 (February 2008).

PubMed

Gianassi, S; Bisin, S; Bindi, B; Spitaleri, I; Bambi, F

2010-01-01

The collection and handling of hematopoietic stem cells (HSCs) must meet high quality requirements. An integrated Quality Risk Management can help to identify and contain potential risks related to HSC production. Risk analysis techniques allow one to "weigh" identified hazards, considering the seriousness of their effects, frequency, and detectability, seeking to prevent the most harmful hazards. The Hazard Analysis Critical Point, recognized as the most appropriate technique to identify risks associated with physical, chemical, and biological hazards for cellular products, consists of classifying finished product specifications and limits of acceptability, identifying all off-specifications, defining activities that can cause them, and finally establishing both a monitoring system for each Critical Control Point and corrective actions for deviations. The severity of possible effects on patients, as well as the occurrence and detectability of critical parameters, are measured on quantitative scales (Risk Priority Number [RPN]). Risk analysis was performed with this technique on manipulation process of HPC performed at our blood center. The data analysis showed that hazards with higher values of RPN with greater impact on the process are loss of dose and tracking; technical skills of operators and manual transcription of data were the most critical parameters. Problems related to operator skills are handled by defining targeted training programs, while other critical parameters can be mitigated with the use of continuous control systems. The blood center management software was completed by a labeling system with forms designed to be in compliance with standards in force and by starting implementation of a cryopreservation management module. Copyright 2010 Elsevier Inc. All rights reserved.

[Introduction of a quality management system compliant with DIN EN 9001:2000 in a university department of nuclear medicine].

PubMed

Jansen-Schmidt, V; Paschen, U; Kröger, S; Bohuslavizki, K H; Clausen, M

2001-12-01

In 1995, the management of the University Clinic Hamburg-Eppendorf proposed to establish a total quality assurance (QA) system. A revised QA-system has been introduced stepwise in the department of nuclear medicine since 1997, and certification was achieved in accordance with DIN EN ISO 9001:2000 on February 14, 2001. The QA-handbook is divided into two parts. The first part contains operational (diagnostic and therapeutic) procedures in so-called standard operating procedures (SOP). They describe the indication of procedures as well as the competences and time necessary in a standardized manner. Up to now, more than 70 SOPs have been written as a collaborative approach between technicians and physicians during daily clinical routine after analysing and discussing the procedures. Thus, the results were more clearly defined processes and more satisfied employees. The second part consists of general rules and directions concerning the security of work and equipment as well as radiation protection tasks, hygiene etc. as it is required by the law. This part was written predominantly by the management of the department of nuclear-medicine and the QA-coordinator. Detailed information for the patients, documentation of the work-flows as well as the medical report was adopted to the QM-system. Although in the introduction phase of a QA-system a vast amount of time is necessary, some months later a surplus for the clinical workday will become available. The well defined relations of competences and procedures will result in a gain of time, a reduction of costs and a help to ensure the legal demands. Last but not least, the QA-system simply helps to build up confidence and acceptance both by the patients and the referring physicians.

Nutritional requirements and feeding recommendations for small for gestational age infants.

PubMed

Tudehope, David; Vento, Maximo; Bhutta, Zulfiqar; Pachi, Paulo

2013-03-01

We define the small for gestational age (SGA) infant as an infant born ≥ 35 weeks' gestation and <10th percentile on the Fenton Growth Chart. Policy statements from many organizations recommend mother's own milk for SGA infants because it meets most of their nutritional requirements and provides short- and long-term benefits. Several distinct patterns of intrauterine growth restriction are identified among the heterogeneous grouping of SGA infants; each varies with regard to neonatal morbidities, requirements for neonatal management, postnatal growth velocities, neurodevelopmental progress, and adult health outcomes. There is much we do not know about nutritional management of the SGA infant. We need to identify and define: infants who have "true" growth restriction and are at high risk for adverse metabolic outcomes in later life; optimal growth velocity and "catch-up" growth rates that are conducive with life-long health and well being; global approaches to management of hypoglycemia; and an optimal model for postdischarge care. Large, rigorously conducted trials are required to determine whether aggressive feeding of SGA infants results in improved nutritional rehabilitation, growth, and neurodevelopmental outcomes. Before birth, maternal supplementation with specific nutrients reduces the rate and severity of growth restriction and may prevent nutrient deficiency states if infants are born SGA. After birth, the generally accepted goal is to provide enough nutrients to achieve postnatal growth similar to that of a normal fetus. In addition, we recommend SGA infants be allowed to "room in" with their mothers to promote breastfeeding, mother-infant attachment, and skin-to-skin contact to assist with thermoregulation. Crown Copyright © 2013. Published by Mosby, Inc. All rights reserved.

A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM.

PubMed

Tyberg, Amy; Seewald, Stefan; Sharaiha, Reem Z; Martinez, Guadalupe; Desai, Amit P; Kumta, Nikhil A; Lambroza, Arnon; Sethi, Amrita; Reavis, Kevin M; DeRoche, Ketisha; Gaidhane, Monica; Talbot, Michael; Saxena, Payal; Zamarripa, Felipe; Barret, Maximilien; Eleftheriadis, Nicholas; Balassone, Valerio; Inoue, Haruhiro; Kahaleh, Michel

2017-06-01

Per-oral endoscopic myotomy (POEM) has become an accepted treatment for patients with achalasia. Despite its excellent efficacy rate of greater than 80%, a small percentage of patients remain symptomatic after the procedure. Limited data exist as to the best management for recurrence of symptoms after POEM. We present the first international, multicenter experience on the efficacy and safety of a repeat POEM in the management of achalasia. Patients who underwent a redo POEM from 15 centers in 9 countries were included in a dedicated registry. Technical success was defined as successful completion of a second myotomy. Clinical success was defined as an Eckardt score of less than or equal to 3 after the second myotomy. Adverse events including anesthesia-related, operative, and postoperative adverse events were recorded. Forty-six patients were included in the study. The average age was 49.3 ± 16.78 years. Twenty (45%) patients were male. The mean pre-redo-POEM Eckardt score was 4.3 ± 2.48. Technical success was achieved in 46 (100%) patients. Clinical success was achieved in 41 patients (85%). The average post-POEM Eckardt score was 1.64 ± 1.67, with a significant difference of 2.58 (P < .00001). Eight patients (17%) had adverse events consisting of procedural bleeding, all managed endoscopically. There were no deaths. No POEMs were aborted or required surgical conversion or assistance. For patients with persistent symptoms after POEM, repeat POEM appears to be an efficacious and safe technique. Further randomized trials comparing redo POEM versus Heller should be considered. (Clinical trial registration number: NCT02162589.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

75 FR 36153 - Surety Companies Acceptable on Federal Bonds-Terminations: Victore Insurance Company

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... DEPARTMENT OF THE TREASURY Fiscal Service Surety Companies Acceptable on Federal Bonds--Terminations: Victore Insurance Company AGENCY: Financial Management Service, Fiscal Service, Department of the... issued by the Treasury to the above-named company under 31 U.S.C. 9305 to qualify as acceptable surety on...

28 CFR 549.65 - Refusal to accept treatment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Refusal to accept treatment. 549.65 Section 549.65 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.65 Refusal to accept treatment. (a) When, as a result of...

Gender Differences in the Determinants of the Willingness to Accept an International Assignment

ERIC Educational Resources Information Center

van der Velde, Mandy E. G.; Bossink, Carin J. H.; Jansen, Paul G. W.

2005-01-01

Multinational organisations experience difficulties in finding managers willing to accept international assignments. This study has therefore focused on factors that can predict males' and females' willingness to accept international assignments, or to follow their partners on international assignments. Hypotheses were formulated based on the…

48 CFR 245.105 - Contractors' property management system compliance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... management system compliance. 245.105 Section 245.105 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE CONTRACT MANAGEMENT GOVERNMENT PROPERTY General 245.105 Contractors' property management system compliance. (a) Definitions— (1) Acceptable property management system...

The Indicator Performance Estimate (IPE) Approach to Defining Acceptable Conditions in Wilderness

Treesearch

Steven Hollenhorst; Lisa Stull-Gardner

1992-01-01

Using data from a study conducted in the Cranberry Wilderness area, this paper describes how the Importance-Performance approach can be used to prioritize wilderness indicators and determine how much change from the pristine is acceptable. The approach uses two key types of information: (1) indicator importance, or visitor opinion as to which wilderness indicators have...

41 CFR 304-6.9 - Does acceptance by OGE of the Standard Form (SF) 326 constitute a determination by OGE that the...

Code of Federal Regulations, 2011 CFR

2011-07-01

... or a concurrence by OGE in the agency's conflict of interest analysis? 304-6.9 Section 304-6.9 Public Contracts and Property Management Federal Travel Regulation System PAYMENT OF TRAVEL EXPENSES FROM A NON... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false Does acceptance by OGE...

41 CFR 304-5.1 - When may we accept payment from a non-Federal source for travel to a meeting or authorize an...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false When may we accept... our behalf? 304-5.1 Section 304-5.1 Public Contracts and Property Management Federal Travel Regulation System PAYMENT OF TRAVEL EXPENSES FROM A NON-FEDERAL SOURCE AGENCY REQUIREMENTS 5-AGENCY RESPONSIBILITIES...

Technical Handbook for Facilities Engineering and Construction Manual, Part 2: Federally Assisted Activities. Guide for Project Applicants-Construction Management Services. Department Technical Handbook Series.

ERIC Educational Resources Information Center

Department of Health , Education, and Welfare, Washington., DC. Office of the Secretary.

This handbook provides a basis for consideration of acceptable approaches which are available and may be used to initiate the use of construction management services in the planning, design, and construction of federally assisted construction projects. It includes the mandatory federal requirements as well as acceptable procedures for selecting…

An investigation of the efficacy of acceptance-based behavioral therapy for academic procrastination.

PubMed

Glick, Debra M; Orsillo, Susan M

2015-04-01

Procrastination among college students is both prevalent and troublesome, harming both academic performance and physical health. Unfortunately, no "gold standard" intervention exists. Research suggests that psychological inflexibility may drive procrastination. Accordingly, interventions using acceptance and mindfulness methods to increase psychological flexibility may decrease procrastination. This study compared time management and acceptance-based behavioral interventions. College students' predictions of how much assigned reading they should complete were compared to what they did complete. Procrastination, anxiety, psychological flexibility, and academic values were also measured. Although a trend suggested that time management intervention participants completed more reading, no group differences in procrastination were revealed. The acceptance-based behavioral intervention was most effective for participants who highly valued academics. Clinical implications and future research are discussed. (c) 2015 APA, all rights reserved).

Associations between body weight status, psychological well-being and disordered eating with intuitive eating among Malaysian undergraduate university students.

PubMed

Gan, Wan Ying; Yeoh, Wei Ching

2017-09-13

Intuitive eating, which can be defined as reliance on physiological hunger and satiety cues to guide eating, has been proposed as a healthy weight management strategy. To date, there has not been a published study on intuitive eating in the context of Malaysia. Therefore, this cross-sectional study aims to determine associations between body weight status, psychological well-being and disordered eating behaviors with intuitive eating among undergraduate university students. A total of 333 undergraduate respondents (21.3% males and 78.7% females) from three randomly selected faculties in a public university in Malaysia participated in this study. Respondents completed a self-administered questionnaire which featured socio-demographic characteristics, intuitive eating, self-esteem, body appreciation, general unconditional acceptance, body acceptance by others, body function and disordered eating. Body weight, height, body fat percentage and waist circumference were measured. The results from this study revealed that there was no difference (t = 0.067, p = 0.947) in intuitive eating scores between males (75.69 ± 7.16) and females (75.62 ± 7.90). Multiple linear regression results have shown that body appreciation (β = 0.385, p < 0.001) and disordered eating (β = -0.168, p = 0.001) were significant predictors of intuitive eating, which accounted for 19.6% of the variance in intuitive eating. Health promotion programs should highlight the importance of enhancing body appreciation and preventing disordered eating behaviors among university students in order to promote intuitive eating as one of the healthy weight management approaches.

[Defining of wheat growth management zones based on remote sensing and geostatistics].

PubMed

Huang, Yan; Zhu, Yan; Ma, Meng-Li; Wang, Hang; Cao, Wei-Xing; Tian, Yong-Chao

2011-02-01

Taking the winter wheat planting areas in Rugao City and Haian County of Jiangsu Province as test objects, the clustering defining of wheat growth management zones was made, based on the spatial variability analysis and principal component extraction of the normalized difference vegetation index (NDVI) data calculated from the HJ-1A/B CCD images (30 m resolution) at different growth stages of winter wheat, and of the soil nutrient indices (total nitrogen, organic matter, available phosphorus, and available potassium). The results showed that the integration of the NDVI at heading stage with above-mentioned soil nutrient indices produced the best results of wheat growth management zone defining, with the variation coefficients of NDVI and soil nutrient indices in each defined zone ranged in 4.5% -6.1% and 3.3% -87.9%, respectively. However, the variation coefficients were much larger when the wheat growth management zones were defined individually by NDVI or by soil nutrient indices, suggesting that the newly developed defining method could reduce the variability within the defined management zones and improve the crop management precision, and thereby, contribute to the winter wheat growth management and process simulation at regional scale.

Addressing social aspects associated with wastewater treatment facilities

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

Padilla-Rivera, Alejandro; Morgan-Sagastume, Juan Manuel; Noyola, Adalberto

In wastewater treatment facilities (WWTF), technical and financial aspects have been considered a priority, while other issues, such as social aspects, have not been evaluated seriously and there is not an accepted methodology for assessing it. In this work, a methodology focused on social concerns related to WWTF is presented. The methodology proposes the use of 25 indicators as a framework for measuring social performance to evaluate the progress in moving towards sustainability. The methodology was applied to test its applicability and effectiveness in two WWTF in Mexico (urban and rural). This evaluation helped define the key elements, stakeholders andmore » barriers in the facilities. In this context, the urban facility showed a better overall performance, a result that may be explained mainly by the better socioeconomic context of the urban municipality. Finally, the evaluation of social aspects using the semi-qualitative approach proposed in this work allows for a comparison between different facilities and for the identification of strengths and weakness, and it provides an alternative tool for achieving and improving wastewater management. - Highlights: • The methodology proposes 25 indicators as a framework for measuring social performance in wastewater treatment facilities. • The evaluation helped to define the key elements, stakeholders and barriers in the wastewater treatment facilities. • The evaluation of social aspects allows the identification of strengths and weakness for improving wastewater management. • It provides a social profile of the facility that highlights the best and worst performances.« less

Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management12

PubMed Central

Vanhauwaert, Erika; Matthys, Christophe; Verdonck, Lies; De Preter, Vicky

2015-01-01

Recently, low-residue diets were removed from the American Academy of Nutrition and Dietetics’ Nutrition Care Manual due to the lack of a scientifically accepted quantitative definition and the unavailability of a method to estimate the amount of food residue produced. This narrative review focuses on defining the similarities and/or discrepancies between low-residue and low-fiber diets and on the diagnostic and therapeutic values of these diets in gastrointestinal disease management. Diagnostically, a low-fiber/low-residue diet is used in bowel preparation. A bowel preparation is a cleansing of the intestines of fecal matter and secretions conducted before a diagnostic procedure. Therapeutically, a low-fiber/low-residue diet is part of the treatment of acute relapses in different bowel diseases. The available evidence on low-residue and low-fiber diets is summarized. The main findings showed that within human disease research, the terms “low residue” and “low fiber” are used interchangeably, and information related to the quantity of residue in the diet usually refers to the amount of fiber. Low-fiber/low-residue diets are further explored in both diagnostic and therapeutic situations. On the basis of this literature review, the authors suggest redefining a low-residue diet as a low-fiber diet and to quantitatively define a low-fiber diet as a diet with a maximum of 10 g fiber/d. A low-fiber diet instead of a low-residue diet is recommended as a diagnostic value or as specific therapy for gastrointestinal conditions. PMID:26567203

40 CFR 63.1323 - Batch process vents-methods and procedures for group determination.

Code of Federal Regulations, 2014 CFR

2014-07-01

... accepted chemical engineering principles, measurable process parameters, or physical or chemical laws or... paragraph (b)(5) of this section. Engineering assessment may be used to estimate emissions from a batch... defined in paragraph (b)(5) of this section, through engineering assessment, as defined in paragraph (b)(6...

40 CFR 63.1323 - Batch process vents-methods and procedures for group determination.

Code of Federal Regulations, 2011 CFR

2011-07-01

... accepted chemical engineering principles, measurable process parameters, or physical or chemical laws or... paragraph (b)(5) of this section. Engineering assessment may be used to estimate emissions from a batch... defined in paragraph (b)(5) of this section, through engineering assessment, as defined in paragraph (b)(6...

40 CFR 63.1323 - Batch process vents-methods and procedures for group determination.

Code of Federal Regulations, 2013 CFR

2013-07-01

... accepted chemical engineering principles, measurable process parameters, or physical or chemical laws or... paragraph (b)(5) of this section. Engineering assessment may be used to estimate emissions from a batch... defined in paragraph (b)(5) of this section, through engineering assessment, as defined in paragraph (b)(6...

40 CFR 63.1323 - Batch process vents-methods and procedures for group determination.

Code of Federal Regulations, 2012 CFR

2012-07-01

... accepted chemical engineering principles, measurable process parameters, or physical or chemical laws or... paragraph (b)(5) of this section. Engineering assessment may be used to estimate emissions from a batch... defined in paragraph (b)(5) of this section, through engineering assessment, as defined in paragraph (b)(6...

41 CFR 304-2.1 - What definitions apply to this chapter?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulation System PAYMENT OF TRAVEL EXPENSES FROM A NON-FEDERAL SOURCE EMPLOYEE'S ACCEPTANCE OF PAYMENT FROM... chapter? The following definitions apply to this chapter: Employee means an appointed officer or employee of an executive agency as defined in 5 U.S.C. 105, including a special Government employee as defined...

41 CFR 304-2.1 - What definitions apply to this chapter?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulation System PAYMENT OF TRAVEL EXPENSES FROM A NON-FEDERAL SOURCE EMPLOYEE'S ACCEPTANCE OF PAYMENT FROM... chapter? The following definitions apply to this chapter: Employee means an appointed officer or employee of an executive agency as defined in 5 U.S.C. 105, including a special Government employee as defined...

PACS: acceptance test, quality control, warranty, and maintenance continuum

NASA Astrophysics Data System (ADS)

Romlein, John R.; Norton, Gary S.; Lyche, David K.; Richardson, Ronald R., Jr.

1999-07-01

As PACS gain greater acceptance and use in medical facilities the question of life cycle management must be addressed in terms that relate to the common business practices for medical information system and medical devices. The issues in life cycle management of such a system are relatively new to the industry. Increased use of PACS within the medical community requires that standardized life cycle management practices by developed and implemented. This paper develops a new of life cycle issues as cyclic and related events that are not only manageable, but also predictable in terms, of, frequency, duration data content, data exchange, potential outcomes, staffing requirement, documentation, and staff interaction. This view is presented as a continuum that begins at the acceptance testing of a PACS and continues throughout its life cycle. The continuum incorporates the required relationship between quality control testing and maintenance actions during warranty period and the maintenance years. Interrelated cyclic events are described that bind these processes together and provide a basis for long-term proactive management of PACS in a medical environment.

The brain injury case management taxonomy (BICM-T); a classification of community-based case management interventions for a common language.

PubMed

Lukersmith, Sue; Fernandez, Ana; Millington, Michael; Salvador-Carulla, Luis

2016-04-01

Case management is a complex intervention. Complexity arises from the interaction of different components: the model (theoretical basis), implementation context (service), population and health condition, focus for the intervention (client and/or their family), case manager's actions (interventions) and the target of case management (integrated care and support, client's community participation). There is a lack of understanding and a common language. To our knowledge there is no classification (taxonomy) for community-based case management. To develop a community-based case management in brain injury taxonomy (BICM-T), as a common language and understanding of case management for use in quality analysis, policy, planning and practice. The mixed qualitative methods used multiple sources of knowledge including scoping, framing and a nominal group technique to iteratively develop the Beta version (draft) of the taxonomy. A two part developmental evaluation involving case studies and mapping to international frameworks assessed the applicability and acceptability (feasibility) before finalization of the BICM-T. The BICM-T includes a definition of community-based case management, taxonomy trees, tables and a glossary. The interventions domain tree has 9 main actions (parent category): engagement, holistic assessment, planning, education, training and skills development, emotional and motivational support, advising, coordination, monitoring; 17 linked actions (children category); 8 related actions; 63 relevant terms defined in the glossary. The BICM-T provides a knowledge map with the definitions and relationships between the core actions (interventions domain). Use of the taxonomy as a common language will benefit practice, quality analysis, evaluation, policy, planning and resource allocation. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Practice Management: The Game Changer

PubMed Central

Pessis, Paul

2016-01-01

The reimbursement landscape is undergoing significant changes. Practice management, which encompasses reimbursement, is becoming increasingly more important in securing business success. Each practitioner within a facility is responsible for fortifying the practice through thoughtful business protocols. Knowing legislation that impacts health care along with understanding the foundational components of reimbursement is key for keeping a practice financially healthy. Change is good, but making the changes is what counts! Legislation such as the Medicare Access and Chip Reauthorization Act defines the new payment models. Correcting current business practices might seem difficult on the surface, but implementing change is rewarding and an obligation of the practitioners within a facility to their patients. Financial stability for a practice occurs when sound business practices are routine. Today's audiologist must not only be proficient at performing his or her scope of practice, but must also accept that performing best business practices is part of the job. In the end, the patients seeking the services of the audiologist benefit most when a practice has the financial stability to be best in its class. PMID:28028326

Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: A prospective Japanese multicenter study

PubMed Central

Sasaki, Reina; Sakai, Yuji; Tsuyuguchi, Toshio; Nishikawa, Takao; Fujimoto, Tatsuya; Mikami, Shigeru; Sugiyama, Harutoshi; Yokosuka, Osamu

2016-01-01

AIM: To determine the safety and efficacy of endoscopic duodenal stent placement in patients with malignant gastric outlet obstruction. METHODS: This prospective, observational, multicenter study included 39 consecutive patients with malignant gastric outlet obstruction. All patients underwent endoscopic placement of a nitinol, uncovered, self-expandable metal stent. The primary outcome was clinical success at 2 wk after stent placement that was defined as improvement in the Gastric Outlet Obstruction Scoring System score relative to the baseline. RESULTS: Technical success was achieved in all duodenal stent procedures. Procedure-related complications occurred in 4 patients (10.3%) in the form of mild pneumonitis. No other morbidities or mortalities were observed. The clinical success rate was 92.3%. The mean survival period after stent placement was 103 d. The mean period of stent patency was 149 d and the patency remained acceptable for the survival period. Stent dysfunction occurred in 3 patients (7.7%) on account of tumor growth. CONCLUSION: Endoscopic management using duodenal stents for patients with incurable malignant gastric outlet obstruction is safe and improved patients’ quality of life. PMID:27076769

Guidelines to implement quality management systems in microbiology laboratories for tissue banking.

PubMed

Vicentino, W; Rodríguez, G; Saldías, M; Alvarez, I

2009-10-01

Human tissues for implants are a biomedical product that is being used more frequently by many medical disciplines. There are infections in the patients related to the implanted tissues. The early detection of infections transmitted by blood and the microbiological study of tissues before their clinical use are strategies in tissue banks to prevent these situations. This work sought to contribute to establish the bases for the operation of a laboratory applied to the microbiological quality control of tissues. Based on classical microbiological principles, we defined the operation of microbiological control and tissues sterilization since 2003. We determine lists of acceptable microorganisms for every tissue, criteria for the interpretation of results, and a diagnostic algorithm of microbiological quality. We observed that the circumstances of donor death can be a determinant of the quality. The environment and the operator should be investigated as probable sources of contamination in outbreaks. The criteria of work based on a solid methodology must help to avoid the transmission of infections between donor and recipient. This is a critical point in the quality management of a tissue bank.

[Hi-Fi simulation: Teaching crisis resource management to surgery residents].

PubMed

Georgescu, Mihai; Tanoubi, Issam; Drolet, Pierre; Robitaille, Arnaud; Perron, Roger; Patenaude, Jean Victor

2015-02-01

High-fidelity (HiFi) simulation has shown its effectiveness for teaching crisis resource management (CRM) principles, and our institutional experience in this area is mainly with anesthesiology residents. We recently added to our postgraduate curriculum a new CRM course designed to cater to the specific needs of surgical residents. This short communication describes the experience of the University of Montreal Simulation Centre (Centre d'Apprentissage des Attitudes et Habiletés Cliniques CAAHC) regarding HiFi simulationbased CRM and communication skills teaching for surgical residents. Thirty residents agreed to participate in a simulation course with pre-established scenarios and educational CRM objectives on a voluntary basis. When surveyed immediately after the activity, all residents agreed that the educational objectives were well defined (80% "strongly agree" and 20% "agree"). The survey also showed that the course was well accepted by all participants (96% "strongly agree" and 4% "agree"). Further trials with randomized groups and more reliable assessment tools are needed to validate our results. Still, integrating HiFi simulation based CRM learning in the surgical residency curriculum seems like an interesting step.

A flight management algorithm and guidance for fuel-conservative descents in a time-based metered air traffic environment: Development and flight test results

NASA Technical Reports Server (NTRS)

Knox, C. E.

1984-01-01

A simple airborne flight management descent algorithm designed to define a flight profile subject to the constraints of using idle thrust, a clean airplane configuration (landing gear up, flaps zero, and speed brakes retracted), and fixed-time end conditions was developed and flight tested in the NASA TSRV B-737 research airplane. The research test flights, conducted in the Denver ARTCC automated time-based metering LFM/PD ATC environment, demonstrated that time guidance and control in the cockpit was acceptable to the pilots and ATC controllers and resulted in arrival of the airplane over the metering fix with standard deviations in airspeed error of 6.5 knots, in altitude error of 23.7 m (77.8 ft), and in arrival time accuracy of 12 sec. These accuracies indicated a good representation of airplane performance and wind modeling. Fuel savings will be obtained on a fleet-wide basis through a reduction of the time error dispersions at the metering fix and on a single-airplane basis by presenting the pilot with guidance for a fuel-efficient descent.

In the time of significant generational diversity - surgical leadership must step up!

PubMed

Money, Samuel R; O'Donnell, Mark E; Gray, Richard J

2014-02-01

The diverse attitudes and motivations of surgeons and surgical trainees within different age groups present an important challenge for surgical leaders and educators. These challenges to surgical leadership are not unique, and other industries have likewise needed to grapple with how best to manage these various age groups. The authors will herein explore management and leadership for surgeons in a time of age diversity, define generational variations within "Baby-Boomer", "Generation X" and "Generation Y" populations, and identify work ethos concepts amongst these three groups. The surgical community must understand and embrace these concepts in order to continue to attract a stellar pool of applicants from medical school. By not accepting the changing attitudes and motivations of young trainees and medical students, we may disenfranchise a high percentage of potential future surgeons. Surgical training programs will fill, but will they contain the highest quality trainees? Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

"Cure" for multiple sclerosis (MS)-Evolving views of therapy goals in patients on different stages of the disease: A pilot study in a cohort of Polish MS patients.

PubMed

Chacińska, Weronika; Brzostowska, Marta; Nojszewska, Monika; Podlecka-Piętowska, Aleksandra; Jędrzejczak, Wiesław W; Snarski, Emilian

2017-06-01

New aggressive treatments promise improvement of results in the treatment of multiple sclerosis (MS), however, with high risk of serious complications. In this study, we analyzed patients' acceptance for risks connected with the MS treatment. The study was designed as a prospective nonanonymous online questionnaire. Responders were asked about the definition of the "cure" for MS and crucial goals in the treatment. One hundred and eighty patients filled in the questionnaire (129 women and 51 men), and the mean age was 33 years ( SD  = 10.29). The MS forms were as follows: relapsing-remitting (65%), secondary progressive (14%), primary progressive (10%), and other (11%), with mean EDSS score of 3 points ( SD  = 2.6). For 50% of the patients, relief of symptoms such as fatigue (72%), paresis (66%), and balance disorders (65%) was synonymous with "cure." The patients with faster progression of the disease were likely to accept risky "curative" treatments-with average 68% accepted mortality risk ( p  = .003). Over 81% of patients accepted mortality rates over 1% for the treatment that achieves self-defined cure. The study shows that the MS patients are likely to accept even very risky treatments as long as they promise patient-defined "cure."

Acceptability of rapid diagnostic test-based management of Malaria among caregivers of under-five children in rural Ghana.

PubMed

Baiden, Frank; Owusu-Agyei, Seth; Okyere, Eunice; Tivura, Mathilda; Adjei, George; Chandramohan, Daniel; Webster, Jayne

2012-01-01

WHO now recommends test-based management of malaria (TBMM) across all age-groups. This implies artemisinin-based combination treatment (ACT) should be restricted to rapid diagnostic test (RDT)-positive cases. This is a departure from what caregivers in rural communities have been used to for many years. We conducted a survey among caregivers living close to 32 health centres in six districts in rural Ghana and used logistic regression to explore factors likely to influence caregiver acceptability of RDT based case management and concern about the denial of ACT on account of negative RDT results. Focus group discussions were conducted to explain the quantitative findings and to elicit further factors. A total of 3047 caregivers were interviewed. Nearly all (98%) reported a preference for TBMM over presumptive treatment. Caregivers who preferred TBMM were less likely to be concerned about the denial of ACT to their test-negative children (O.R. 0.57, 95%C.I. 0.33-0.98). Compared with caregivers who had never secured national health insurance cover, caregivers who had valid (adjusted O.R. 1.30, 95% CI 1.07-1.61) or expired (adjusted O.R. 1.38, 95% CI 1.12-1.73) insurance cover were more likely to be concerned about the denial of ACT to their RDT-negative children. Major factors that promote TBMM acceptability include the perception that a blood test at health centre level represents improvement in the quality of care, leads to improvement in treatment outcomes, and offers opportunity for better communication between health workers and caregivers. Acceptability is also enhanced by engaging caregivers in the procedures of the test. Apprehensions about negative health worker attitude could however undermine acceptance. Test (RDT)-based management of malaria in under-five children is likely to be acceptable to caregivers in rural Ghana. The quality of caregiver-health worker interaction needs to be improved if acceptability is to be sustained.

LIMS user acceptance testing.

PubMed

Klein, Corbett S

2003-01-01

Laboratory Information Management Systems (LIMS) play a key role in the pharmaceutical industry. Thorough and accurate validation of such systems is critical and is a regulatory requirement. LIMS user acceptance testing is one aspect of this testing and enables the user to make a decision to accept or reject implementation of the system. This paper discusses key elements in facilitating the development and execution of a LIMS User Acceptance Test Plan (UATP).

Targeting acceptance in the management of food craving: The mediating roles of eating styles and thought suppression.

PubMed

Coffino, Jaime A; Heiss, Sydney; Hormes, Julia M

2018-04-01

Food craving is now widely considered to be a cognitively motivated state. Acceptance-based treatments are effective in reducing the adverse impact of food cravings on consumption, via a hypothesized decrease in experiential avoidance. The mechanisms that drive the success of acceptance-based management of craving remain to be empirically tested. This study examined the role of eating styles and thought suppression as mediators in the relationship between experiential avoidance and craving. Participants (n = 298, 51.5% female) completed the Food Craving Acceptance and Awareness Questionnaire (FAAQ), the Dutch Eating Behavior Questionnaire (DEBQ), the White Bear Suppression Inventory (WBSI; a measure of thought suppression), and the reduced version of the Food Craving Questionnaire- Trait (FCQ-T-r). Scores on the FAAQ were inversely associated with scores on the FCQ-T-r, DEBQ, and WBSI; FCQ-T-r scores were positively correlated with scores on the DEBQ and WBSI (all p < 0.001). The total indirect effect of acceptance on craving through the hypothesized mediators was significantly different from zero. Controlling for eating styles and thought suppression, acceptance remained a significant predictor of craving. Results thus provide initial evidence that eating styles and thought suppression mediate the relationship between food-specific experiential avoidance and food craving. Findings lay the foundation for future study of the proximal antecedents of food cravings and lend preliminary support for targeting thought suppression and eating styles in acceptance-based approaches to the management of craving. Copyright © 2018 Elsevier Ltd. All rights reserved.

Acceptance and expressed emotion in Mexican American caregivers of relatives with schizophrenia.

PubMed

Dorian, Marina; Ramírez García, Jorge I; López, Steven R; Hernández, Brenda

2008-06-01

The relation between Expressed Emotion (EE) and caregiver acceptance was tested with the use of video-recorded interactions between 31 Mexican American family caregivers and their relatives with schizophrenia. Borrowing the concept from Integrative Behavioral Couple Therapy, acceptance was defined as caregiver's engagement with the ill relative along with low levels of expectations for behavioral change. Three aspects of caregiver acceptance were measured: global acceptance of the patient, unified detachment (i.e., nonblaming but engaged problem discussion), and low aversive responses to patient behavior (e.g., criticisms and demanding change). Relative to high EE caregivers, low EE caregivers were consistently more accepting of their ill relatives across the three measures of acceptance. Unified detachment was negatively associated with emotional overinvolvement and aversive responses were positively related to criticism. Warmth was not related to acceptance. The findings suggest that the study of acceptance in family caregivers is a heuristic avenue for future research due to its potential to shed light on specifically what family members do in caring for their ill relatives with schizophrenia.

USING CFD TO ANALYZE NUCLEAR SYSTEMS BEHAVIOR: DEFINING THE VALIDATION REQUIREMENTS

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

Richard Schultz

2012-09-01

A recommended protocol to formulate numeric tool specifications and validation needs in concert with practices accepted by regulatory agencies for advanced reactors is described. The protocol is based on the plant type and perceived transient and accident envelopes that translates to boundary conditions for a process that gives the: (a) key phenomena and figures-of-merit which must be analyzed to ensure that the advanced plant can be licensed, (b) specification of the numeric tool capabilities necessary to perform the required analyses—including bounding calculational uncertainties, and (c) specification of the validation matrices and experiments--including the desired validation data. The result of applyingmore » the process enables a complete program to be defined, including costs, for creating and benchmarking transient and accident analysis methods for advanced reactors. By following a process that is in concert with regulatory agency licensing requirements from the start to finish, based on historical acceptance of past licensing submittals, the methods derived and validated have a high probability of regulatory agency acceptance.« less

How Do Severe Constraints Affect the Search Ability of Multiobjective Evolutionary Algorithms in Water Resources?

NASA Astrophysics Data System (ADS)

Clarkin, T. J.; Kasprzyk, J. R.; Raseman, W. J.; Herman, J. D.

2015-12-01

This study contributes a diagnostic assessment of multiobjective evolutionary algorithm (MOEA) search on a set of water resources problem formulations with different configurations of constraints. Unlike constraints in classical optimization modeling, constraints within MOEA simulation-optimization represent limits on acceptable performance that delineate whether solutions within the search problem are feasible. Constraints are relevant because of the emergent pressures on water resources systems: increasing public awareness of their sustainability, coupled with regulatory pressures on water management agencies. In this study, we test several state-of-the-art MOEAs that utilize restricted tournament selection for constraint handling on varying configurations of water resources planning problems. For example, a problem that has no constraints on performance levels will be compared with a problem with several severe constraints, and a problem with constraints that have less severe values on the constraint thresholds. One such problem, Lower Rio Grande Valley (LRGV) portfolio planning, has been solved with a suite of constraints that ensure high reliability, low cost variability, and acceptable performance in a single year severe drought. But to date, it is unclear whether or not the constraints are negatively affecting MOEAs' ability to solve the problem effectively. Two categories of results are explored. The first category uses control maps of algorithm performance to determine if the algorithm's performance is sensitive to user-defined parameters. The second category uses run-time performance metrics to determine the time required for the algorithm to reach sufficient levels of convergence and diversity on the solution sets. Our work exploring the effect of constraints will better enable practitioners to define MOEA problem formulations for real-world systems, especially when stakeholders are concerned with achieving fixed levels of performance according to one or more metrics.

The Development and Acceptability of a Mobile Application for Tracking Symptoms of Heart Failure Among Older Adults.

PubMed

Portz, Jennifer Dickman; Vehovec, Anton; Dolansky, Mary A; Levin, Jennifer B; Bull, Sheana; Boxer, Rebecca

2018-02-01

Heart failure (HF) is common in older adults. With increases in technology use among older adults, mobile applications may provide a solution for older adults to self-manage symptoms of HF. This article discusses the development and acceptability of a HF symptom-tracking mobile application (HF app). The HF app was developed to allow patients to track their symptoms of HF. Thirty (N = 30) older adults completed an acceptability survey after using the mobile app. The survey used Likert items and open-ended feedback questions. Overall, the acceptability feedback from users was positive with participants indicating that the HF app was both easy to use and understand. Participants identified recommendations for improvement including additional symptoms to track and the inclusion of instructions and reminders. HF is common in older adults, and acceptability of mobile apps is of key importance. The HF app is an acceptable tool for older patients with HF to self-manage their symptoms, identify patterns, and changes in symptoms, and ultimately prevent HF readmission.

Research on the full life cycle management system of smart electric energy meter

NASA Astrophysics Data System (ADS)

Chen, Xiangqun; Huang, Rui; Shen, Liman; Guo, Dingying; Xiong, Dezhi; Xiao, Xiangqi; Liu, Mouhai; Renheng, Xu

2018-02-01

At present, China’s smart electric energy meter life management is started from the procurement and acceptance. The related monitoring and management of the manufacturing sector has not yet been carried out. This article applies RFID technology and network cloud platform to full life cycle management system of smart electric energy meters, builds this full life cycle management system including design and manufacturing, process control, measurement and calibration testing, storage management, user acceptance, site operation, maintenance scrap and other aspects. Exploring smart electric energy meters on-line and off-line communication by the application of active RFID communication functions, and the actual functional application such as local data exchange and instrument calibration. This system provides technical supports on power demand side management and the improvement of smart electric energy meter reliability evaluation system.

48 CFR 46.504 - Certificate of conformance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... MANAGEMENT QUALITY ASSURANCE Acceptance 46.504 Certificate of conformance. A certificate of conformance (see... acceptable and any defective work would be replaced, corrected, or repaired without contest. In no case shall...

Relationship between colorimetric (instrumental) evaluation and consumer-defined beef colour acceptability.

PubMed

Holman, Benjamin W B; Mao, Yanwei; Coombs, Cassius E O; van de Ven, Remy J; Hopkins, David L

2016-11-01

The relationship between instrumental colorimetric values (L*, a*, b*, the ratio of reflectance at 630nm and 580nm) and consumer perception of acceptable beef colour was evaluated using a web-based survey and standardised photographs of beef m. longissimus lumborum with known colorimetrics. Only L* and b* were found to relate to average consumer opinions of beef colour acceptability. Respondent nationality was also identified as a source of variation in beef colour acceptability score. Although this is a preliminary study with the findings necessitating additional investigation, these results suggest L* and b* as candidates for developing instrumental thresholds for consumer beef colour expectations. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Hunter perceptions and acceptance of alternative deer management regulations

USGS Publications Warehouse

Cornicelli, L.; Fulton, D.C.; Grund, M.D.; Fieberg, J.

2011-01-01

Wildlife managers are often confronted with a policy paradox where a majority of the public supports an outcome, but there is no agreement on specific management strategies to achieve this outcome. Previous research has also reported a link between regulatory acceptance, hunter satisfaction, and hunter participation rates. Thus, human dimensions research aimed at understanding hunter motivations and behavior is needed for effective management. In 2005, we surveyed Minnesota (USA) deer hunters (n = 6,000; 59% response) to evaluate attitudes regarding alternative deer (Odocoileus virginianus) harvest regulations. We also conducted a series of forced choice experiments in which respondents were asked to select an option from a list of representative regulations that might be adopted to achieve a particular deer management goal. Specifically, we modeled 5 deer population scenarios ranging from low populations with high buck-harvest rates to populations 50% over goal density. Our results indicate that hunters preferred different regulations depending on the population scenario, but generally preferred antler-point restrictions and disliked limiting buck licenses through a lottery. We also found consistency among scenarios, in that a small percentage of respondents indicated they would not hunt if regulations were changed. The results from this study should help wildlife managers design deer harvest regulations that are both acceptable to hunters and achieve management objectives. ?? 2011 The Wildlife Society.

The tidal waves of connected health devices with healthcare applications: consequences on privacy and care management in European healthcare systems.

PubMed

Allaert, Francois-André; Mazen, Noël-Jean; Legrand, Louis; Quantin, Catherine

2017-01-17

The market for Connected Health Devices (CHD) with healthcare applications is growing fast and should be worth several billion euros in turnover in the coming years. Their development will completely transform the organisation of our healthcare system, profoundly change the way patients are managed and revolutionizes disease prevention. The CHD with healthcare applications is a tidal wave that has societal impact calling into question the privacy of patients' personal and healthcare information and its protection in secure systems. Rather than trying to stop the use of CHD, we must channel the wave by clearly examining the advantages versus the risks and threats to the patients, and find counter-measures for implementation. The main difficulty is channeling the wave in a way that is acceptable to CHD developers who otherwise will bypass the rules, even if they can be sued for it. Therefore, it appears necessary to implement guidelines that can be used by all developers, defining the minimum requirement for assuring the security of patient privacy and healthcare management. In European Healthcare Systems, there is an imperative need for establishing security guidelines that CHD producers could use to ensure compliance, so that patient privacy and healthcare management is safeguarded. The aim would be to implement the guidelines a posteriori rather than a priori control so as not to hamper innovation.

Method ranks competing projects by priorities, risk. [A method to help prioritize oil and gas pipeline project goals

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

Moeckel, D.R.

A practical, objective guide for ranking projects based on risk-based priorities has been developed by Sun Pipe Line Co. The deliberately simple system guides decisions on how to allocate scarce company resources because all managers employ the same criteria in weighing potential risks to the company versus benefits. Managers at all levels are continuously having to comply with an ever growing amount of legislative and regulatory requirements while at the same time trying to run their businesses effectively. The system primarily is designed for use as a compliance oversight and tracking process to document, categorize, and follow-up on work concerningmore » various issues or projects. That is, the system consists of an electronic database which is updated periodically, and is used by various levels of management to monitor progress of health, safety, environmental and compliance-related projects. Criteria used in determining a risk factor and assigning a priority also have been adapted and found useful for evaluating other types of projects. The process enables management to better define potential risks and/or loss of benefits that are being accepted when a project is rejected from an immediate work plan or budget. In times of financial austerity, it is extremely important that the right decisions are made at the right time.« less

CTS (Hermes): United States experiments and operations summary

NASA Technical Reports Server (NTRS)

Donoughe, P. L.; Hunczak, H. R.

1977-01-01

The Communications Technology Satellite, launched in January 1976 and embodying the highest power transmitter in a communications satellite, was considered. As a joint program between the U.S. and Canada, close coordination of the two countries was necessitated since the management and control of experiments were done in real time. Criteria used by NASA for acceptance of the United States experiments are noted and acceptance procedures are discussed. The category for each accepted experiment is given. The modus operandi employed for the U.S. experiments in the areas of management, coordination, liaison, and real time operation are described. Some of the highlights associated with satellite utilization are given.

Defining care products to finance health care in the Netherlands.

PubMed

Westerdijk, Machiel; Zuurbier, Joost; Ludwig, Martijn; Prins, Sarah

2012-04-01

A case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the methodology and techniques that were developed and applied in order to define the casemix product structure. The central research question was how to develop a manageable product structure, i.e., a limited set of hospital products, with acceptable cost homogeneity. For this purpose, a data warehouse with approximately 1.5 million patient records from 27 hospitals was build up over a period of 3 years. The data associated with each patient consist of a large number of a priori independent parameters describing the resource utilization in different stages of the treatment process, e.g., activities in the operating theatre, the lab and the radiology department. Because of the complexity of the database, it was necessary to apply advanced data analysis techniques. The full analyses process that starts from the database and ends up with a product definition consists of four basic analyses steps. Each of these steps has revealed interesting insights. This paper describes each step in some detail and presents the major results of each step. The result consists of 687 product groups for 24 medical specialties used for billing purposes.

77 FR 47514 - Management Contracts-Background Investigations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... DEPARTMENT OF THE INTERIOR National Indian Gaming Commission 25 CFR Part 537 Management Contracts... management responsibility for, a management contract, and to update the forms of payment that may be accepted... interest in, or management responsibility for, a management contract for class II gaming, and in the case...

Pluralistic Tensions in Expatriating Managers

ERIC Educational Resources Information Center

Perkins, Stephen J.; Daste, Romain

2007-01-01

Purpose--The purpose of this article is to enhance understanding of influences on interaction between corporate personnel and development specialists and line functions associated with expatriating managers. Line managers are expected to accept greater responsibility for people management and development. But line managers' strategies for managing…

Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease.

PubMed

Ammenwerth, E; Woess, S; Baumgartner, C; Fetz, B; van der Heidt, A; Kastner, P; Modre-Osprian, R; Welte, S; Poelzl, G

2015-01-01

Cardiovascular diseases are the most frequent cause of death in industrialized countries. Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events. The telemonitoring programme MyCor (Myokardinfarkt und Koronarstent Programm in Tirol) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease (CHD). It includes patient education, self-monitoring with goal-setting and feedback, and regular clinical visits. We evaluated the MyCor telemonitoring programme regarding technical feasibility, user acceptance, patient adherence, change in health status, and change in quality of life. A 4½-month study was conducted with two telemonitoring phases and one interim phase. The study comprised patient surveys, standardized assessment of quality of life using the MacNew questionnaire at study entry and after 4 and 18 weeks, analysis of adherence to medication and physical activity during the two telemonitoring phases, and analysis of reached goals regarding health conditions during the telemonitoring phases. Twenty-five patients (mean age: 63 years) participated in the study. Patients showed a high acceptance of the MyCor telemonitoring programme. Patients reported feelings of self-control, motivation for lifestyle changes, and improved quality of life. Adherence to daily measurements was high with 86% and 77% in the two telemonitoring phases. Adherence to medication was also high with up to 87% and 80%. Pre-defined goals for physical activity were reached in up to 86% and 73% of days, respectively. Quality of life improved from 5.5 at study entry to 6.3 at the end (p< 0.01; MacNew questionnaire). Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed. The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients. Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes. Achieving long-term adherence and verifying clinical outcomes, however, remains an open issue. Our findings will promote further studies, addressing different strategies for an optimal mix of patient education, telemonitoring, feedback, and clinical follow-ups.

A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles.

PubMed

Shayeghian, Zeinab; Hassanabadi, Hamidreza; Aguilar-Vafaie, Maria E; Amiri, Parisa; Besharat, Mohammad Ali

2016-01-01

Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles. One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment. After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range. Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in the intensive care unit.

PubMed

Martorella, Géraldine; Boitor, Mădălina; Michaud, Cécile; Gélinas, Céline

2014-01-01

The purpose was to evaluate the acceptability and feasibility of hand massage therapy in the intensive care unit (ICU). Clinical guidelines suggest the use of non-pharmacological interventions for pain management in ICU adults. The results presented are secondary to a pilot RCT evaluating the preliminary effectiveness of hand massage on pain after cardiac surgery. A qualitative descriptive design was used. Acceptability was evaluated using individual interviews with participants in both groups i.e., experimental and control (n = 40). Feasibility was examined using field notes and video recordings. While participants receiving the massage perceived it as appropriate, the control group suggested different dosages of the treatment and body areas targeted. Results also suggest that barriers (e.g. noise, numerous clinical activities) need to be overcome. Increasing staff acceptance, reducing the rest period, involving families, and repeating the treatment are avenues to consider. Building evidence for non-pharmacological pain management in the critical care setting is necessary. Copyright © 2014 Elsevier Inc. All rights reserved.

41 CFR 304-9.2 - May we allow an employee to accept contributions and awards pertaining to training and payments...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May we allow an employee to accept contributions and awards pertaining to training and payments incident to attendance at meetings under this subchapter? 304-9.2 Section 304-9.2 Public Contracts and Property Management Federal Travel Regulation System PAYMENT OF TRAVEL...

Using Social Networking Sites for Teaching and Learning: Students' Involvement in and Acceptance of Facebook® as a Course Management System

ERIC Educational Resources Information Center

Albayrak, Duygu; Yildirim, Zahide

2015-01-01

This study investigates students' involvement in Facebook® as a course management system (CMS), Facebook acceptance, and the relationships between the two. The study used Facebook as a CMS in two freshman courses and employed mixed method as part of an action-research approach. Forty-two students participated in the study, and 12 of those students…

Transfusion-free management of gastrointestinal bleeding: the experience of a bloodless institute.

PubMed

Sharma, Prabin; Barajas, Francisco J; Krishnamoorthy, Parasuram; Campo, Lyna M; Blumenthal, Ezra; Spinnell, Mitchell

2015-03-01

The Institute for Patient Blood Management and Bloodless Medicine at the Englewood Hospital has considerable experience in managing patients with gastrointestinal bleeding who do not accept blood-derived products. We present our data and experience over the last 8 years in managing such patients. There is paucity of data on management and outcomes of gastrointestinal bleeding in patients who do not accept blood-derived products. We performed a retrospective study of patients from 2003 to 2011 presenting with gastrointestinal bleeding who do not accept blood-derived products. Inclusion criteria were either overt bleeding with a presenting hemoglobin (Hb) of <12 g/dL or a decrease in Hb of >1.5 g/dL. Ninety-six patients who met the inclusion criteria were included. Forty-one upper and 48 lower gastrointestinal bleeding sources were identified. Mean Hb was 8.8 g/dL and mean nadir was 6.9 g/dL. Among 37 patients (80.5%) with Hb ≤6.0 g/dL, 30 (81%) survived. Four of 7 patients (57%) with a Hb <3 g/dL survived. The overall mortality rate was 10.4%. In unadjusted logistic regression models, age [1.06 (1.01-1.12 y)], admission to ICU [6.37(1.27-31.9)], and anticoagulation use [6.95 (1.57-30.6)] were associated with increased mortality. Initial Hb [0.68 (0.51-0.92)] and nadir Hb [0.48 (0.29-0.78)] inversely predicted mortality. These results suggest that transfusion-free management of gastrointestinal hemorrhage can be effective with mortality comparable with the general population accepting medically indicated transfusion. Management of these patients is challenging and requires a dedicated multidisciplinary team approach knowledgeable in techniques of blood conservation.

Socioeconomic impact of asthma, chronic obstructive pulmonary disease and asthma-COPD overlap syndrome.

PubMed

Kim, Jinhee; Kim, Young Sam; Kim, Kyungjoo; Oh, Yeon-Mok; Yoo, Kwang Ha; Rhee, Chin Kook; Lee, Jin Hwa

2017-06-01

Asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) is defined as having both features of asthma and COPD, which are airway hyper-responsiveness and incompletely reversible airway obstruction. However, socioeconomic impact of ACOS have not been well appreciated. Adults with available wheezing history and acceptable spirometry were selected from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV) in 2007-2009. Their data were merged with the Korean National Health Insurance claim data. 'Asthma group' was defined as having self-reported wheezing history and FEV 1 /FVC ≥0.7, 'COPD group' was defined as having FEV 1 /FVC <0.7 and no wheezing, 'ACOS group' was defined as having both wheezing and FEV 1 /FVC <0.7, and 'no airway disease (NAD) group' was defined as having no wheezing and FEV 1 /FVC ≥0.7. Among a total of 11,656 subjects, ACOS comprise 2.2%; COPD, 8.4%; asthma, 5.8% and NAD, 83.6%. Total length of healthcare utilization and medical costs of ACOS group was the top among four groups (P<0.001), though inpatient medical cost was the highest in COPD group (P=0.025). Multiple linear regression analyses showed that ACOS group (β=12.63, P<0.001) and asthma group (β=6.14, P<0.001) were significantly associated with longer duration of healthcare utilization and ACOS group (β=350,475.88, P=0.008) and asthma group (β=386,876.81, P<0.001) were associated with higher medical costs. This study demonstrated that ACOS independently influences healthcare utilization after adjusting several factors. In order to utilize limited medical resources efficiently, it may be necessary to find and manage ACOS patients.

Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review

PubMed Central

Kemper, Jessica; Stürmer, Carolina

2017-01-01

Background Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems. Objective This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies. Methods We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs. Results The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or “e-awareness” and intentions to use e-mental health services were weak or inconsistent. Conclusions Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care. PMID:28373153

Development of performance indicators for municipal solid waste management (PIMS): A review.

PubMed

Sanjeevi, V; Shahabudeen, P

2015-12-01

The aim of this paper is to review papers on municipal solid waste management (SWM) systems, especially on performance indicators (PIs), and suggest practical methods to manage the same by administrators. Worldwide, about 4 billion metric tons of solid waste (SW) is generated annually; the management of SW across cities is increasingly getting more complex and the funds available for providing service to citizens are shrinking. Analysis of the non-technical research papers shows that focus areas on SW can be grouped into 18 types, one being PIs. Historically, PIs for municipal SWM (PIMS) commenced with the publication of guidelines by various government agencies, starting in 1969. This was followed by a few benchmarking studies, commencing in 1998, by various international institutions. Many published comparative studies also disseminated good practices across the cities. From the 1990s onwards, research work started defining PIMS. These initiatives by various researchers took multiple dimensions and are reviewed in this paper. In almost all studies, the PIMS is measured in terms of investment decisions, public acceptance levels, social participation and environmental needs. The multiple indicators are complex, however, and managers of cities need simple tools to use. To make it simple, five-factor PIs are arrived at, considering simplicity and covering all the factors. A research agenda is outlined for future directions in the areas of cost reduction, citizens' services, citizen involvement and environmental impact. © The Author(s) 2015.

[Self-acceptance as adaptively resigning the self to low self-evaluation].

PubMed

Ueda, T

1996-10-01

In past studies, the concept of self-acceptance has often been confused with self-evaluation or self-esteem. The purpose of this study was to distinguish these concepts, and operationally define self-acceptance as Carl Rogers proposed: feeling all right toward the self when self-evaluation was low. Self-acceptance as adaptive resignation, a moderating variable, therefore should raise self-esteem of only those people with low self-evaluation. Self-acceptance was measured in the study as affirmative evaluation of own self-evaluation. Two hundred and forty college students, 120 each for men and women, completed a questionnaire of self-evaluative consciousness and self-esteem scales. Results of statistical analyses showed that among subjects with low self-evaluation, the higher self-acceptance, the higher the person's self-esteem. The same relation was not observed among those with high self-evaluation. Thus, it may be concluded that self-acceptance was adaptive resignation, and therefore meaningful to only those with low self-evaluation.

Determinants of telemedicine acceptance in selected public hospitals in Malaysia: clinical perspective.

PubMed

Zailani, Suhaiza; Gilani, Mina Sayyah; Nikbin, Davoud; Iranmanesh, Mohammad

2014-09-01

The purpose of this study is to explore the determinants of telemedicine acceptance in selected public hospitals in Malaysia and to investigate the effect of health culture on the relationship between these determinants and telemedicine acceptance. Data were gathered by means of a survey of physicians and nurses as the main group of users of telemedicine technology from hospitals that are currently using telemedicine technology. The results indicated that government policies, top management support, perception of usefulness and computer self-efficiency have a positive and significant impact on telemedicine acceptance by public hospitals in Malaysia. The results also confirmed the moderating role of health culture on the relationship between government policies as well as perceived usefulness on telemedicine acceptance by Malaysian hospitals. The results are useful for decision-makers as well as managers to recognize the potential role of telemedicine and assist in the process of implementation, adoption and utilization, and, therefore, spread the usage of telemedicine technology in more hospitals in the country.

76 FR 21877 - Environmental Management Advisory Board

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-19

... DEPARTMENT OF ENERGY Environmental Management Advisory Board AGENCY: Department of Energy. ACTION: Notice of call for nominations for appointment to the Environmental Management Advisory Board. SUMMARY... Environmental Management Advisory Board. DATES: Nominations will be accepted through May 13, 2011. ADDRESSES...

The influence of tinnitus acceptance on the quality of life and psychological distress in patients with chronic tinnitus

PubMed Central

Riedl, David; Rumpold, Gerhard; Schmidt, Annette; Zorowka, Patrick G.; Bliem, Harald R.; Moschen, Roland

2015-01-01

Recent findings show the importance of acceptance in the treatment of chronic tinnitus. So far, very limited research investigating the different levels of tinnitus acceptance has been conducted. The aim of this study was to investigate the quality of life (QoL) and psychological distress in patients with chronic tinnitus who reported different levels of tinnitus acceptance. The sample consisted of outpatients taking part in a tinnitus coping group (n = 97). Correlations between tinnitus acceptance, psychological distress, and QoL were calculated. Receiver operating characteristic (ROC) curves were used to calculate a cutoff score for the German “Tinnitus Acceptance Questionnaire” (CTAQ-G) and to evaluate the screening abilities of the CTAQ-G. Independent sample t-tests were conducted to compare QoL and psychological distress in patients with low tinnitus acceptance and high tinnitus acceptance. A cutoff point for CTAQ-G of 62.5 was defined, differentiating between patients with “low-to-mild tinnitus acceptance” and “moderate-to-high tinnitus acceptance.” Patients with higher levels of tinnitus acceptance reported a significantly higher QoL and lower psychological distress. Tinnitus acceptance plays an important role for patients with chronic tinnitus. Increased levels of acceptance are related to better QoL and less psychological distress. PMID:26356381

26 CFR 1.861-4 - Compensation for labor or personal services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... employer as advances or reimbursements for travel expenses incurred on behalf of the employer shall be... apportionment on the time basis, as defined in paragraph (b)(2)(ii)(E) of this section, will be acceptable. (ii... facts and circumstances will be such that an apportionment on a time basis, as defined in paragraph (b...

A Study of Biblical Sources of Management Principles.

DTIC Science & Technology

1976-07-01

to, currently identified and accepted management principles. The remaining five principles found in the Biblical source have definite United States Air Force application and are offered as proposed principles of management .

Management of juvenile idiopathic arthritis: hitting the target.

PubMed

Hinze, Claas; Gohar, Faekah; Foell, Dirk

2015-05-01

The treatment of juvenile idiopathic arthritis (JIA) is evolving. The growing number of effective drugs has led to successful treatment and prevention of long-term sequelae in most patients. Although patients with JIA frequently achieve lasting clinical remission, sustained remission off medication is still elusive for most. Treatment approaches vary substantially among paediatric rheumatologists owing to the inherent heterogeneity of JIA and, until recently, to the lack of accepted and well-evidenced guidelines. Furthermore, many pertinent questions related to patient management remain unanswered, in particular regarding treatment targets, and selection, intensity and sequence of initiation or withdrawal of therapy. Existing JIA guidelines and recommendations do not specify treat-to-target or tight control strategies, in contrast to adult rheumatology in which these approaches have been successful. The concepts of window of opportunity (early treatment to improve long-term outcomes) and immunological remission (abrogation of subclinical disease activity) are also fundamental when defining treatment methodologies. This Review explores the application of these concepts to JIA and their possible contribution to the development of future clinical guidelines or consensus treatment protocols. The article also discusses how diverse forms of standardized, guideline-led care and personalized treatment can be combined into a targeted, patient-centred approach to optimize management strategies for patients with JIA.

An Initial Design of ISO 19152:2012 LADM Based Valuation and Taxation Data Model

NASA Astrophysics Data System (ADS)

Çağdaş, V.; Kara, A.; van Oosterom, P.; Lemmen, C.; Işıkdağ, Ü.; Kathmann, R.; Stubkjær, E.

2016-10-01

A fiscal registry or database is supposed to record geometric, legal, physical, economic, and environmental characteristics in relation to property units, which are subject to immovable property valuation and taxation. Apart from procedural standards, there is no internationally accepted data standard that defines the semantics of fiscal databases. The ISO 19152:2012 Land Administration Domain Model (LADM), as an international land administration standard focuses on legal requirements, but considers out of scope specifications of external information systems including valuation and taxation databases. However, it provides a formalism which allows for an extension that responds to the fiscal requirements. This paper introduces an initial version of a LADM - Fiscal Extension Module for the specification of databases used in immovable property valuation and taxation. The extension module is designed to facilitate all stages of immovable property taxation, namely the identification of properties and taxpayers, assessment of properties through single or mass appraisal procedures, automatic generation of sales statistics, and the management of tax collection, dealing with arrears and appeals. It is expected that the initial version will be refined through further activities held by a possible joint working group under FIG Commission 7 (Cadastre and Land Management) and FIG Commission 9 (Valuation and the Management of Real Estate) in collaboration with other relevant international bodies.

Treatment Acceptability of Behavioral Interventions for Children: An Assessment by Mothers of Children with Disruptive Behavior Disorders.

ERIC Educational Resources Information Center

Jones, Melanie L.; Eyberg, Sheila M.; Adams, Christina D.; Boggs, Stephen R.

1998-01-01

Study assesses the acceptability of six child-management interventions as rated by mothers (N=20) of children referred for treatment for a disruptive-behavior disorder. Positive reinforcement was rated as a more acceptable treatment than response time, time-out, differential attention, overcorrection, and spanking. Results validate findings of…

41 CFR 102-38.290 - What types of payment may we accept?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What types of payment... PROPERTY Completion of Sale Payments § 102-38.290 What types of payment may we accept? You must adopt a payment policy that protects the Government against fraud. Acceptable payments include, but are not...

The Use of a Mobile Learning Management System at an Online University and Its Effect on Learning Satisfaction and Achievement

ERIC Educational Resources Information Center

Shin, Won Sug; Kang, Minseok

2015-01-01

This study investigates online students' acceptance of mobile learning and its influence on learning achievement using an information system success and extended technology acceptance model (TAM). Structural equation modeling was used to test the structure of individual, social, and systemic factors influencing mobile learning's acceptance, and…

Conceptualizing and communicating ecological river restoration: Chapter 2

USGS Publications Warehouse

Jacobson, Robert B.; Berkley, Jim

2011-01-01

We present a general conceptual model for communicating aspects of river restoration and management. The model is generic and adaptable to most riverine settings, independent of size. The model has separate categories of natural and social-economic drivers, and management actions are envisioned as modifiers of naturally dynamic systems. The model includes a decision-making structure in which managers, stakeholders, and scientists interact to define management objectives and performance evaluation. The model depicts a stress to the riverine ecosystem as either (1) deviation in the regimes (flow, sediment, temperature, light, biogeochemical, and genetic) by altering the frequency, magnitude, duration, timing, or rate of change of the fluxes or (2) imposition of a hard structural constraint on channel form. Restoration is depicted as naturalization of those regimes or removal of the constraint. The model recognizes the importance of river history in conditioning future responses. Three hierarchical tiers of essential ecosystem characteristics (EECs) illustrate how management actions typically propagate through physical/chemical processes to habitat to biotic responses. Uncertainty and expense in modeling or measuring responses increase in moving from tiers 1 to 3. Social-economic characteristics are shown in a parallel structure that emphasizes the need to quantify trade-offs between ecological and social-economic systems. Performance measures for EECs are also hierarchical, showing that selection of measures depend on participants’ willingness to accept uncertainty. The general form is of an adaptive management loop in which the performance measures are compared to reference conditions or success criteria and the information is fed back into the decision-making process.

Disability prevention and communication among workers, physicians, employers, and insurers--current models and opportunities for improvement.

PubMed

Pransky, Glenn; Shaw, William; Franche, Renee-Louise; Clarke, Andrew

2004-06-03

To review prevailing models of disability management and prevention with respect to communication, and to suggest alternative approaches. Review of selected articles. Effective disability management and return to work strategies have been the focus of an increasing number of intervention programmes and associated research studies, spanning a variety of worker populations and provider and business perspectives. Although primary and secondary disability prevention approaches have addressed theoretical basis, methods and costs, few identify communication as a key factor influencing disability outcomes. Four prevailing models of disability management and prevention (medical model, physical rehabilitation model, job-match model, and managed care model) are identified. The medical model emphasizes the physician's role to define functional limitations and job restrictions. In the physical rehabilitation model, rehabilitation professionals communicate the importance of exercise and muscle reconditioning for resuming normal work activities. The job-match model relies on the ability of employers to accurately communicate physical job requirements. The managed care model focuses on dissemination of acceptable standards for medical treatment and duration of work absence, and interventions by case managers when these standards are exceeded. Despite contrary evidence for many health impairments, these models share a common assumption that medical disability outcomes are highly predictable and unaffected by either individual or contextual factors. As a result, communication is often authoritative and unidirectional, with workers and employers in a passive role. Improvements in communication may be responsible for successes across a variety of new interventions. Communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective; however, controlled trials are needed.

Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review.

PubMed

Ofman, Joshua J; Badamgarav, Enkhe; Henning, James M; Knight, Kevin; Gano, Anacleto D; Levan, Rebecka K; Gur-Arie, Shoval; Richards, Margaret S; Hasselblad, Vic; Weingarten, Scott R

2004-08-01

To assess the clinical and economic effects of disease management in patients with chronic diseases. Electronic databases were searched for English-language articles from 1987 to 2001. Articles were included if they used a systematic approach to care and evaluated patients with chronic disease, reported objective measurements of the processes or outcomes of care, and employed acceptable experimental or quasi-experimental study designs as defined by the Cochrane Effective Practice and Organization of Care Group. Two reviewers evaluated 16,917 titles and identified 102 studies that met the inclusion criteria. Identified studies represented 11 chronic conditions: depression, diabetes, rheumatoid arthritis, chronic pain, coronary artery disease, asthma, heart failure, back pain, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia. Disease management programs for patients with depression had the highest percentage of comparisons (48% [41/86]) showing substantial improvements in patient care, whereas programs for patients with chronic obstructive pulmonary disease (9% [2/22]) or chronic pain (8% [1/12]) appeared to be the least effective. Of the outcomes more frequently studied, disease management appeared to improve patient satisfaction (71% [12/17]), patient adherence (47% [17/36]), and disease control (45% [33/74]) most commonly and cost-related outcomes least frequently (11% to 16%). Disease management programs were associated with marked improvements in many different processes and outcomes of care. Few studies demonstrated a notable reduction in costs. Further research is needed to understand how disease management can most effectively improve the quality and cost of care for patients with chronic diseases.

Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning.

PubMed

Wouters, S; van Exel, N J A; Rohde, K I M; Vromen, J J; Brouwer, W B F

2017-05-01

Health care systems are challenged in allocating scarce health care resources, which are typically insufficient to fulfil all health care wants and needs. One criterion for priority setting may be the 'acceptable health' approach, which suggests that society may want to assign higher priority to health benefits in people with "unacceptable" than in people with "acceptable" health. A level of acceptable health then serves as a reference point for priority setting. Empirical research has indicated that people may be able and willing to define health states as "unacceptable" or "acceptable", but little attention has been given to the normative implications of evaluating health benefits in relation to a reference level of acceptable health. The current paper aims to address this gap by relating insights from the distributive justice literature, i.e. the sufficientarian literature, to the acceptable health approach, as we argue that these approaches are related. We specifically focus on the implications of an 'acceptability' approach for priority weighting of health benefits, derived from sufficientarian reasoning and debates, and assess the moral implications of such weighting. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effectiveness, cost effectiveness, acceptability and implementation barriers/enablers of chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada: a systematic review of mixed evidence.

PubMed

Reilly, Rachel; Evans, Katharine; Gomersall, Judith; Gorham, Gillian; Peters, Micah D J; Warren, Steven; O'Shea, Rebekah; Cass, Alan; Brown, Alex

2016-04-06

Indigenous peoples in Australia, New Zealand and Canada carry a greater burden of chronic kidney disease (CKD) than the general populations in each country, and this burden is predicted to increase. Given the human and economic cost of dialysis, understanding how to better manage CKD at earlier stages of disease progression is an important priority for practitioners and policy-makers. A systematic review of mixed evidence was undertaken to examine the evidence relating to the effectivness, cost-effectiveness and acceptability of chronic kidney disease management programs designed for Indigenous people, as well as barriers and enablers of implementation of such programs. Published and unpublished studies reporting quantitative and qualitative data on health sector-led management programs and models of care explicitly designed to manage, slow progression or otherwise improve the lives of Indigenous people with CKD published between 2000 and 2014 were considered for inclusion. Data on clinical effectiveness, ability to self-manage, quality of life, acceptability, cost and cost-benefit, barriers and enablers of implementation were of interest. Quantitative data was summarized in narrative and tabular form and qualitative data was synthesized using the Joanna Briggs Institute meta-aggregation approach. Ten studies were included. Six studies provided evidence of clinical effectiveness of CKD programs designed for Indigenous people, two provided evidence of cost and cost-effectiveness of a CKD program, and two provided qualitative evidence of barriers and enablers of implementation of effective and/or acceptable CKD management programs. Common features of effective and acceptable programs were integration within existing services, nurse-led care, intensive follow-up, provision of culturally-appropriate education, governance structures supporting community ownership, robust clinical systems supporting communication and a central role for Indigenous Health Workers. Given the human cost of dialysis and the growing population of people living with CKD, there is an urgent need to draw lessons from the available evidence from this and other sources, including studies in the broader population, to better serve this population with programs that address the barriers to receiving high-quality care and improve quality of life.

Mud, models, and managers: Reaching consensus on a watershed strategy for sediment load reduction

NASA Astrophysics Data System (ADS)

Wilcock, P. R.; Cho, S. J.; Gran, K.; Belmont, P.; Hobbs, B. F.; Heitkamp, B.; Marr, J. D.

2017-12-01

Agricultural nonpoint source sediment pollution is a leading cause of impairment of U.S. waters. Sediment sources are often on private land, such that solutions require not only considerable investment, but broad acceptance among landowners. We present the story of a participatory modeling exercise whose goal was to develop a consensus strategy for reducing sediment loading from the Greater Blue Earth River Basin, a large (9,200 km2) watershed in southern Minnesota dominated by row crop agriculture. The Collaborative for Sediment Source Reduction was a stakeholder group of farmers, industry representatives, conservation groups, and regulatory agencies. We used a participatory modeling approach to promote understanding of the problem, to define the scope of solutions acceptable to farmers, to develop confidence in a watershed model, and to reach consensus on a watershed strategy. We found that no existing watershed model could provide a reliable estimate of sediment response to management actions and developed a purpose-built model that could provide reliable, transparent, and fast answers. Because increased stream flow was identified as an important driver of sediment loading, the model and solutions included both hydrologic and sediment transport components. The model was based on an annual sediment budget with management actions serving to proportionally reduce both sediment sources and sediment delivery. Importantly, the model was developed in collaboration with stakeholders, such that a shared understanding emerged regarding of the modeling challenges and the reliability of information used to strongly constrain model output. The simplicity of the modeling approach supported stakeholder engagement and understanding, thereby lowering the social barrier between expert modeler and concerned stakeholder. The consensus strategy focused on water storage higher in the watershed in order to reduce river discharge and the large supply of sediment from near-channel sources. Because water storage must occur largely on private farmland, this strategy was initially opposed by some stakeholders, such that model simplicity and transparency was essential in reaching a consensus strategy.

Identifying and Developing Women For Management Positions

ERIC Educational Resources Information Center

McCord, Bird

1971-01-01

Organizational attitudes and effective development are key factors in acceptance of women managers. Article examines the development of sex role stereotypes and how they effect the placement of women in management positions. (RB)

EDITORIAL: Greetings from the new Editor-in-Chief

NASA Astrophysics Data System (ADS)

Bhattacharya, P.

2004-04-01

On 1 January, 2004, I assumed the position of Editor-in-Chief of Journal of Physics D: Applied Physics. I will start by saying that I will do my best to justify the confidence of the journal management and publishing staff in my abilities. I was fortunate to have been able to work, as an Editorial Board member, with my predecessor, the previous Editor-in-Chief, Professor Allister Ferguson. Allister has provided a high degree of intellectual stewardship for the journal in the last five years. He has made the job appear a worthy challenge for me. I therefore take this opportunity to thank Allister on behalf of the Editorial Board and publishing staff of the journal. Several other factors contributed to my decision to accept this position. The first is the group of people who actually go about the business of publishing. The Senior Publisher, Nicola Gulley (and her predecessor Sophy Le Masurier); the Managing Editor, Jill Membrey; the Publishing Administrators, Nina Blakesley and Sarah Towell; the Production Editor, Katie Gerrard and their office staff form an amazing group and have managed to make the operation of the journal incredibly efficient. An index of this is the speed with which incoming manuscripts are processed. The average time between the receipt of a manuscript and its web publication, if accepted, is 130 days. This is three to five times shorter than for most other journals. A factor that contributes to this success is a responsive pool of referees that the publishing staff have as a valuable resource. Ultimately, the standard bearers of any journal are the referees. Therefore, a grateful `thank you' is due from all of us at J. Phys. D to all our referees, who diligently perform this honourable task. The Associate Editors of the journal, Professors Lawler, Margaritondo and O'Grady, also provide immense scientific leadership. They help in defining new directions for the journal and in the publishing process. Last, but not least, a remarkable asset of the journal, and a tremendous intellectual resource, is the Editorial Board. The board members are all distinguished scientists and engineers who provide valuable counsel in defining the technical scope of the journal and its management. The members attend the board meetings at least once a year and, as a dynamic group, discuss ways of making the journal better. Most of them, including myself, also publish in J. Phys. D on a regular basis. This is truly a unique feature. So, what do I hope to accomplish during my tenure? I will strive to continue the legacy established by Allister and to look at ways of making a first-rate journal even better. At the heart of this is the quality of papers published. This can be done in several ways: raising the bar for refereeing and acceptance, regular publication of topical clusters and special issues in important areas, and publication of review articles by internationally renowned researchers and academics. In all these areas, the Editorial Board members can play a leading role. While I believe that the present topical scope of the journal is adequate and covers the important areas of applied physics, it is easy to miss out on important emerging areas. Therefore, we will have to keep the scope of the journal under constant scrutiny. Above all, the content of the journal must remain relevant at all times. I look forward to working with the journal's excellent staff, Associate Editors, and the Editorial Board.

The Chronic Disease Self-Management Program: the experience of frequent users of health care services and peer leaders.

PubMed

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

2016-04-01

Large amount of evidence supports the contribution of the Stanford Chronic Disease Self-Management Program (CDSMP) to a global chronic disease management strategy. However, many studies have suggested further exploring of the factors influencing acceptance and completion of participants in this program. This study aimed to describe and examine factors associated with acceptance and completion rates of the CDSMP among frequent users of health care services, and to highlight the experience of patients and peer leaders who facilitated the program. A descriptive design with mixed sequential data was used. Acceptance and completion rates were calculated and their relationship with patient characteristics was examined in regression analysis (n = 167). Interviews were conducted among patients who accepted (n = 11) and refused (n = 13) to participate and with the program coordinator. Focus groups were held with the seven peer leaders who facilitated the program. Data were analysed using thematic analysis. Of the 167 patients invited, 60 (36%) accepted to participate in the program. Group format was the most frequent reason to decline the invitation to participate. Twenty-eight participants (47%) completed the program. Participants who dropped out during the program raised different reasons such as poor health and too much heterogeneity among participants. Factors such as location, schedule, content, group composition and facilitation were considered as important elements contributing to the success of the program. The CDSMP could therefore be considered as a self-management support option for this vulnerable clientele, while taking measures to avoid too much heterogeneity among participants to improve completion rates. © The Author 2016. Published by Oxford University Press.

7 CFR 600.2 - National headquarters.

Code of Federal Regulations, 2010 CFR

2010-01-01

...; accepting departmental leadership for programs for other activities assigned by the Secretary of Agriculture... assist the Chief as follows: (1) Deputy Chief for Management. The Deputy Chief for Management is responsible for policies, guidelines, and standards for management services, human resources management...

77 FR 15091 - Environmental Management Advisory Board

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-14

... DEPARTMENT OF ENERGY Environmental Management Advisory Board AGENCY: Department of Energy. ACTION: Notice of Solicitation of Nominations for Appointment as a member of the Environmental Management... Environmental Management Advisory Board (EMAB). DATES: The deadline for nominations for members will be accepted...

75 FR 68811 - Recovery Publication, P-395, Fire Management Assistance Grant Program (FMAGP) Guide

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2010-0066] Recovery Publication, P-395, Fire Management Assistance Grant Program (FMAGP) Guide AGENCY: Federal... Emergency Management Agency (FEMA) is accepting comments on the Fire Management Assistance Grant Program...

Quality of life and acceptability of medical versus surgical management of early pregnancy failure*

PubMed Central

Harwood, B; Nansel, T

2008-01-01

Objective This study compares quality of life (QOL) and acceptability of medical versus surgical treatment of early pregnancy failure (EPF). Design A randomised clinical trial of treatment for EPF compared misoprostol vaginally versus vacuum aspiration (VA). Setting A multisite trial at four US Urban University Hospitals. Population A total of 652 women with an EPF were randomised to treatment. Methods Participants completed a daily symptom diary and a questionnaire 2 weeks after treatment. Main outcome measures The questionnaire assessment included subscales of the Short Form-36 Health Survey Revised for QOL and measures of wellbeing, recovery difficulties, and treatment acceptability. Results The two groups did not differ in mean scores for QOL except bodily pain; medical treatment was associated with higher levels of bodily pain than VA (P < 0.001). Success of treatment was not related to QOL, but acceptability of the procedure was decreased for medical therapy if unsuccessful (P = 0.003). Type of treatment was not associated with differences in recovery, and the two groups reported similar acceptability except for cramping (P = 0.02), bleeding (P < 0.001), and symptom duration (P = 0.03). Conclusions Despite reporting greater pain and lower acceptability of treatment-related symptoms, QOL and treatment acceptability were similar for medical and surgical treatment of EPF. Acceptability, but not QOL, was influenced by success or failure of medical management. PMID:18271887

Emerging mHealth and eHealth Interventions for Serious Mental Illness: A Review of the Literature

PubMed Central

Naslund, John A.; Marsch, Lisa A.; McHugo, Gregory J.; Bartels, Stephen J.

2016-01-01

Background Serious mental illness is one of the leading causes of disability worldwide. Emerging mobile health (mHealth) and eHealth interventions may afford opportunities for reaching this at-risk group. Aim To review the evidence on using emerging mHealth and eHealth technologies among people with serious mental illness. Methods We searched MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane Central, and Web of Science through July 2014. Only studies reporting outcomes for mHealth or eHealth interventions, defined as remotely delivered using mobile, online, or other devices, targeting people with schizophrenia, schizoaffective disorder, or bipolar disorder, were included. Results Forty-six studies spanning 12 countries were included. Interventions were grouped into four categories: 1) illness self-management and relapse prevention; 2) promoting adherence to medications and/or treatment; 3) psychoeducation, supporting recovery, and promoting health and wellness; and 4) symptom monitoring. The interventions were consistently found to be highly feasible and acceptable, though clinical outcomes were variable but offered insight regarding potential effectiveness. Conclusions Our findings confirm the feasibility and acceptability of emerging mHealth and eHealth interventions among people with serious mental illness; however, it is not possible to draw conclusions regarding effectiveness. Further rigorous investigation is warranted to establish effectiveness and cost benefit in this population. PMID:26017625

Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature.

PubMed

Naslund, John A; Marsch, Lisa A; McHugo, Gregory J; Bartels, Stephen J

2015-01-01

Serious mental illness (SMI) is one of the leading causes of disability worldwide. Emerging mobile health (mHealth) and eHealth interventions may afford opportunities for reaching this at-risk group. To review the evidence on using emerging mHealth and eHealth technologies among people with SMI. We searched MEDLINE, PsychINFO, CINAHL, Scopus, Cochrane Central, and Web of Science through July 2014. Only studies which reported outcomes for mHealth or eHealth interventions, defined as remotely delivered using mobile, online, or other devices, targeting people with schizophrenia, schizoaffective disorder, or bipolar disorder, were included. Forty-six studies spanning 12 countries were included. Interventions were grouped into four categories: (1) illness self-management and relapse prevention; (2) promoting adherence to medications and/or treatment; (3) psychoeducation, supporting recovery, and promoting health and wellness; and (4) symptom monitoring. The interventions were consistently found to be highly feasible and acceptable, though clinical outcomes were variable but offered insight regarding potential effectiveness. Our findings confirm the feasibility and acceptability of emerging mHealth and eHealth interventions among people with SMI; however, it is not possible to draw conclusions regarding effectiveness. Further rigorous investigation is warranted to establish effectiveness and cost benefit in this population.

Acoustics

NASA Technical Reports Server (NTRS)

Goodman, Jerry R.; Grosveld, Ferdinand

2007-01-01

The acoustics environment in space operations is important to maintain at manageable levels so that the crewperson can remain safe, functional, effective, and reasonably comfortable. High acoustic levels can produce temporary or permanent hearing loss, or cause other physiological symptoms such as auditory pain, headaches, discomfort, strain in the vocal cords, or fatigue. Noise is defined as undesirable sound. Excessive noise may result in psychological effects such as irritability, inability to concentrate, decrease in productivity, annoyance, errors in judgment, and distraction. A noisy environment can also result in the inability to sleep, or sleep well. Elevated noise levels can affect the ability to communicate, understand what is being said, hear what is going on in the environment, degrade crew performance and operations, and create habitability concerns. Superfluous noise emissions can also create the inability to hear alarms or other important auditory cues such as an equipment malfunctioning. Recent space flight experience, evaluations of the requirements in crew habitable areas, and lessons learned (Goodman 2003; Allen and Goodman 2003; Pilkinton 2003; Grosveld et al. 2003) show the importance of maintaining an acceptable acoustics environment. This is best accomplished by having a high-quality set of limits/requirements early in the program, the "designing in" of acoustics in the development of hardware and systems, and by monitoring, testing and verifying the levels to ensure that they are acceptable.

An exploratory study investigating children's perceptions of dental behavioural management techniques.

PubMed

Davies, E Bethan; Buchanan, Heather

2013-07-01

Behaviour management techniques (BMTs) are utilised by dentists to aid children's dental anxiety (DA). Children's perceptions of these have been underexplored, and their feedback could help inform paediatric dentistry. To explore children's acceptability and perceptions of dental communication and BMTs and to compare these by age, gender, and DA. A total of sixty-two 9- to 11-year-old school children participated in the study. Children's acceptability of BMTs was quantified using a newly developed Likert scale, alongside exploration of children's experiences and perceptions through interviews. anova and t-tests explored BMT acceptability ratings by age, gender, and DA. Thematic analysis was used to analyse interviews. Statistical analyses showed no effect of age, gender, or DA upon BMT acceptability. Children generally perceived the BMTs as acceptable or neutral; stop signals were the most acceptable, and voice control the least acceptable BMT. Beneficial experiences of distraction and positive reinforcement were common. Children described the positive nature of their dentist's communication and BMT utilisation. Dental anxiety did not affect children's perceptions of BMTs. Children were generally positive about dentist's communication and established BMTs. Children's coping styles may impact perceptions and effectiveness of BMTs and should be explored in future investigations. © 2012 John Wiley & Sons Ltd, BSPD and IAPD.

Modern concepts of caries measurement.

PubMed

Pitts, N B

2004-01-01

Following the consideration of several recent systematic and other reviews, there is a growing professional and scientific consensus that caries measurement methodology in caries clinical trials (CCT) should be updated to reflect progress made elsewhere in cariology. In this paper, therefore, "modern" means accepted in contemporary dental research and dental practice on the basis of sound research evidence--not necessarily new or requiring the use of new technology. Caries measurement should be seen in the context of the objectives of modern clinical caries management and the continuum of disease states, ranging from sub-surface carious changes through to more advanced lesions. Measurement concepts can be applied to at least three levels: the tooth surface, the individual, or the group/population. All are relevant to CCTs. Modern clinical caries management can be seen as comprised of seven discrete but linked steps (Steps 2, 3, and 4 are directly concerned with measurement.): (1) 'Caries detection' represents a yes/no decision as to whether caries is present; (2) lesion measurement assesses defined stages of the caries process, taking into account the histopatholgical morphology and appearance of different sizes and types of lesion and the diagnostic threshold(s) being used; (3) lesion monitoring by repeated measures at a series of examinations is used when lesions are less advanced than the stage judged to require operative intervention (A comparison of serial measurements permits the efficacy of preventive care aiming either to arrest or to reverse the lesion to be assessed.); (4) caries activity measures would be very valuable, but are relatively poorly developed and tested at present; (5) diagnosis, prognosis, and clinical decision-making are the important human processes in which all the information obtained from steps 1 to 4 is synthesised; (6) interventions/treatments, both preventive and operative, are now routinely used for caries management; and (7) outcome of caries control/management assesses caries management by examining evidence on the long-term outcomes. A challenge for the future is to define a range of optimal caries measurement methods--in use or in development in recent trials, in clinical practice, and/or in caries epidemiology--that will best contribute to more efficient, modern caries clinical trials.

Defining International Contracting Terms

DTIC Science & Technology

1994-09-01

compensation so that another nation or company can make a sale or export. The Coca - Cola company refused to accept offsets to break into the lucrative Soviet...Union Market. Their main competitor, Pepsi- Cola , broke into this market 15 years earlier by accepting Stolichnaya vodka as a reciprocal purchase, a... advantages over the other available alternatives (personal interviews or a telephone A-2 survey). While personal interviews offer the advantages of a high

Establishing a proactive safety and health risk management system in the fire service.

PubMed

Poplin, Gerald S; Pollack, Keshia M; Griffin, Stephanie; Day-Nash, Virginia; Peate, Wayne F; Nied, Ed; Gulotta, John; Burgess, Jefferey L

2015-04-19

Formalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service. In this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting. The RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury. As implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.

Guidelines for developing transportation management plans in Virginia.

DOT National Transportation Integrated Search

2005-01-01

A transportation management plan (TMP) is a comprehensive program of traffic control, communication, operation, and demand management strategies designed to maintain acceptable levels of traffic flow in work zones. A systematic procedure and/or check...

7 CFR 1485.21 - Financial management.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Financial management. 1485.21 Section 1485.21.... AGRICULTURAL COMMODITIES Market Access Program § 1485.21 Financial management. (a) A MAP Participant shall implement and maintain a financial management system that conforms to generally accepted accounting...

38 CFR 61.66 - Financial management.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Financial management. 61...) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.66 Financial management. (a) All recipients... management system that follows generally accepted accounting principals and provides accounting records...

38 CFR 61.66 - Financial management.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Financial management. 61...) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.66 Financial management. (a) All recipients... management system that follows generally accepted accounting principals and provides accounting records...

41 CFR 109-27.202 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... more suitable, designated contractors may use other generally accepted approaches to the management of... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Applicability. 109-27.202 Section 109-27.202 Public Contracts and Property Management Federal Property Management...

41 CFR 109-27.202 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-07-01

... more suitable, designated contractors may use other generally accepted approaches to the management of... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Applicability. 109-27.202 Section 109-27.202 Public Contracts and Property Management Federal Property Management...

Written advice can provide a safe and acceptable alternative to new patient assessment for selected referrals to haematologists.

PubMed

Ganly, Peter S; Keeman, Helen; Spearing, Ruth L; Smith, Mark P; Patton, Nigel; Merriman, Eileen G; Gibbons, Steve S

2008-01-07

To measure the safety and acceptability of providing written advice (WA) for selected patients referred to a haematology service, as an alternative to inpatient or outpatient assessment. Review of the initial management and subsequent course of patients newly referred to a tertiary referral hospital in Christchurch, New Zealand, between 16 October 2003 and 8 June 2006. Structured questionnaires were sent to all referring doctors and patients recently managed with WA. Numbers and diagnoses of patients managed with WA, early assessment or delayed assessment; re-referral and treatment details; characteristics of WA letters; and opinions of referring doctors and their patients on the WA process. 26% of new referrals (714/2785) were managed with prompt WA, while 16% (455/2785) received the alternative of delayed assessment. After a median follow-up of 23 months (range, 8-40 months), 13% of those managed with WA (91/714) were re-referred back to the same haematologists; 7% (52/714) were assessed in hospital and 2% (15/714) eventually required treatment. There were no deaths due to haematological causes. Over 90% of responding referring doctors said the WA process was rapid and effective, and 77% of recently managed patients were pleased to be treated by their own doctors. Using WA to manage a substantial minority of patients referred to haematologists can be rapid and safe. It is widely accepted by referring doctors.

Acceptance and Continuance Factors Associated with Mobile Medical App Use: A Qualitative Case Study of Diabetes Apps

ERIC Educational Resources Information Center

MacDonald, Amy Joy

2017-01-01

Despite advances in smartphone technologies and development of myriad apps that can support self-management efforts for chronic disease like diabetes, initial acceptance of such apps by actual users was characterized by low consistent use by these users. Few studies conducted by researchers on acceptance and use outcomes of mobile apps focused on…

Expanding the Space of Plausible Solutions in a Medical Tutoring System for Problem-Based Learning

ERIC Educational Resources Information Center

Kazi, Hameedullah; Haddawy, Peter; Suebnukarn, Siriwan

2009-01-01

In well-defined domains such as Physics, Mathematics, and Chemistry, solutions to a posed problem can objectively be classified as correct or incorrect. In ill-defined domains such as medicine, the classification of solutions to a patient problem as correct or incorrect is much more complex. Typical tutoring systems accept only a small set of…

Implications of Studies on Self-Esteem for Educational Research and Practice.

ERIC Educational Resources Information Center

Coopersmith, Stanley

The research of this author indicates that the development of high self-esteem (defined as the good-bad dimension of self-concept) is associated with (1) acceptance, (2) clearly defined limits and moderately high goals, and (3) respectful treatment. Such factors as status, income, and education are only related to high self-esteem if they are a…

Acceptable Risk Analysis for Abrupt Environmental Pollution Accidents in Zhangjiakou City, China.

PubMed

Du, Xi; Zhang, Zhijiao; Dong, Lei; Liu, Jing; Borthwick, Alistair G L; Liu, Renzhi

2017-04-20

Abrupt environmental pollution accidents cause considerable damage worldwide to the ecological environment, human health, and property. The concept of acceptable risk aims to answer whether or not a given environmental pollution risk exceeds a societally determined criterion. This paper presents a case study on acceptable environmental pollution risk conducted through a questionnaire survey carried out between August and October 2014 in five representative districts and two counties of Zhangjiakou City, Hebei Province, China. Here, environmental risk primarily arises from accidental water pollution, accidental air pollution, and tailings dam failure. Based on 870 valid questionnaires, demographic and regional differences in public attitudes towards abrupt environmental pollution risks were analyzed, and risk acceptance impact factors determined. The results showed females, people between 21-40 years of age, people with higher levels of education, public servants, and people with higher income had lower risk tolerance. People with lower perceived risk, low-level risk knowledge, high-level familiarity and satisfaction with environmental management, and without experience of environmental accidents had higher risk tolerance. Multiple logistic regression analysis indicated that public satisfaction with environmental management was the most significant factor in risk acceptance, followed by perceived risk of abrupt air pollution, occupation, perceived risk of tailings dam failure, and sex. These findings should be helpful to local decision-makers concerned with environmental risk management (e.g., selecting target groups for effective risk communication) in the context of abrupt environmental accidents.

Discrete choice experiment produced estimates of acceptable risks of therapeutic options in cancer patients with febrile neutropenia.

PubMed

Sung, Lillian; Alibhai, Shabbir M; Ethier, Marie-Chantal; Teuffel, Oliver; Cheng, Sylvia; Fisman, David; Regier, Dean A

2012-06-01

To use a discrete choice experiment (DCE) to describe patient/proxy tolerance for the number of clinic visits, and chances of readmission, intensive care unit admission, and mortality to accept oral outpatient management of low-risk febrile neutropenia. Adults and children aged 12-18 years with cancer and parents of pediatric cancer patients were asked to choose between outpatient oral and inpatient intravenous management of low-risk febrile neutropenia. Using a DCE, we varied the attribute levels with the outpatient option and kept them constant for the inpatient option. Seventy-eight adults, 153 parents, and 43 children provided responses. All four attributes significantly affected choices. The mean tolerance (95% confidence interval) for the number of clinic visits per week was 3.6 (2.2-4.8), 2.1 (1.1-3.2), and 4.3 (2.5-6.0) to accept outpatient management among adults, parents, and children, respectively. With thrice weekly clinic visits and 7.5% chance of readmission, probabilities of accepting the outpatient strategy were 50% (44-54%) for adults, 43% (39-48%) for parents, and 53% (46-59%) for children. Using a DCE, we determined that a 7.5% chance of readmission and clinic visits more frequently than thrice weekly are unlikely to be acceptable. Copyright © 2012 Elsevier Inc. All rights reserved.

Acceptability of Flight Deck-Based Interval Management Crew Procedures

NASA Technical Reports Server (NTRS)

Murdock, Jennifer L.; Wilson, Sara R.; Hubbs, Clay E.; Smail, James W.

2013-01-01

The Interval Management for Near-term Operations Validation of Acceptability (IM-NOVA) experiment was conducted at the National Aeronautics and Space Administration (NASA) Langley Research Center (LaRC) in support of the NASA Next Generation Air Transportation System (NextGen) Airspace Systems Program's Air Traffic Management Technology Demonstration - 1 (ATD-1). ATD-1 is intended to showcase an integrated set of technologies that provide an efficient arrival solution for managing aircraft using NextGen surveillance, navigation, procedures, and automation for both airborne and ground-based systems. The goal of the IM-NOVA experiment was to assess if procedures outlined by the ATD-1 Concept of Operations, when used with a minimum set of Flight deck-based Interval Management (FIM) equipment and a prototype crew interface, were acceptable to and feasible for use by flight crews in a voice communications environment. To investigate an integrated arrival solution using ground-based air traffic control tools and aircraft automatic dependent surveillance broadcast (ADS-B) tools, the LaRC FIM system and the Traffic Management Advisor with Terminal Metering and Controller Managed Spacing tools developed at the NASA Ames Research Center (ARC) were integrated in LaRC's Air Traffic Operations Laboratory. Data were collected from 10 crews of current, qualified 757/767 pilots asked to fly a high-fidelity, fixed based simulator during scenarios conducted within an airspace environment modeled on the Dallas-Fort Worth (DFW) Terminal Radar Approach Control area. The aircraft simulator was equipped with the Airborne Spacing for Terminal Area Routes algorithm and a FIM crew interface consisting of electronic flight bags and ADS-B guidance displays. Researchers used "pseudo-pilot" stations to control 24 simulated aircraft that provided multiple air traffic flows into DFW, and recently retired DFW air traffic controllers served as confederate Center, Feeder, Final, and Tower controllers. Pilot participant feedback indicated that the procedures used by flight crews to receive and execute interval management (IM) clearances in a voice communications environment were logical, easy to follow, did not contain any missing or extraneous steps, and required the use of an acceptable level of workload. The majority of the pilot participants found the IM concept, in addition to the proposed FIM crew procedures, to be acceptable and indicated that the ATD-1 procedures can be successfully executed in a near-term NextGen environment.

Development and application of an acceptance testing model

NASA Technical Reports Server (NTRS)

Pendley, Rex D.; Noonan, Caroline H.; Hall, Kenneth R.

1992-01-01

The process of acceptance testing large software systems for NASA has been analyzed, and an empirical planning model of the process constructed. This model gives managers accurate predictions of the staffing needed, the productivity of a test team, and the rate at which the system will pass. Applying the model to a new system shows a high level of agreement between the model and actual performance. The model also gives managers an objective measure of process improvement.

Development of an integrated configuration management/flight director system for piloted STOL approaches

NASA Technical Reports Server (NTRS)

Hoh, R. H.; Klein, R. H.; Johnson, W. A.

1977-01-01

A system analysis method for the development of an integrated configuration management/flight director system for IFR STOL approaches is presented. Curved descending decelerating approach trajectories are considered. Considerable emphasis is placed on satisfying the pilot centered requirements (acceptable workload) as well as the usual guidance and control requirements (acceptable performance). The Augmentor Wing Jet STOL Research Aircraft was utilized to allow illustration by example, and to validate the analysis procedure via manned simulation.

Acceptability of Rapid Diagnostic Test-Based Management of Malaria among Caregivers of Under-Five Children in Rural Ghana

PubMed Central

Baiden, Frank; Owusu-Agyei, Seth; Okyere, Eunice; Tivura, Mathilda; Adjei, George; Chandramohan, Daniel; Webster, Jayne

2012-01-01

Introduction WHO now recommends test-based management of malaria (TBMM) across all age-groups. This implies artemisinin-based combination treatment (ACT) should be restricted to rapid diagnostic test (RDT)-positive cases. This is a departure from what caregivers in rural communities have been used to for many years. Methods We conducted a survey among caregivers living close to 32 health centres in six districts in rural Ghana and used logistic regression to explore factors likely to influence caregiver acceptability of RDT based case management and concern about the denial of ACT on account of negative RDT results. Focus group discussions were conducted to explain the quantitative findings and to elicit further factors. Results A total of 3047 caregivers were interviewed. Nearly all (98%) reported a preference for TBMM over presumptive treatment. Caregivers who preferred TBMM were less likely to be concerned about the denial of ACT to their test-negative children (O.R. 0.57, 95%C.I. 0.33–0.98). Compared with caregivers who had never secured national health insurance cover, caregivers who had valid (adjusted O.R. 1.30, 95% CI 1.07–1.61) or expired (adjusted O.R. 1.38, 95% CI 1.12–1.73) insurance cover were more likely to be concerned about the denial of ACT to their RDT-negative children. Major factors that promote TBMM acceptability include the perception that a blood test at health centre level represents improvement in the quality of care, leads to improvement in treatment outcomes, and offers opportunity for better communication between health workers and caregivers. Acceptability is also enhanced by engaging caregivers in the procedures of the test. Apprehensions about negative health worker attitude could however undermine acceptance. Conclusion Test (RDT)-based management of malaria in under-five children is likely to be acceptable to caregivers in rural Ghana. The quality of caregiver-health worker interaction needs to be improved if acceptability is to be sustained. PMID:23029094

23 CFR 500.109 - CMS.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Congestion management means the application of strategies to improve system performance and reliability by... SYSTEMS Management Systems § 500.109 CMS. (a) For purposes of this part, congestion means the level at... management system or process is a systematic and regionally accepted approach for managing congestion that...

23 CFR 500.109 - CMS.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Congestion management means the application of strategies to improve system performance and reliability by... SYSTEMS Management Systems § 500.109 CMS. (a) For purposes of this part, congestion means the level at... management system or process is a systematic and regionally accepted approach for managing congestion that...

44 CFR 6.30 - Form of requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Form of requests. 6.30 Section 6.30 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF... manager, at his discretion, may accept oral requests for access subject to verification of identity. ...

23 CFR 500.109 - CMS.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SYSTEMS Management Systems § 500.109 CMS. (a) For purposes of this part, congestion means the level at.... Congestion management means the application of strategies to improve system performance and reliability by... management system or process is a systematic and regionally accepted approach for managing congestion that...

23 CFR 500.109 - CMS.

Code of Federal Regulations, 2014 CFR

2014-04-01

... SYSTEMS Management Systems § 500.109 CMS. (a) For purposes of this part, congestion means the level at.... Congestion management means the application of strategies to improve system performance and reliability by... management system or process is a systematic and regionally accepted approach for managing congestion that...

23 CFR 500.109 - CMS.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SYSTEMS Management Systems § 500.109 CMS. (a) For purposes of this part, congestion means the level at.... Congestion management means the application of strategies to improve system performance and reliability by... management system or process is a systematic and regionally accepted approach for managing congestion that...

The feasibility and acceptability of nurse-led chronic disease management interventions in primary care: An integrative review.

PubMed

Stephen, Catherine; McInnes, Susan; Halcomb, Elizabeth

2018-02-01

To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Integrative review guided by the work of Whittemore and Knafl (). Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base. © 2017 John Wiley & Sons Ltd.

An investigation on physicians' acceptance of hospital information systems: a case study.

PubMed

Chen, Rai-Fu; Hsiao, Ju-Ling

2012-12-01

Information technology is used to support a wide range of highly specified healthcare tasks and services. There is, therefore, a need to understand the factors affecting the acceptance of this technology by healthcare professionals. Physicians are key providers of healthcare services and are among the principal users of hospital information systems. Their acceptance of hospital information systems is hence of great significance when evaluating the success of those systems. The survey methodology was employed to targeted physicians in the selected case hospital for investigating factors affecting physicians' acceptance of hospital information systems. A total of 202 questionnaires were sent out, with 124 completed copies returned, indicating a valid response rate of 61.4%. We used structural equation modeling to analyze the data. The results indicated that top management support (γ=0.431, p<0.001) had a significant impact on perceived usefulness. Project team competency (γ=0.381, p<0.001) and system quality (γ=0.369, p<0.001) had a significant impact on physicians' perceived ease of use of hospital information systems. Physicians' perceptions of the usefulness (β=0.132, p<0.05, R(2)=0.296) and ease of use (β=0.952, p<0.001, R(2)=0.784) of hospital information systems had a significant impact on the acceptance of the systems, accounting for 81.4% of total explained variance. Through the understanding of the identified critical factors affecting physicians' HIS acceptance, the planners and managers should ensure that hospital information systems to be introduced into a hospital are useful and ease to use. Effort should be focuses on providing sufficient top management support, selecting qualified project team members, and delivering higher system quality in addressing physicians' clinical needs. Thus, our research results can help planners and managers understand key considerations affecting HIS development and use, and may be used as a reference for system design, development and implementation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

43 CFR 3830.23 - What types of payment will BLM accept?

Code of Federal Regulations, 2014 CFR

2014-10-01

... Interior—Bureau of Land Management; (4) Valid credit card that is acceptable to the BLM; or (5) An... issuing institution of your check, negotiable instrument, or credit card refuses to pay and it is not...

43 CFR 3830.23 - What types of payment will BLM accept?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Interior—Bureau of Land Management; (4) Valid credit card that is acceptable to the BLM; or (5) An... issuing institution of your check, negotiable instrument, or credit card refuses to pay and it is not...

43 CFR 3830.23 - What types of payment will BLM accept?

Code of Federal Regulations, 2013 CFR

2013-10-01

... Interior—Bureau of Land Management; (4) Valid credit card that is acceptable to the BLM; or (5) An... issuing institution of your check, negotiable instrument, or credit card refuses to pay and it is not...

43 CFR 3830.23 - What types of payment will BLM accept?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Interior—Bureau of Land Management; (4) Valid credit card that is acceptable to the BLM; or (5) An... issuing institution of your check, negotiable instrument, or credit card refuses to pay and it is not...

Development and pilot test of a new set of good practice indicators for chronic cancer pain management.

PubMed

Saturno, P J; Martinez-Nicolas, I; Robles-Garcia, I S; López-Soriano, F; Angel-García, D

2015-01-01

Pain is among the most important symptoms in terms of prevalence and cause of distress for cancer patients and their families. However, there is a lack of clearly defined measures of quality pain management to identify problems and monitor changes in improvement initiatives. We built a comprehensive set of evidence-based indicators following a four-step model: (1) review and systematization of existing guidelines to list evidence-based recommendations; (2) review and systematization of existing indicators matching the recommendations; (3) development of new indicators to complete a set of measures for the identified recommendations; and (4) pilot test (in hospital and primary care settings) for feasibility, reliability (kappa), and usefulness for the identification of quality problems using the lot quality acceptance sampling (LQAS) method and estimates of compliance. Twenty-two indicators were eventually pilot tested. Seventeen were feasible in hospitals and 12 in all settings. Feasibility barriers included difficulties in identifying target patients, deficient clinical records and low prevalence of cases for some indicators. Reliability was mostly very good or excellent (k > 0.8). Four indicators, all of them related to medication and prevention of side effects, had acceptable compliance at 75%/40% LQAS level. Other important medication-related indicators (i.e., adjustment to pain intensity, prescription for breakthrough pain) and indicators concerning patient-centred care (i.e., attention to psychological distress and educational needs) had very low compliance, highlighting specific quality gaps. A set of good practice indicators has been built and pilot tested as a feasible, reliable and useful quality monitoring tool, and underscoring particular and important areas for improvement. © 2014 European Pain Federation - EFIC®

Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies

PubMed Central

Vora, N.M.; Orciari, L.A.; Niezgoda, M.; Selvaggi, G.; Stosor, V.; Lyon, G.M.; Wallace, R.M.; Gabel, J.; Stanek, D.R.; Jenkins, P.; Shiferaw, M.; Yager, P.; Jackson, F.; Hanlon, C.A.; Damon, I.; Blanton, J.D.; Recuenco, S.; Franka, R.

2015-01-01

Background The rabies virus causes a fatal encephalitis and can be transmitted through organ transplantation. In 2013, a man developed rabies 18 months after receiving a kidney from a donor with rabies, who was not known to have been infected when the organs were procured. Three additional persons who received organs from the same donor (liver, kidney, heart), all of whom were not vaccinated for rabies before transplantation, received rabies post-exposure prophylaxis (PEP) with rabies immune globulin and 5 doses of rabies vaccine as soon as the diagnosis of rabies was made in the donor (18 months after their transplant surgeries). We describe their clinical management. Methods As the 3 recipients were all on immunosuppressive medications, post-vaccination serologic testing was performed using the rapid fluorescent focus inhibition test to measure rabies virus neutralizing antibodies (RVNAs). An acceptable antibody response to administration of rabies vaccine was defined as detection of RVNAs at a concentration ≥0.1 IU/mL from a serum specimen collected ≥7 days after the fifth vaccine dose. Results All 3 recipients demonstrated an acceptable antibody response despite their immunosuppressed states. More than 36 months have passed since their transplant surgeries, and all 3 recipients have no evidence of rabies. Conclusions The survival of 3 previously unvaccinated recipients of solid organs from a donor with rabies is unexpected. Although the precise factors that led to their survival remain unclear, our data suggest that PEP can possibly enhance transplant safety in settings in which donors are retrospectively diagnosed with rabies. PMID:25851103

Hemodialysis patients' preferences for the management of anemia.

PubMed

Hauber, Brett; Caloyeras, John; Posner, Joshua; Brommage, Deborah; Tzivelekis, Spiros; Pollock, Allan

2017-07-28

Patient engagement in end-stage renal disease (ESRD) is expected to result in a more patient-centered approach to care that aligns with patients' values, preferences, and goals for treatment. Nevertheless, no previous studies of which we are aware have evaluated patients' benefit-risk preferences for the management of anemia associated with ESRD. The primary objective of this study was to quantify the tradeoffs patients are willing to make between cardiovascular risks associated with some anemia medicines and red blood cell (RBC) transfusions. A secondary objective was to quantify the importance of avoiding transfusion-related risks. A survey instrument was developed from the clinical literature, clinician input, patient-education resources, and a patient focus group. The survey instrument was qualitatively pretested before its administration to a broader sample of patients. The National Kidney Foundation invited individuals in the United States to participate in the survey. In a discrete-choice experiment (DCE), respondents chose between two hypothetical anemia medications in a series of questions. Each medication was defined by symptom relief, frequency of transfusions, cardiovascular risk, mode of administration, and out-of-pocket cost. The survey also included a best-worst scaling (BWS) exercise to quantify the importance of avoiding attributes of blood transfusions. Results from the DCE were used to estimate relative importance and marginal willingness to pay. Results from the BWS were converted to relative importance weights. A total of 200 individuals completed the survey. Patients were willing to accept a 6% medication-related risk of heart attack to avoid having two RBC transfusions per month. Symptom relief and mode of administration were of moderate importance. The most important transfusion-related risk to avoid was transfusion-related lung injury. Patients with ESRD and anemia have measurable treatment preferences and are willing to accept risks associated with anemia medications to avoid transfusions.

Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies.

PubMed

Vora, N M; Orciari, L A; Niezgoda, M; Selvaggi, G; Stosor, V; Lyon, G M; Wallace, R M; Gabel, J; Stanek, D R; Jenkins, P; Shiferaw, M; Yager, P; Jackson, F; Hanlon, C A; Damon, I; Blanton, J D; Recuenco, S; Franka, R

2015-06-01

The rabies virus causes a fatal encephalitis and can be transmitted through organ transplantation. In 2013, a man developed rabies 18 months after receiving a kidney from a donor with rabies, who was not known to have been infected when the organs were procured. Three additional persons who received organs from the same donor (liver, kidney, heart), all of whom were not vaccinated for rabies before transplantation, received rabies post-exposure prophylaxis (PEP) with rabies immune globulin and 5 doses of rabies vaccine as soon as the diagnosis of rabies was made in the donor (18 months after their transplant surgeries). We describe their clinical management. As the 3 recipients were all on immunosuppressive medications, post-vaccination serologic testing was performed using the rapid fluorescent focus inhibition test to measure rabies virus neutralizing antibodies (RVNAs). An acceptable antibody response to administration of rabies vaccine was defined as detection of RVNAs at a concentration ≥0.1 IU/mL from a serum specimen collected ≥7 days after the fifth vaccine dose. All 3 recipients demonstrated an acceptable antibody response despite their immunosuppressed states. More than 36 months have passed since their transplant surgeries, and all 3 recipients have no evidence of rabies. The survival of 3 previously unvaccinated recipients of solid organs from a donor with rabies is unexpected. Although the precise factors that led to their survival remain unclear, our data suggest that PEP can possibly enhance transplant safety in settings in which donors are retrospectively diagnosed with rabies. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Turning on the care coordination switch in rural primary care: voices from the practices--clinician champions, clinician partners, administrators, and nurse care managers.

PubMed

Fagnan, Lyle J; Dorr, David A; Davis, Melinda; McGinnis, Paul; Mahler, Jo; King, Molly McCarthy; Michaels, LeAnn

2011-01-01

This study sought to understand the acceptability and feasibility of office-based nurse care management in medium to large rural primary care practices. A qualitative assessment of Care Management Plus (a focused medical home model for complex patients) implementation was conducted using semistructured interviews with 4 staff cohorts. Cohorts included clinician champions, clinician partners, practice administrators, and nurse care managers. Seven key implementation attributes were: a proven care coordination program; adequate staffing; practice buy-in; adequate time; measurement; practice facilitation; and functional information technology. Although staff was positive about the care coordination concept, model acceptability was varied and additional study is required to determine sustainability.

Compounds affecting cholesterol absorption

NASA Technical Reports Server (NTRS)

Koo, Sung I. (Inventor); Noh, Sang K. (Inventor); Hua, Duy H. (Inventor)

2004-01-01

A class of novel compounds is described for use in affecting lymphatic absorption of cholesterol. Compounds of particular interest are defined by Formula I: ##STR1## or a pharmaceutically acceptable salt thereof.

Mission analysis report for single-shell tank leakage mitigation

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

Cruse, J.M.

1994-09-01

This document provides an analysis of the leakage mitigation mission applicable to past and potential future leakage from the Hanford Site`s 149 single-shell high-level waste tanks. This mission is a part of the overall missions of the Westinghouse Hanford Company Tank Waste Remediation System division to remediate the tank waste in a safe and acceptable manner. Systems engineers principles are being applied to this effort. Mission analysis supports early decision making by clearly defining program objectives. This documents identifies the initial conditions and acceptable final conditions, defines the programmatic and physical interfaces and constraints, estimates the resources to carry outmore » the mission, and establishes measures of success. The results of the mission analysis provide a consistent basis for subsequent systems engineering work.« less

Remedial investigation/feasibility study for the David Witherspoon, Inc., 901 Site, Knoxville, Tennessee: Volume 1

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

NONE

1996-10-01

This remedial investigation (RI)/feasibility study (FS) supports the selection of remedial actions for the David Witherspoon, Inc. 901 Maryville Pike Site in Knoxville, Tennessee. Operations at the site, used as a recycling center, have resulted in past, present, and potential future releases of hazardous substances in to the environment. This Site is a Tennessee Superfund site. A phased approach was planned to (1) gather existing data from previous investigations managed by the Tenn. Dept. of Environment and Conservation; (2) perform a preliminary RI, including risk assessments, and an FS with existing data to identify areas where remedial action may bemore » necessary; (3) gather additional field data to adequately define the nature and extent of risk-based contaminants that present identifiable threats to human and/or ecological receptors; and (4) develop remedial action alternatives to reduce risks to acceptable levels.« less

Interactive access and management for four-dimensional environmental data sets using McIDAS

NASA Technical Reports Server (NTRS)

Hibbard, William L.; Tripoli, Gregory J.

1995-01-01

This grant has fundamentally changed the way that meteorologists look at the output of their atmospheric models, through the development and wide distribution of the Vis5D system. The Vis5D system is also gaining acceptance among oceanographers and atmospheric chemists. Vis5D gives these scientists an interactive three-dimensional movie of their very large data sets that they can use to understand physical mechanisms and to trace problems to their sources. This grant has also helped to define the future direction of scientific visualization through the development of the VisAD system and its lattice data model. The VisAD system can be used to interactively steer and visualize scientific computations. A key element of this capability is the flexibility of the system's data model to adapt to a wide variety of scientific data, including the integration of several forms of scientific metadata.

Visual interface for space and terrestrial analysis

NASA Technical Reports Server (NTRS)

Dombrowski, Edmund G.; Williams, Jason R.; George, Arthur A.; Heckathorn, Harry M.; Snyder, William A.

1995-01-01

The management of large geophysical and celestial data bases is now, more than ever, the most critical path to timely data analysis. With today's large volume data sets from multiple satellite missions, analysts face the task of defining useful data bases from which data and metadata (information about data) can be extracted readily in a meaningful way. Visualization, following an object-oriented design, is a fundamental method of organizing and handling data. Humans, by nature, easily accept pictorial representations of data. Therefore graphically oriented user interfaces are appealing, as long as they remain simple to produce and use. The Visual Interface for Space and Terrestrial Analysis (VISTA) system, currently under development at the Naval Research Laboratory's Backgrounds Data Center (BDC), has been designed with these goals in mind. Its graphical user interface (GUI) allows the user to perform queries, visualization, and analysis of atmospheric and celestial backgrounds data.

Biopathways representation and simulation on hybrid functional petri net.

PubMed

Matsuno, Hiroshi; Tanaka, Yukiko; Aoshima, Hitoshi; Doi, Atsushi; Matsui, Mika; Miyano, Satoru

2011-01-01

The following two matters should be resolved in order for biosimulation tools to be accepted by users in biology/medicine: (1) remove issues which are irrelevant to biological importance, and (2) allow users to represent biopathways intuitively and understand/manage easily the details of representation and simulation mechanism. From these criteria, we firstly define a novel notion of Petri net called Hybrid Functional Petri Net (HFPN). Then, we introduce a software tool, Genomic Object Net, for representing and simulating biopathways, which we have developed by employing the architecture of HFPN. In order to show the usefulness of Genomic Object Net for representing and simulating biopathways, we show two HFPN representations of gene regulation mechanisms of Drosophila melanogaster (fruit fly) circadian rhythm and apoptosis induced by Fas ligand. The simulation results of these biopathways are also correlated with biological observations. The software is available to academic users from http://www.GenomicObject.Net/.

The Department of Energy`s Remedial Action Assessment System (RAAS): Decision support tools for performing streamlined feasibility studies

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

White, M.K.

1994-06-01

The United States Department of Energy (DOE) faces the major task of cleaning up hundreds of waste sites across the nation, which will require completion of a large number of remedial investigation/feasibility studies (RI/FSs). The intent of each RI/FS is to characterize the waste problems and environmental conditions at the operable unit level, segment the remediation problem into manageable medium-specific and contaminant-specific pieces, define corresponding remediation objectives, and identify remedial response actions to satisfy those objectives. The RI/FS team can then identify combinations of remediation technologies that will meet the remediation objectives. Finally, the team must evaluate these remedial alternativesmore » in terms of effectiveness, implementability, cost, and acceptability. The Remedial Action Assessment System (RAAS) is being developed by Pacific Northwest Laboratory (PNL) to support DOE in this effort.« less

Dynamic fluctuation of proteins watched in real time

PubMed Central

Ormos, Pál

2008-01-01

The dynamic nature of protein function is a fundamental concept in the physics of proteins. Although the basic general ideas are well accepted most experimental evidence has an indirect nature. The detailed characterization of the dynamics is necessary for the understanding in detail. The dynamic fluctuations thought crucial for the function span an extremely broad time, starting from the picosecond regime. Recently, a few new experimental techniques emerged that permit the observation of dynamical phenomena directly. Notably, pulsed infrared (IR) spectroscopy has been applied with great success to observe structural changes with picosecond time resolution. Using two-dimensional-IR vibrational echo chemical exchange spectroscopy Ishikawa and co-workers [Ishikawa et al. (2008), Proc. Natl. Acad. Sci. U.S.A. 101, 14402–14407] managed to observe the transition between well defined conformational substrates of carbonmonoxy myoglobin directly. This is an important step in improving our insight into the details of protein function. PMID:19436491

Airspace Technology Demonstration 3 (ATD-3): Multi-Flight Common Route (MFCR) Technology Transfer Document Summary Version 1.0

NASA Technical Reports Server (NTRS)

Sheth, Kapil; Bilimoria, Karl; Amer, Maryam M.; Wang, Easter M.

2017-01-01

This summary document and accompanying technology artifacts satisfy the second of three Research Transition Products (RTPs) defined in the ATD-3 Applied Traffic Flow Management (ATFM) Research Transition Team (RTT) Plan. This transfer consists of NASA's Multi-Flight Common Route (MFCR) research for efficient route corrections for en-route weather avoidance. The MFCR concept builds on the experience of the legacy Dynamic Weather Routes (DWR) and focuses on a better balance of potential savings with ATC acceptability, common route corrections options for multiple flights on similar routings, and better use of existing and/or modern automation for communication and coordination of route change options. All of these capabilities are expected to improve system performance significantly in terms of actual delay-reducing clearances issued to flights compared to that of the DWR tool and operating concept.

A Planning Tool for Estimating Waste Generated by a Radiological Incident and Subsequent Decontamination Efforts - 13569

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

Boe, Timothy; Lemieux, Paul; Schultheisz, Daniel

2013-07-01

Management of debris and waste from a wide-area radiological incident would probably constitute a significant percentage of the total remediation cost and effort. The U.S. Environmental Protection Agency's (EPA's) Waste Estimation Support Tool (WEST) is a unique planning tool for estimating the potential volume and radioactivity levels of waste generated by a radiological incident and subsequent decontamination efforts. The WEST was developed to support planners and decision makers by generating a first-order estimate of the quantity and characteristics of waste resulting from a radiological incident. The tool then allows the user to evaluate the impact of various decontamination/demolition strategies onmore » the waste types and volumes generated. WEST consists of a suite of standalone applications and Esri{sup R} ArcGIS{sup R} scripts for rapidly estimating waste inventories and levels of radioactivity generated from a radiological contamination incident as a function of user-defined decontamination and demolition approaches. WEST accepts Geographic Information System (GIS) shape-files defining contaminated areas and extent of contamination. Building stock information, including square footage, building counts, and building composition estimates are then generated using the Federal Emergency Management Agency's (FEMA's) Hazus{sup R}-MH software. WEST then identifies outdoor surfaces based on the application of pattern recognition to overhead aerial imagery. The results from the GIS calculations are then fed into a Microsoft Excel{sup R} 2007 spreadsheet with a custom graphical user interface where the user can examine the impact of various decontamination/demolition scenarios on the quantity, characteristics, and residual radioactivity of the resulting waste streams. (authors)« less

Morbidity and Mortality conference as part of PDCA cycle to decrease anastomotic failure in colorectal surgery.

PubMed

Vogel, Peter; Vassilev, Georgi; Kruse, Bernd; Cankaya, Yesim

2011-10-01

Morbidity and Mortality meetings are an accepted tool for quality management in many hospitals. However, it is not proven whether these meetings increase quality. It was the aim of this study to investigate whether Morbidity and Mortality meetings as part of a PDCA cycle (Plan, Do, Check, Act) can improve the rate of anastomotic failure in colorectal surgery. From January 1, 2004, to December 31, 2009, data for all anastomotic failures in patients operated on for colorectal diseases in the Department of Surgery (Klinikum Friedrichshafen, Germany) were prospectively collected. The events were discussed in Morbidity and Mortality meetings. On the basis of these discussions, a strategy to prevent anastomotic leaks and a new target were defined (i.e. 'Plan'). This strategy was implemented in the following period (i.e. 'Do') and results were prospectively analysed. A new strategy was established when the results differed from the target, and a new standard was defined when the target was achieved (i.e. 'Check, Act'). The year 2004 was set as the base year. In 2005 and 2006, new strategies were established. Comparing this period with the period of strategy conversion (2007-2009), we found a significant decrease in the anastomotic failure rate in colorectal surgery patients (5.7% vs 2.8%; p = 0.05), whereas the risk factors for anastomotic failure were unchanged or unfavourable. If Morbidity and Mortality meetings are integrated in a PDCA cycle, they can decrease anastomotic failure rates and improve quality of care in colorectal surgery. Therefore, the management tool 'PDCA cycle' should be considered also for medical issues.

Low-residue and low-fiber diets in gastrointestinal disease management.

PubMed

Vanhauwaert, Erika; Matthys, Christophe; Verdonck, Lies; De Preter, Vicky

2015-11-01

Recently, low-residue diets were removed from the American Academy of Nutrition and Dietetics' Nutrition Care Manual due to the lack of a scientifically accepted quantitative definition and the unavailability of a method to estimate the amount of food residue produced. This narrative review focuses on defining the similarities and/or discrepancies between low-residue and low-fiber diets and on the diagnostic and therapeutic values of these diets in gastrointestinal disease management. Diagnostically, a low-fiber/low-residue diet is used in bowel preparation. A bowel preparation is a cleansing of the intestines of fecal matter and secretions conducted before a diagnostic procedure. Therapeutically, a low-fiber/low-residue diet is part of the treatment of acute relapses in different bowel diseases. The available evidence on low-residue and low-fiber diets is summarized. The main findings showed that within human disease research, the terms "low residue" and "low fiber" are used interchangeably, and information related to the quantity of residue in the diet usually refers to the amount of fiber. Low-fiber/low-residue diets are further explored in both diagnostic and therapeutic situations. On the basis of this literature review, the authors suggest redefining a low-residue diet as a low-fiber diet and to quantitatively define a low-fiber diet as a diet with a maximum of 10 g fiber/d. A low-fiber diet instead of a low-residue diet is recommended as a diagnostic value or as specific therapy for gastrointestinal conditions. © 2015 American Society for Nutrition.

Flight Deck Interval Management Avionics: Eye-Tracking Analysis

NASA Technical Reports Server (NTRS)

Latorella, Kara; Harden, John W.

2015-01-01

Interval Management (IM) is one NexGen method for achieving airspace efficiencies. In order to initiate IM procedures, Air Traffic Control provides an IM clearance to the IM aircraft's pilots that indicates an intended spacing from another aircraft (the target to follow - or TTF) and the point at which this should be achieved. Pilots enter the clearance in the flight deck IM (FIM) system; and once the TTF's Automatic Dependent Surveillance-Broadcast signal is available, the FIM algorithm generates target speeds to meet that IM goal. This study examined four Avionics Conditions (defined by the instrumentation and location presenting FIM information) and three Notification Methods (defined by the visual and aural alerts that notified pilots to IM-related events). Current commercial pilots flew descents into Dallas/Fort-Worth in a high-fidelity commercial flight deck simulation environment with realistic traffic and communications. All 12 crews experienced each Avionics Condition, where order was counterbalanced over crews. Each crew used only one of the three Notification Methods. This paper presents results from eye tracking data collected from both pilots, including: normalized number of samples falling within FIM displays, normalized heads-up time, noticing time, dwell time on first FIM display look after a new speed, a workload-related metric, and a measure comparing the scan paths of pilot flying and pilot monitoring; and discusses these in the context of other objective (vertical and speed profile deviations, response time to dial in commanded speeds, out-of-speed-conformance and reminder indications) and subjective measures (workload, situation awareness, usability, and operational acceptability).

Acceptability of Bibliotherapy for Patients With Cancer: A Qualitative, Descriptive Study.

PubMed

Roberts, Nicole; Lee, Virginia; Ananng, Bethsheba; Körner, Annett

2016-09-01

To determine the acceptability of a self-help workbook, Mastering the Art of Coping in Good Times and Bad, for patients with cancer.
. Descriptive, qualitative.
. Participants were recruited from the psychosocial support cancer centers of two tertiary care teaching hospitals in Montreal, Quebec, Canada.
. 18 individuals diagnosed with cancer.
. A semistructured interview guide with open-ended questions was used to gather feedback from participants about the workbook. 
. 18 participants completed the interviews from which the data emerged. Two main categories were identified from the respondents' interviews regarding the acceptability of the workbook. The first category focuses on content, whereas the other focuses on recommendations. Interviewees specified the following content as most helpful. Bibliotherapy gives patients access to knowledge to help them cope and engage in their own self-management. The workbook Mastering the Art of Coping in Good Times and Bad may be an acceptable means of helping them manage their stress. 
. Bibliotherapy is not only cost-effective and easy to administer but also an acceptable minimal intervention.

LPTA Versus Tradeoff: Analysis of Contract Source Selection Strategies and Performance Outcomes

DTIC Science & Technology

2016-06-01

methodologies contracting professionals employ to acquire what the DOD needs. Contracting professionals may use lowest price technically acceptable (LPTA) and...contract management process, source selection, lowest price technically acceptable, tradeoff 15. NUMBER OF PAGES 69 16. PRICE CODE 17. SECURITY...use lowest price technically acceptable (LPTA) and tradeoff strategies to procure requirements to maximize the overall best value to the government

End-user satisfaction analysis on library management system unnes using technology acceptance model towards national standard of integrated library

NASA Astrophysics Data System (ADS)

Hardyanto, W.; Purwinarko, A.; Adhi, M. A.

2018-03-01

The library which is the gate of the University should be supported by the existence of an adequate information system, to provide excellent service and optimal to every user. Library management system that has been in existence since 2009 needs to be re-evaluated so that the system can meet the needs of both operator and Unnes user in particular, and users from outside Unnes in general. This study aims to evaluate and improve the existing library management system to produce a system that is accountable and able to meet the needs of end users, as well as produce a library management system that is integrated Unnes. Research is directed to produce evaluation report with Technology Acceptance Model (TAM) approach and library management system integrated with the national standard.

Relevance of Lick Creek ecosystem-based management treatments to National Forest management

Treesearch

Cathy Stewart

1999-01-01

Treatments applied at Lick Creek were the first landscape-scale applications of ecosystem management on the Bitterroot National Forest. The coordinated effort between educators, researchers, resource managers, and the public helped gain acceptance and understanding of new approaches to management, both internally and externally. The longer skidding distances, high...

10 CFR 600.311 - Standards for financial management systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Standards for financial management systems. 600.311... Requirements § 600.311 Standards for financial management systems. (a) Recipients are encouraged to use existing financial management systems to the extent that the systems comply with Generally Accepted...

14 CFR 91.1023 - Program operating manual requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... manager must prepare and keep current a program operating manual setting forth procedures and policies acceptable to the Administrator. The program manager's management, flight, ground, and maintenance personnel... personnel. (b) Each program manager must maintain at least one copy of the manual at its principal base of...

10 CFR 600.311 - Standards for financial management systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Standards for financial management systems. 600.311... Requirements § 600.311 Standards for financial management systems. (a) Recipients are encouraged to use existing financial management systems to the extent that the systems comply with Generally Accepted...

77 FR 41457 - Aging Management Associated With Wall Thinning Due to Erosion Mechanisms

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-13

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0170] Aging Management Associated With Wall Thinning Due... management program (AMP) in NUREG-1801, Revision 2, ``Generic Aging Lessons Learned (GALL) Report,'' and the NRC staff's aging management review procedure and acceptance criteria contained in NUREG-1800...

Simulation of operating rules and discretional decisions using a fuzzy rule-based system integrated into a water resources management model

NASA Astrophysics Data System (ADS)

Macian-Sorribes, Hector; Pulido-Velazquez, Manuel

2013-04-01

Water resources systems are operated, mostly, using a set of pre-defined rules not regarding, usually, to an optimal allocation in terms of water use or economic benefits, but to historical and institutional reasons. These operating policies are reproduced, commonly, as hedging rules, pack rules or zone-based operations, and simulation models can be used to test their performance under a wide range of hydrological and/or socio-economic hypothesis. Despite the high degree of acceptation and testing that these models have achieved, the actual operation of water resources systems hardly follows all the time the pre-defined rules with the consequent uncertainty on the system performance. Real-world reservoir operation is very complex, affected by input uncertainty (imprecision in forecast inflow, seepage and evaporation losses, etc.), filtered by the reservoir operator's experience and natural risk-aversion, while considering the different physical and legal/institutional constraints in order to meet the different demands and system requirements. The aim of this work is to expose a fuzzy logic approach to derive and assess the historical operation of a system. This framework uses a fuzzy rule-based system to reproduce pre-defined rules and also to match as close as possible the actual decisions made by managers. After built up, the fuzzy rule-based system can be integrated in a water resources management model, making possible to assess the system performance at the basin scale. The case study of the Mijares basin (eastern Spain) is used to illustrate the method. A reservoir operating curve regulates the two main reservoir releases (operated in a conjunctive way) with the purpose of guaranteeing a high realiability of supply to the traditional irrigation districts with higher priority (more senior demands that funded the reservoir construction). A fuzzy rule-based system has been created to reproduce the operating curve's performance, defining the system state (total water stored in the reservoirs) and the month of the year as inputs; and the demand deliveries as outputs. The developed simulation management model integrates the fuzzy-ruled system of the operation of the two main reservoirs of the basin with the corresponding mass balance equations, the physical or boundary conditions and the water allocation rules among the competing demands. Historical information on inflow time series is used as inputs to the model simulation, being trained and validated using historical information on reservoir storage level and flow in several streams of the Mijares river. This methodology provides a more flexible and close to real policies approach. The model is easy to develop and to understand due to its rule-based structure, which mimics the human way of thinking. This can improve cooperation and negotiation between managers, decision-makers and stakeholders. The approach can be also applied to analyze the historical operation of the reservoir (what we have called a reservoir operation "audit").

System acceptance test plan : Dallas Integrated Corridor Management (ICM) demonstration project.

DOT National Transportation Integrated Search

2013-02-01

The Dallas Area Rapid Transit (DART) is leading the US 75 Integrated Corridor Management (ICM) Demonstration Project for the Dallas region. Coordinated corridor operations and management is predicated on being able to share transportation information...

Proceedings of the Joint Logistics Commanders Joint Policy Coordinating Group on Computer Resource Management; Computer Software Management Software Workshop, 2-5 April 1979.

DTIC Science & Technology

1979-08-21

Appendix s - Outline and Draft Material for Proposed Triservice Interim Guideline on Application of Software Acceptance Criteria....... 269 Appendix 9...AND DRAFT MATERIAL FOR PROPOSED TRISERVICE INTERIM GUIDELINE ON APPLICATION OF SOFTWARE ACCEPTANCE CRITERIA I I INTRODUCTION The purpose of this guide...contract item (CPCI) (code) 5. CPCI test plan 6. CPCI test procedures 7. CPCI test report 8. Handbooks and manuals. Al though additional material does

Assessment of irrigation performance: contribution to improve water management in a small catchment in the Brazilian savannas

NASA Astrophysics Data System (ADS)

Rodrigues, Lineu; Marioti, Juliana; Steenhuis, Tammo; Wallender, Wesley

2010-05-01

Irrigated agriculture is the major consumer of surface water in Brazil using over 70% of the total supply. Due to the growing competition for water among different sectors of the economy, sustainable water use can only be achieved by decreasing the portion of water used by the irrigated agriculture. Thus, in order to maintain yield, farmers need to irrigate more efficiently. There is little known on irrigation efficiency in Brazil. Therefore a study was carried out in the Buriti Vermelho basin to assess the irrigation performance of existing system. The experimental basin has a drainage area of 940 hectares and is located in the eastern part of the Federal District, in the Brazilian savanna region. Agriculture is the main activity. There is a dominance of red latosols. Several types of land use and crop cover are encountered in the basin. Conflicts among farmers for water are increasing. As water, in quality and quantity, is crucial to maintain the livelihood of the population in the basin, concern about risk of water lack due to climatic and land use change is in place. Once irrigation is the main water user in the basin, to increase water availability and reduce conflicts a water resource management plan has to be established. For this purpose, irrigation system performance has to be understood. The objective of this work was to assess the performance and the management of irrigation (small and big) that has been carried out by farmers in the Buriti Vermelho experimental watershed. A survey undertaken in 2007 was used to identify the irrigation systems in the basin. It was verified that irrigation is practiced by both small (area up to 6 hectare) and big farmers. Small farmers usually crop limes and vegetables and use micro-irrigation, drip, sprinkler, guns or furrow to irrigate them. Big farmers plant annual crops and use center pivot as irrigation system. In this first assessment 13 irrigation systems were evaluated: five conventional sprinklers, four drip systems, one microirrigation system and three center pivots schemes. Field evaluations used the method advocated by Keller and Bliesner and conducted during farmer scheduled irrigation. Soil samples were taken before irrigations to investigate adequacy of water applied. Since the irrigation water management and the uniformity of water distribution are the two major factors used to define the quality of irrigation, the following criteria for uniformity was used: i) Localized irrigations (distribution uniformity - UD) - excellent (90% < UD), acceptable (70% < UD < 90%), not acceptable (UD < 70); ii) Center pivots and conventional sprinkler irrigations (Christiansen coefficient - UC) - excellent (85% < UC), acceptable (85% < UC < 75%), not acceptable (UC < 75%). The water stored in the root zone after an irrigation event was compared with the real necessity. The results showed that: i) Localized irrigations - Three systems had UD < 70% and all systems presented deficit or excess of irrigation; ii) Conventional sprinkler system - Three system had UD smaller than 75% and all systems applied less water than the minimum necessary to keep an amount of water in the soil that don't cause plant stress; iii) Center pivot - In two system were observed UC < 75%. In one of the center pivots the depth applied was about 42% higher than the required and in the other two it was 39% and 47% lower. The study demonstrated the importance of adopting irrigation management criteria, in agricultural basins, once irrigation water becomes limiting and reduces basin water productivity.

Patients' views and needs about systemic sclerosis and its management: a qualitative interview study.

PubMed

Mouthon, Luc; Alami, Sophie; Boisard, Anne-Sophie; Chaigne, Benjamin; Hachulla, Eric; Poiraudeau, Serge

2017-05-30

Systemic sclerosis (SSc) is a chronic connective-tissue disease responsible for reduced life expectancy, disability and a decreased quality of life. In order to optimize patients-physicians relationship and care strategy we aimed to survey views of patients on SSc and its management to reveal potential hurdles and improve health care strategies. A qualitative study combined semi-structured interviews, focus groups, and a direct observation of an information session was performed between November 2008 and January 2009. Twenty-five patients with SSc were included. They encounter difficulties to have a clear representation of their disease. Physical, psychological, and social repercussions of SSc may lead to a psychological distress and different coping strategies, which widely differ among interviewed patients. Patients' views on their therapeutic journey and the management of their disease highlighted strong expectations about patient-physician relationship. These expectations were numerous, complex and sometimes ambivalent. Patients expected physicians to be human and attentive but also involved in research in the field and to provide psychological and affective support to help them to accept the uncertainty of disease evolution and lack of curative treatment. They also expected more individualized management, improvements in diagnosis and follow-up organization, more efforts in education and information, comprehensive behaviors and support from working colleagues and relatives, and increased funding from the health care system. Our results suggest that SSc management could be optimized, particularly with more attention to the patient-practitioner relationship. Patient profiles should be more precisely defined in terms of coping strategies and treatment preferences to propose more individualized options.

A contemporary perspective on capitated reimbursement for imaging services.

PubMed

Schwartz, H W

1995-01-01

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Experimental Evaluation of an Integrated Datalink and Automation-Based Strategic Trajectory Concept

NASA Technical Reports Server (NTRS)

Mueller, Eric

2007-01-01

This paper presents research on the interoperability of trajectory-based automation concepts and technologies with modern Flight Management Systems and datalink communication available on many of today s commercial aircraft. A tight integration of trajectory-based ground automation systems with the aircraft Flight Management System through datalink will enable mid-term and far-term benefits from trajectory-based automation methods. A two-way datalink connection between the trajectory-based automation resident in the Center/TRACON Automation System and the Future Air Navigation System-1 integrated FMS/datalink in NASA Ames B747-400 Level D simulator has been established and extensive simulation of the use of datalink messages to generate strategic trajectories completed. A strategic trajectory is defined as an aircraft deviation needed to solve a conflict or honor a route request and then merge the aircraft back to its nominal preferred trajectory using a single continuous trajectory clearance. Engineers on the ground side of the datalink generated lateral and vertical trajectory clearances and transmitted them to the Flight Management System of the 747; the airborne automation then flew the new trajectory without human intervention, requiring the flight crew only to review and to accept the trajectory. This simulation established the protocols needed for a significant majority of the trajectory change types required to solve a traffic conflict or deviate around weather. This demonstration provides a basis for understanding the requirements for integration of trajectory-based automation with current Flight Management Systems and datalink to support future National Airspace System operations.

Multi-dimensionality of chronic pain of the oral cavity and face

PubMed Central

2013-01-01

Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team. PMID:23617409

Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews.

PubMed

Fisher, Edwin B; Boothroyd, Renée I; Elstad, Emily A; Hays, Laura; Henes, Amy; Maslow, Gary R; Velicer, Clayton

2017-01-01

Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

PubMed

Bo, Kari; Frawley, Helena C; Haylen, Bernard T; Abramov, Yoram; Almeida, Fernando G; Berghmans, Bary; Bortolini, Maria; Dumoulin, Chantale; Gomes, Mario; McClurg, Doreen; Meijlink, Jane; Shelly, Elizabeth; Trabuco, Emanuel; Walker, Carolina; Wells, Amanda

2017-02-01

There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

Air Traffic Management Technology Demostration Phase 1 (ATD) Interval Management for Near-Term Operations Validation of Acceptability (IM-NOVA) Experiment

NASA Technical Reports Server (NTRS)

Kibler, Jennifer L.; Wilson, Sara R.; Hubbs, Clay E.; Smail, James W.

2015-01-01

The Interval Management for Near-term Operations Validation of Acceptability (IM-NOVA) experiment was conducted at the National Aeronautics and Space Administration (NASA) Langley Research Center (LaRC) in support of the NASA Airspace Systems Program's Air Traffic Management Technology Demonstration-1 (ATD-1). ATD-1 is intended to showcase an integrated set of technologies that provide an efficient arrival solution for managing aircraft using Next Generation Air Transportation System (NextGen) surveillance, navigation, procedures, and automation for both airborne and ground-based systems. The goal of the IMNOVA experiment was to assess if procedures outlined by the ATD-1 Concept of Operations were acceptable to and feasible for use by flight crews in a voice communications environment when used with a minimum set of Flight Deck-based Interval Management (FIM) equipment and a prototype crew interface. To investigate an integrated arrival solution using ground-based air traffic control tools and aircraft Automatic Dependent Surveillance-Broadcast (ADS-B) tools, the LaRC FIM system and the Traffic Management Advisor with Terminal Metering and Controller Managed Spacing tools developed at the NASA Ames Research Center (ARC) were integrated into LaRC's Air Traffic Operations Laboratory (ATOL). Data were collected from 10 crews of current 757/767 pilots asked to fly a high-fidelity, fixed-based simulator during scenarios conducted within an airspace environment modeled on the Dallas-Fort Worth (DFW) Terminal Radar Approach Control area. The aircraft simulator was equipped with the Airborne Spacing for Terminal Area Routes (ASTAR) algorithm and a FIM crew interface consisting of electronic flight bags and ADS-B guidance displays. Researchers used "pseudo-pilot" stations to control 24 simulated aircraft that provided multiple air traffic flows into the DFW International Airport, and recently retired DFW air traffic controllers served as confederate Center, Feeder, Final, and Tower controllers. Analyses of qualitative data revealed that the procedures used by flight crews to receive and execute interval management (IM) clearances in a voice communications environment were logical, easy to follow, did not contain any missing or extraneous steps, and required the use of an acceptable workload level. The majority of the pilot participants found the IM concept, in addition to the proposed FIM crew procedures, to be acceptable and indicated that the ATD-1 procedures could be successfully executed in a nearterm NextGen environment. Analyses of quantitative data revealed that the proposed procedures were feasible for use by flight crews in a voice communications environment. The delivery accuracy at the achieve-by point was within +/-5 sec, and the delivery precision was less than 5 sec. Furthermore, FIM speed commands occurred at a rate of less than one per minute, and pilots found the frequency of the speed commands to be acceptable at all times throughout the experiment scenarios.

"Convenience Food."

ERIC Educational Resources Information Center

Lemieux, Colette

1980-01-01

Defines the meaning of the American expression "convenience food," quoting definitions given by dictionaries and specialized publications. Discusses the problem of finding the exact equivalent of this expression in French, and recommends some acceptable translations. (MES)

Ecological function as a target for ecosystem-based management: Defining when change matters in decision making

EPA Science Inventory

Ecosystem-based management (EBM) accounts for both direct and indirect drivers of ecological change for decision making. Just as with direct management of a resource, EBM requires a definition of management thresholds that define when change in function is sufficient to merit ma...

Managing Enrollments for Institutional Vitality.

ERIC Educational Resources Information Center

Hossler, Don

1985-01-01

The concept of enrollment management is gaining acceptance as a means of ensuring institutional vitality. Those responsible for enrollment management must have direct responsibility for: student marketing and recruitment, pricing and financial aid, academic and career advising, academic assistance programs, institutional research, orientation,…

50 CFR 600.15 - Other acronyms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION... management terms. (1) ABC—acceptable biological catch (2) ATCA-Atlantic Tunas Convention Act (3) BFT... advisory committee (11) FMP—fishery management plan (12) ICCAT means the International Commission for the...

Management of Instructional Development: A Matter of Principles.

ERIC Educational Resources Information Center

Patterson, Amos C.; Gilger, Rebecca L.

1979-01-01

Examines how instructional development processes can be successfully managed. Principles of management are offered for setting precise goals; acceptance of these goals; and maximizing self-concept through formal rewards that are goal oriented, through performance evaluation, and through change analysis. (RAO)

Technology Insight: Combined external-beam radiation therapy and brachytherapy in the management of prostate cancer.

PubMed

Hurwitz, Mark D

2008-11-01

External-beam radiation therapy (EBRT) combined with brachytherapy is an attractive treatment option for selected patients with clinically localized prostate cancer. This therapeutic strategy offers dosimetric coverage if local-regional microscopic disease is present and provides a highly conformal boost of radiation to the prostate and immediate surrounding tissues. Either low-dose-rate (LDR) permanent brachytherapy or high-dose-rate (HDR) temporary brachytherapy can be combined with EBRT; such combined-modality therapy (CMT) is typically used to treat patients with intermediate-risk to high-risk, clinically localized disease. Controversy persists with regard to indications for CMT, choice of LDR or HDR boost, isotope selection for LDR, and integration of EBRT and brachytherapy. Initial findings from prospective, multicenter trials of CMT support the feasibility of this strategy. Updated results from these trials as well as those of ongoing and new phase III trials should help to define the role of CMT in the management of prostate cancer. In the meantime, long-term expectations for outcomes of CMT are based largely on the experience of single institutions, which demonstrate that CMT with EBRT and either LDR or HDR brachytherapy can provide freedom from disease recurrence with acceptable toxicity.

75 FR 11229 - Surety Companies Acceptable on Federal Bonds: Pennsylvania Manufacturers' Association Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-10

... DEPARTMENT OF THE TREASURY Fiscal Service Surety Companies Acceptable on Federal Bonds: Pennsylvania Manufacturers' Association Insurance Company AGENCY: Financial Management Service, Fiscal Service...: Pennsylvania Manufacturers' Association Insurance Company (NAIC 12262). Business Address: P.O. Box 3031, Blue...

48 CFR 1446.501 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false General. 1446.501 Section 1446.501 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Acceptance 1446.501 General. Acceptance of supplies or services shall be documented as prescribed...

Adaptability of contingency management in justice settings: survey findings on attitudes toward using rewards.

PubMed

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S

2012-09-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, 5 federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (N = 186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that most of the respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not probation officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. Copyright © 2012 Elsevier Inc. All rights reserved.

Adaptability of Contingency Management in Justice Settings: Survey Findings on Attitudes Towards Using Rewards

PubMed Central

Murphy, Amy; Rhodes, Anne Giuranna; Taxman, Faye S.

2011-01-01

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, five federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (n=186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that the majority of respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not Probation Officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards. PMID:22209658

Exploring visitor acceptability for hardening trails to sustain visitation and minimize impacts

USGS Publications Warehouse

Cahill, K.L.; Marion, J.L.; Lawson, S.R.

2008-01-01

Protected natural area managers are challenged to provide high quality recreation opportunities and ensure the protection of resources from impacts associated with visitation. Development of visitor use facilities and application of site hardening practices are commonly applied tools for achieving these competing management objectives. This study applies stated choice analysis to examine visitor opinions on acceptability when they are asked to make tradeoffs among competing social, resource and management attributes in backcountry and frontcountry settings of Acadia National Park. This study demonstrates that asking visitors about recreation setting attributes uni-dimensionally, a common approach, can yield less informative responses. Analyses that considered direct tradeoffs revealed more divergent opinions on acceptability for setting attributes than a unidimensional approach. Findings revealed that visitors to an accessible and popular attraction feature supported trail development options to protect resource conditions with unrestricted visitor access. In contrast, visitors to a remote undeveloped island expressed stronger support for no or limited trail development and access restrictions to protect resource conditions.

Reputation and its risks.

PubMed

Eccles, Robert G; Newquist, Scott C; Schatz, Roland

2007-02-01

Regulators, industry groups, consultants, and individual companies have developed elaborate guidelines over the years for assessing and managing risks in a wide range of areas, from commodity prices to natural disasters. Yet they have all but ignored reputational risk, mostly because they aren't sure how to define or measure it. That's a big problem, say the authors. Because so much market value comes from hard-to-assess intangible assets like brand equity and intellectual capital, organizations are especially vulnerable to anything that damages their reputations. Moreover, companies with strong positive reputations attract better talent and are perceived as providing more value in their products and services, which often allows them to charge a premium. Their customers are more loyal and buy broader ranges of products and services. Since the market believes that such companies will deliver sustained earnings and future growth, they have higher price-earnings multiples and market values and lower costs of capital. Most companies, however, do an inadequate job of managing their reputations in general and the risks to their reputations in particular. They tend to focus their energies on handling the threats to their reputations that have already surfaced. That is not risk management; it is crisis management--a reactive approach aimed at limiting the damage. The authors provide a framework for actively managing reputational risk. They introduce three factors (the reputation-reality gap, changing beliefs and expectations, and weak internal coordination) that affect the level of such risks and then explore several ways to sufficiently quantify and control those factors. The process outlined in this article will help managers do a better job of assessing existing and potential threats to their companies' reputations and deciding whether to accept a particular risk or take actions to avoid or mitigate it.

Usability and Acceptability of a Web-Based Program for Chemotherapy-Induced Peripheral Neuropathy.

PubMed

Tofthagen, Cindy; Kip, Kevin E; Passmore, Denise; Loy, Ian; Berry, Donna L

2016-07-01

Chemotherapy-induced neuropathy is a painful and debilitating adverse effect of certain chemotherapy drugs. There have not been any patient-centered, easily accessible Web-based interventions to assist with self-management of chemotherapy-induced neuropathy. The aims of this study were to evaluate usability and acceptability and to estimate an effect size of a Web-based intervention for assessing and managing chemotherapy-induced neuropathy. Participants (N = 14) were instructed to complete the Creativity, Optimism, Planning, and Expert Information for Chemotherapy-Induced Peripheral Neuropathy program and provide verbal responses to the program. Participants completed the Chemotherapy Induced Peripheral Neuropathy Assessment Tool and Post-Study System Usability Questionnaire. Iterative changes were made to the COPE-CIPN. Participants were asked to provide feedback on the revised COPE-CIPN, repeat the Chemotherapy Induced Peripheral Neuropathy Assessment Tool, and evaluate acceptability using the Acceptability e-Scale. The COPE-CIPN demonstrated high usability (mean, 1.98 [SD, 1.12]) and acceptability (mean, 4.40 [SD, 0.52]). Comments indicated that the interface was easy to use, and the information was helpful. While neuropathy symptoms continued to increase in this group of patients receiving neurotoxic chemotherapy, there was a decrease in mean level of interference with activities from 53.71 to 39.29 over 3 to 4 months, which indicated a moderate effect (d = 0.39) size. The COPE-CIPN may be a useful intervention to support self-management of chemotherapy-induced neuropathy.

Acceptable Risk Analysis for Abrupt Environmental Pollution Accidents in Zhangjiakou City, China

PubMed Central

Du, Xi; Zhang, Zhijiao; Dong, Lei; Liu, Jing; Borthwick, Alistair G. L.; Liu, Renzhi

2017-01-01

Abrupt environmental pollution accidents cause considerable damage worldwide to the ecological environment, human health, and property. The concept of acceptable risk aims to answer whether or not a given environmental pollution risk exceeds a societally determined criterion. This paper presents a case study on acceptable environmental pollution risk conducted through a questionnaire survey carried out between August and October 2014 in five representative districts and two counties of Zhangjiakou City, Hebei Province, China. Here, environmental risk primarily arises from accidental water pollution, accidental air pollution, and tailings dam failure. Based on 870 valid questionnaires, demographic and regional differences in public attitudes towards abrupt environmental pollution risks were analyzed, and risk acceptance impact factors determined. The results showed females, people between 21–40 years of age, people with higher levels of education, public servants, and people with higher income had lower risk tolerance. People with lower perceived risk, low-level risk knowledge, high-level familiarity and satisfaction with environmental management, and without experience of environmental accidents had higher risk tolerance. Multiple logistic regression analysis indicated that public satisfaction with environmental management was the most significant factor in risk acceptance, followed by perceived risk of abrupt air pollution, occupation, perceived risk of tailings dam failure, and sex. These findings should be helpful to local decision-makers concerned with environmental risk management (e.g., selecting target groups for effective risk communication) in the context of abrupt environmental accidents. PMID:28425956

A Systems Analysis to Define the Types of Rations Needed to Support Amphibious Operations

DTIC Science & Technology

1985-09-01

Navy and the individual Marine) and in cost. • RATION QUALITY - High Acceptance - Maximize Quality - Minimize Menu Cycle As one of four...maintaining high customer acceptance. Carbohydrate-enhanced A- or B-Ration menus would be provided to embarked (shipboard) Marines for approximately 72...assistance; 2) the typical dietery myth that high protein meals are what will "help me perform at my peak" would be circumvented; the Marine would

The Fourth Factor: The Case for Parity of Information as an Operational Factor With Space, Time & Force

DTIC Science & Technology

2008-10-31

problem is devoid of a factor, it incurs additional (and sometimes unacceptable) risk. Operational art exists in an area that inter mingles science ...Operational Art as defined in U.S. Joint Doctrine is an accepted process for use by operational commanders to visualize how to most efficiently and...effectively employ military capabilities to achieve a desired objective. Within Operational Art are three accepted factors in which all other

Effect of pulsed current charging on the performance of nickel-cadium cells

NASA Technical Reports Server (NTRS)

Bedrossian, A. A.; Cheh, H. Y.

1977-01-01

The effect of pulsed current charging on the charge acceptance of NiCd cells in terms of mass transfer, kinetic, and structural considerations was investigated. A systemic investigation on the performance of Ni-Cd cells by pulsed current charging was conducted under a variety of well-defined charge-discharge conditions. Experiments were carried out with half cells and film electrodes. The system behavior was studied by charge acceptance, mechanistic, and structural measurements.

Post-fire logging produces minimal persistent impacts on understory vegetation in northeastern Oregon, USA

Treesearch

David W. Peterson; Erich Dodson

2016-01-01

Post-fire forest management commonly requires accepting some negative ecological impacts from management activities in order to achieve management objectives. Managers need to know, however, whether ecological impacts from post-fire management activities are transient or cause long-term ecosystem degradation. We studied the long-term response of understory vegetation...

Using soil quality indicators for monitoring sustainable forest management

Treesearch

James A. Burger; Garland Gray; D. Andrew Scott

2010-01-01

Most private and public forest land owners and managers are compelled to manage their forests sustainably, which means management that is economically viable,environmentally sound, and socially acceptable. To meet this mandate, the USDA Forest Service protects the productivity of our nation’s forest soils by monitoring and evaluating management activities to ensure...

Thermostable Shelf Life Study

NASA Technical Reports Server (NTRS)

Perchonok, M. H.; Antonini, D. K.

2008-01-01

The objective of this project is to determine the shelf life end-point of various food items by means of actual measurement or mathematical projection. The primary goal of the Advanced Food Technology Project in these long duration exploratory missions is to provide the crew with a palatable, nutritious and safe food system while minimizing volume, mass, and waste. The Mars missions could be as long as 2.5 years with the potential of the food being positioned prior to the crew arrival. Therefore, it is anticipated that foods that are used during the Mars missions will require a 5 year shelf life. Shelf life criteria are safety, nutrition, and acceptability. Any of these criteria can be the limiting factor in determining the food's shelf life. Due to the heat sterilization process used for the thermostabilized food items, safety will be preserved as long as the integrity of the package is maintained. Nutrition and acceptability will change over time. Since the food can be the sole source of nutrition to the crew, a significant loss in nutrition may determine when the shelf life endpoint has occurred. Shelf life can be defined when the food item is no longer acceptable. Acceptability can be defined in terms of appearance, flavor, texture, or aroma. Results from shelf life studies of the thermostabilized food items suggest that the shelf life of the foods range from 0 months to 8 years, depending on formulation.

Thermostabilized Shelf Life Study

NASA Technical Reports Server (NTRS)

Perchonok, Michele H.; Catauro, Patricia M.

2009-01-01

The objective of this project is to determine the shelf life end-point of various food items by means of actual measurement or mathematical projection. The primary goal of the Advanced Food Technology Project in these long duration exploratory missions is to provide the crew with a palatable, nutritious and safe food system while minimizing volume, mass, and waste. The Mars missions could be as long as 2.5 years with the potential of the food being positioned prior to the crew arrival. Therefore, it is anticipated that foods that are used during the Mars missions will require a 5 year shelf life. Shelf life criteria are safety, nutrition, and acceptability. Any of these criteria can be the limiting factor in determining the food's shelf life. Due to the heat sterilization process used for the thermostabilized food items, safety will be preserved as long as the integrity of the package is maintained. Nutrition and acceptability will change over time. Since the food can be the sole source of nutrition to the crew, a significant loss in nutrition may determine when the shelf life endpoint has occurred. Shelf life can be defined when the food item is no longer acceptable. Acceptability can be defined in terms of appearance, flavor, texture, or aroma. Results from shelf life studies of the thermostabilized food items suggest that the shelf life of the foods range from 0 months to 8 years, depending on formulation.

Quantifying the chemical composition of soil organic carbon with solid-state 13C NMR

NASA Astrophysics Data System (ADS)

Baldock, J. A.; Sanderman, J.

2011-12-01

The vulnerability of soil organic carbon (SOC) to biological decomposition and mineralisation to CO2 is defined at least partially by its chemical composition. Highly aromatic charcoal-like SOC components are more stable to biological decomposition than other forms of carbon including cellulose. Solid-state 13C NMR has gained wide acceptance as a method capable of defining SOC chemical composition and mathematical fitting processes have been developed to estimate biochemical composition. Obtaining accurate estimates depends on an ability to quantitatively detect all carbon present in a sample. Often little attention has been paid to defining the proportion of organic carbon present in a soil that is observable in solid-state 13C NMR analyses of soil samples. However, if such data is to be used to inform carbon cycling studies, it is critical that quantitative assessments of SOC observability be undertaken. For example, it is now well established that a significant discrimination exists against the detection of the low proton content polyaromatic structures typical of charcoal using cross polarisation 13C NMR analyses. Such discrimination does not exist where direct polarisation analyses are completed. In this study, the chemical composition of SOC as defined by cross polarisation and direct polarisation13C NMR analyses will be compared for Australian soils collected from under a diverse range of agricultural managements and climatic conditions. Results indicate that where significant charcoal C contents exist, it is highly under-represented in the acquired CP spectra. For some soils, a discrimination against alkyl carbon was also evident. The ability to derive correction factors to compensate for such discriminations will be assessed and presented.

Orientation/Time Management Skill Training Lesson: Development and Evaluation

DTIC Science & Technology

1979-07-01

instructional environment. This Orientation/ Time Management lesson provides students with appropriate role models for increasing acceptance of their...time savings can be obtained by a combination of this type of orientation and time management skill training with a computer-based progress targeting

30 CFR 725.22 - Financial management.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... An agency shall use generally accepted accounting principles and practices, consistently applied... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Financial management. 725.22 Section 725.22... PROGRAM REGULATIONS REIMBURSEMENTS TO STATES § 725.22 Financial management. (a) The agency shall account...

40 CFR 1518.3 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OFFICE OF ENVIRONMENTAL QUALITY MANAGEMENT FUND § 1518.3 Policy. (a) All studies and projects financed through the OEQ Management Fund shall be... Quality Improvement Act. (b) Agency funds accepted by the Director for transfer into the OEQ Management...

50 CFR 600.15 - Other acronyms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION... published at 75 FR 59149, Sept. 27, 2010. (a) Fishery management terms. (1) ABC—acceptable biological catch...—fishery management plan (10) ICCAT means the International Commission for the Conservation of Atlantic...

77 FR 553 - Surety Companies Acceptable on Federal Bonds: Termination; Western Bonding Company

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-05

.... Department of the Treasury, Financial Management Service, Financial Accounting and Services Division, Surety..., 2011. Laura Carrico, Director, Financial Accounting and Services Division, Financial Management Service...: Termination; Western Bonding Company AGENCY: Financial Management Service, Fiscal Service, Department of the...

10 CFR 706.2 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-01-01

... ENERGY SECURITY POLICIES AND PRACTICES RELATING TO LABOR-MANAGEMENT RELATIONS General § 706.2 Basis and... objectives for labor-management relations in the DOE program, namely: (a) Wholehearted acceptance by... efficient management expected from DOE contractors; (e) Minimum interference with the traditional rights and...

78 FR 65688 - Recovery Policy, RP9525.2, Donated Resources

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-01

... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2013-0044] Recovery Policy, RP9525.2, Donated Resources AGENCY: Federal Emergency Management Agency, DHS. ACTION: Notice. SUMMARY: The Federal Emergency Management Agency (FEMA) is accepting comments on Recovery Policy...

EDUCATING MANAGERS ABOUT QUALITY THROUGH CUSTOMER-SUPPLIER UNDERSTANDING

EPA Science Inventory

The successful implementation of a Quality System depends largely on the commitment to Quality by managers and their participation in the quality management process. oday, an accepted definition of quality is largely based on the concept of customer and supplier partnerships in a...

Voluntary euthanasia, physician-assisted suicide, and the goals of medicine.

PubMed

Varelius, Jukka

2006-04-01

It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately determined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assisted suicide on the basis of identifying the proper goals of medicine. This article examines the main ways of defining the proper goals of medicine found in the recent bioethics literature and argues that they cannot provide a clear answer to the question of whether or not voluntary euthanasia and physician-assisted suicide are morally acceptable. It is suggested that to find a plausible answer to this question and to complete the task of defining the proper goals of medicine, we must determine what is the best philosophical theory about the nature of prudential value.

Barcode Technology Acceptance and Utilization in Health Information Management Department at Academic Hospitals According to Technology Acceptance Model

PubMed Central

Ehteshami, Asghar

2017-01-01

Nowdays, due to the increasing importance of quality care, organizations focuse on the improving provision, management and distribution of health. On one hand, incremental costs of the new technologies and on the other hand, increased knowledge of health care recipients and their expectations for high quality services have doubled the need to make changes in order to respond to resource constraints (financial, human, material). For this purpose, several technologies, such as barcode, have been used in hospitals to improve services and staff productivity; but various factors effect on the adoption of new technologies and despite good implementation of a technology and its benefits, sometimes personnel don’t accept and don’t use it. Methods: This is an applied descriptive cross-sectional study in which all the barcode users in health information management department of the three academic hospitals (Feiz, Al-Zahra, Ayatollah Kashani) affiliated to Isfahan University of Medical Sciences were surveyed by the barcode technology acceptance questionnaire, in six areas as following: barcode ease of learning, capabilities, perception of its usefulness and its ease of use, users attitudes towards its using, and users intention. Results: The finding showed that barcode technology total acceptance was relatively desirable (%76.9); the most compliance with TAM model was related to the user perceptions about the ease of use of barcode technology and the least compliance was related to the ease of learning barcode technology (respectively %83.7 and %71.5). Conclusion: Ease of learning and barcode capability effect of usefulness and perceived ease of barcode technology. Users perceptions effect their attitudes toward greater use of technology and their attitudes have an effect on their intention to use the technology and finally, their intention makes actual use of the technology (acceptance). Therefore, considering the six elements related to technology implementation can be important in the barcode acceptance; because their chained relationship is clearly visible. PMID:28484289

Barcode Technology Acceptance and Utilization in Health Information Management Department at Academic Hospitals According to Technology Acceptance Model.

PubMed

Ehteshami, Asghar

2017-03-01

Nowdays, due to the increasing importance of quality care, organizations focuse on the improving provision, management and distribution of health. On one hand, incremental costs of the new technologies and on the other hand, increased knowledge of health care recipients and their expectations for high quality services have doubled the need to make changes in order to respond to resource constraints (financial, human, material). For this purpose, several technologies, such as barcode, have been used in hospitals to improve services and staff productivity; but various factors effect on the adoption of new technologies and despite good implementation of a technology and its benefits, sometimes personnel don't accept and don't use it. This is an applied descriptive cross-sectional study in which all the barcode users in health information management department of the three academic hospitals (Feiz, Al-Zahra, Ayatollah Kashani) affiliated to Isfahan University of Medical Sciences were surveyed by the barcode technology acceptance questionnaire, in six areas as following: barcode ease of learning, capabilities, perception of its usefulness and its ease of use, users attitudes towards its using, and users intention. The finding showed that barcode technology total acceptance was relatively desirable (%76.9); the most compliance with TAM model was related to the user perceptions about the ease of use of barcode technology and the least compliance was related to the ease of learning barcode technology (respectively %83.7 and %71.5). Ease of learning and barcode capability effect of usefulness and perceived ease of barcode technology. Users perceptions effect their attitudes toward greater use of technology and their attitudes have an effect on their intention to use the technology and finally, their intention makes actual use of the technology (acceptance). Therefore, considering the six elements related to technology implementation can be important in the barcode acceptance; because their chained relationship is clearly visible.

48 CFR 246.407 - Nonconforming supplies or services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SYSTEM, DEPARTMENT OF DEFENSE CONTRACT MANAGEMENT QUALITY ASSURANCE Government Contract Quality Assurance... the material, or perform the service, at no cost to the Government; and (iii) May accept consideration... design control activity is the approval authority for acceptance of any nonconforming aviation or ship...

Examining Acceptance of an Integrated Personal Health Record (PHR)

ERIC Educational Resources Information Center

Morton, Alicia A.

2011-01-01

Objective: The purpose of this project was to examine the practice question, "What are the factors influencing acceptance of integrated PHRs for self-care management among the Howard University Hospital (HUH) Diabetes Treatment Clinic (DTC) patients?" These factors include a) demographic characteristics, b) computer…

The "general recognition and acceptance" standard of objectivity for good faith in prescribing: legal and medical implications.

PubMed

Brushwood, David B

2007-01-01

The United States Court of Appeals for the 4th Circuit has ruled that a jury considering charges of drug trafficking against a pain management physician should be instructed that the defendant's good faith is a defense to the charges. The court rejected a subjective standard of good faith, and instead ruled that the good faith of the defendant must be evaluated from an objective perspective. This objective standard requires that the jury determine whether the defendant was practicing in accordance with the standard generally recognized and accepted in the United States. General recognition and acceptance are determined on a case-by-case basis, within the context of a defendant's practice. Simply because a physician's practice is out of the norm for many physicians does not mean it can't be generally recognized and accepted within the standard of medical practice. Expert witness testimony of pain management physicians will assist juries in the application of this standard for good faith in prescribing.

WRAP low level waste restricted waste management (LLW RWM) glovebox acceptance test report

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

Leist, K.J.

1997-11-24

On April 22, 1997, the Low Level Waste Restricted Waste Management (LLW RWM) glovebox was tested using acceptance test procedure 13027A-87. Mr. Robert L. Warmenhoven served as test director, Mr. Kendrick Leist acted as test operator and test witness, and Michael Lane provided miscellaneous software support. The primary focus of the glovebox acceptance test was to examine glovebox control system interlocks, operator Interface Unit (OIU) menus, alarms, and messages. Basic drum port and lift table control sequences were demonstrated. OIU menus, messages, and alarm sequences were examined, with few exceptions noted. Barcode testing was bypassed, due to the lack ofmore » installed equipment as well as the switch from basic reliance on fixed bar code readers to the enhanced use of portable bar code readers. Bar code testing was completed during performance of the LLW RWM OTP. Mechanical and control deficiencies were documented as Test Exceptions during performance of this Acceptance Test. These items are attached as Appendix A to this report.« less

Investigating IT Faculty Resistance to Learning Management System Adoption Using Latent Variables in an Acceptance Technology Model.

PubMed

Bousbahi, Fatiha; Alrazgan, Muna Saleh

2015-01-01

To enhance instruction in higher education, many universities in the Middle East have chosen to introduce learning management systems (LMS) to their institutions. However, this new educational technology is not being used at its full potential and faces resistance from faculty members. To investigate this phenomenon, we conducted an empirical research study to uncover factors influencing faculty members' acceptance of LMS. Thus, in the Fall semester of 2014, Information Technology faculty members were surveyed to better understand their perceptions of the incorporation of LMS into their courses. The results showed that personal factors such as motivation, load anxiety, and organizational support play important roles in the perception of the usefulness of LMS among IT faculty members. These findings suggest adding these constructs in order to extend the Technology acceptance model (TAM) for LMS acceptance, which can help stakeholders of the university to implement the use of this system. This may assist in planning and evaluating the use of e-learning.

Investigating IT Faculty Resistance to Learning Management System Adoption Using Latent Variables in an Acceptance Technology Model

PubMed Central

Bousbahi, Fatiha; Alrazgan, Muna Saleh

2015-01-01

To enhance instruction in higher education, many universities in the Middle East have chosen to introduce learning management systems (LMS) to their institutions. However, this new educational technology is not being used at its full potential and faces resistance from faculty members. To investigate this phenomenon, we conducted an empirical research study to uncover factors influencing faculty members' acceptance of LMS. Thus, in the Fall semester of 2014, Information Technology faculty members were surveyed to better understand their perceptions of the incorporation of LMS into their courses. The results showed that personal factors such as motivation, load anxiety, and organizational support play important roles in the perception of the usefulness of LMS among IT faculty members. These findings suggest adding these constructs in order to extend the Technology acceptance model (TAM) for LMS acceptance, which can help stakeholders of the university to implement the use of this system. This may assist in planning and evaluating the use of e-learning. PMID:26491712

What is “natural”? : Yellowstone elk population - A case study

USGS Publications Warehouse

Keigley, R.B.; Wagner, Frederic H.

2000-01-01

Ecology analyzes the structure and function of ecosystems at all points along the continuum of human disturbance, from so-called pristine forests to urban backyards. Undisturbed systems provide reference points at one end of the spectrum, and nature reserves and parks are highly valued because they can provide unique examples of such ecosystems. Unfortunately the concept of “natural” or pristine is not that easy to define. Indeed, although ecologists have considered pre-Columbian, western-hemisphere ecosystems to have been largely unaltered by human action, and have termed their state “natural” or “pristine,” evidence from archaeology challenges this view. U.S. and Canadian national parks are charged with preserving the “natural,” and thus need to be able to understand and manage for the “natural.” A pivotal “natural” question in Yellowstone National Park management is the size of the northern-range, wintering elk population at Park establishment in 1872, argued both to have been small and large. Integrating and quantifying several sources of evidence provides a consistent picture of a low population (ca. 5,000–6,000), largely migrating out of the northern range in winter, with little vegetation impact. If we accept this conclusion about what is natural for the Yellowstone ecosystem, then it dramatically alters how we view management alternatives for the Park, which currently supports a northern wintering herd of up to ˜ 25,000 elk.

[E-Learning in radiology; the practical use of the content management system ILIAS].

PubMed

Schütze, B; Mildenberger, P; Kämmerer, M

2006-05-01

Due to the possibility of using different kinds of visualization, e-learning has the advantage of allowing individualized learning. A check should be performed to determine whether the use of the web-based content management system ILIAS simplifies the writing and production of electronic learning modules in radiology. Internet-based e-learning provides access to existing learning modules regardless of time and location, since fast Internet connections are readily available. Web Content Management Systems (WCMS) are suitable platforms for imparting radiology-related information (visual abilities like the recognition of patterns as well as interdisciplinary specialized knowledge). The open source product ILIAS is a free WCMS. It is used by many universities and is accepted by both students and lecturers. Its modular and object-oriented software architecture makes it easy to adapt and enlarge the platform. The employment of e-learning standards such as LOM and SCORM within ILIAS makes it possible to reuse contents, even if the platform has to be changed. ILIAS renders it possible to provide students with texts, images, or files of any other kind within a learning context which is defined by the lecturer. Students can check their acquired knowledge via online testing and receive direct performance feedback. The significant interest that students have shown in ILIAS proves that e-learning can be a useful addition to conventional learning methods.

Factors of accepting pain management decision support systems by nurse anesthetists

PubMed Central

2013-01-01

Background Pain management is a critical but complex issue for the relief of acute pain, particularly for postoperative pain and severe pain in cancer patients. It also plays important roles in promoting quality of care. The introduction of pain management decision support systems (PM-DSS) is considered a potential solution for addressing the complex problems encountered in pain management. This study aims to investigate factors affecting acceptance of PM-DSS from a nurse anesthetist perspective. Methods A questionnaire survey was conducted to collect data from nurse anesthetists in a case hospital. A total of 113 questionnaires were distributed, and 101 complete copies were returned, indicating a valid response rate of 89.3%. Collected data were analyzed by structure equation modeling using the partial least square tool. Results The results show that perceived information quality (γ=.451, p<.001), computer self-efficacy (γ=.315, p<.01), and organizational structure (γ=.210, p<.05), both significantly impact nurse anesthetists’ perceived usefulness of PM-DSS. Information quality (γ=.267, p<.05) significantly impacts nurse anesthetists’ perceptions of PM-DSS ease of use. Furthermore, both perceived ease of use (β=.436, p<.001, R2=.487) and perceived usefulness (β=.443, p<.001, R2=.646) significantly affected nurse anesthetists’ PM-DSS acceptance (R2=.640). Thus, the critical role of information quality in the development of clinical decision support system is demonstrated. Conclusions The findings of this study enable hospital managers to understand the important considerations for nurse anesthetists in accepting PM-DSS, particularly for the issues related to the improvement of information quality, perceived usefulness and perceived ease of use of the system. In addition, the results also provide useful suggestions for designers and implementers of PM-DSS in improving system development. PMID:23360305

Acceptance model of a Hospital Information System.

PubMed

Handayani, P W; Hidayanto, A N; Pinem, A A; Hapsari, I C; Sandhyaduhita, P I; Budi, I

2017-03-01

The purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance. This study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia. The respondents involved in this study are low-level and mid-level hospital management officers, doctors, nurses, and administrative staff who work at medical record, inpatient, outpatient, emergency, pharmacy, and information technology units. Data was processed using Structural Equation Modeling (SEM) and AMOS 21.0. The study concludes that non-technological factors, such as human characteristics (i.e. compatibility, information security expectancy, and self-efficacy), and organizational characteristics (i.e. management support, facilitating conditions, and user involvement) which have level of significance of p<0.05, significantly influenced users' opinions of both the ease of use and the benefits of the HIS. This study found that different factors may affect the acceptance of each user in each type of hospital regarding the use of HIS. Finally, this model is best suited for government-owned hospitals. Based on the results of this study, hospital management and IT developers should have more understanding on the non-technological factors to better plan for HIS implementation. Support from management is critical to the sustainability of HIS implementation to ensure HIS is easy to use and provides benefits to the users as well as hospitals. Finally, this study could assist hospital management and IT developers, as well as researchers, to understand the obstacles faced by hospitals in implementing HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Acceptability and Feasibility of a Mobile Phone-Based Case Management Intervention to Retain Mothers and Infants from an Option B+ Program in Postpartum HIV Care.

PubMed

Schwartz, Sheree R; Clouse, Kate; Yende, Nompumelelo; Van Rie, Annelies; Bassett, Jean; Ratshefola, Mamothe; Pettifor, Audrey

2015-09-01

The objective of this study was to assess the acceptability and feasibility of a cell phone based case manager intervention targeting HIV-infected pregnant women on highly-active antiretroviral therapy (HAART). Pregnant women ≥36 weeks gestation attending antenatal care and receiving HAART through the Option B+ program at a primary care clinic in South Africa were enrolled into a prospective pilot intervention to receive text messages and telephone calls from a case manager through 6 weeks postpartum. Acceptability and feasibility of the intervention were assessed along with infant HIV testing rates and 10-week and 12-month postpartum maternal retention in care. Retention outcomes were compared to women of similar eligibility receiving care prior to the intervention. Fifty women were enrolled into the pilot from May to July 2013. Most (70%) were HAART-naive at time of conception and started HAART during antenatal care. During the intervention, the case manager sent 482 text messages and completed 202 telephone calls, for a median of 10 text messages and 4 calls/woman. Ninety-six percent completed the postpartum interview and 47/48 (98%) endorsed the utility of the intervention. Engagement in 10-week postpartum maternal HIV care was >90% in the pre-intervention (n = 50) and intervention (n = 50) periods; by 12-months retention fell to 72% and was the same across periods. More infants received HIV-testing by 10-weeks in the intervention period as compared to pre-intervention (90.0 vs. 63.3%, p < 0.01). Maternal support through a cell phone based case manager approach was highly acceptable among South African HIV infected women on HAART and feasible, warranting further assessment of effectiveness.

Workplace violence: managing a culture of acceptance.

PubMed

Fredrick, Marie

2014-01-01

The cultural acceptance of workplace violence is changing. Management has become more educated on regulatory issues around its tolerance of workplace violence. Events around the country in a variety of settings have aided in raising awareness of this issue. Healthcare professionals are not immune to workplace violence, including those working in the imaging profession. Healthcare workers, historically, have given care despite the demeanor of patients, often putting up with aggressive behavior including sexual harassment and physical assault. Management needs to take all possible measures to ensure employees feel safe at work. It is essential to have well thought out policies and procedures to mitigate workplace violence; keeping in mind that a goal of eliminating workplace violence is unrealistic.

Influence of lactation stage and some flock management practices on sensory characteristics of goat milk from Brazilian Saanen breed.

PubMed

de Cássia Ramos do Egypto Queiroga, Rita; Costa, Roberto Germano; Madruga, Marta Suely; de Medeiros, Ariosvaldo Nunes; Dos Santos Garruti, Deborah; Magnani, Marciane; de Souza, Evandro Leite

2016-04-01

This study evaluated the influence of lactation stage (early, middle, late) and management practices (milking hygiene and buck presence) on the sensory attributes of Saanen goat milk. Goats were randomly divided in four groups in respect of different milking sanitary procedures and the presence/absence of the buck in the barn. Milk samples were analyzed for sensory attributes including quantitative descriptive analysis (QDA) and acceptance. The milking hygiene practice caused no significant influence on microbiological parameters. Results of QDA revealed that the buck presence increased the characteristic odor of milk at the middle and late lactation stages. The off-odor and off-flavor descriptors showed a distinct response since a higher intensity of these sensory characteristics was noted in the samples obtained from goats maintained without the buck. Odor and flavor contributed most in characterizing the different samples regardless of the management practice and lactation stage. The acceptance of odor showed to be influenced only by the lactation stage, while the acceptance of flavor was only through the presence of the buck. Odor acceptance correlated negatively to off-odor and off-flavor, suggesting that these two sensory attributes impaired the preference for the aroma of the milk samples. © 2015 Japanese Society of Animal Science.

The ground prototype processor: Level-1 production during Sentinel-2 in-orbit acceptance

NASA Astrophysics Data System (ADS)

Petrucci, B.; Dechoz, C.; Lachérade, S.; L'Helguen, C.; Raynaud, J.-L.; Trémas, T.; Picard, C.; Rolland, A.

2015-10-01

Jointly with the European Commission, the Sentinel-2 earth observation optical mission is developed by the European Space Agency (ESA). Relying on a constellation of satellites put in orbit starting mid-2015, Sentinel-2 will be devoted to the monitoring of land and coastal areas worldwide thanks to an imagery at high revisit (5 days with two satellites), high resolution (10m, 20m and 60m) with large swath (290km), and multi-spectral imagery (13 bands in visible and shortwave infra-red). In this framework, the French Space Agency (CNES: Centre National d'Etudes Spatiales) supports ESA on the activities related to Image Quality, defining the image products and prototyping the processing techniques. Scope of this paper is to present the Ground Prototype Processor (GPP) that will be in charge of Level-1 production during Sentinel-2 In Orbit Acceptance phase. GPP has been developed by a European industrial consortium composed of Advanced Computer Systems (ACS), Magellium and DLR on the basis of CNES technical specification of Sentinel-2 data processing and under the joint management of ESA-ESTEC and CNES. It will assure the generation of the products used for Calibration and Validation activities and it will provide the reference data for Sentinel-2 Payload Data Ground Segment Validation. At first, Sentinel-2 end-users products definition is recalled with the associated radiometric and geometric performances; secondly the methods implemented will be presented with an overview of the Ground Image Processing Parameters that need to be tuned during the In Orbit Acceptance phase to assure the required performance of the products. Finally, the complexity of the processing having been showed, the challenges of the production in terms of data volume and processing time will be highlighted. The first Sentinel-2 Level-1 products are shown.

Managing the difficult penile prosthesis patient.

PubMed

Trost, Landon W; Baum, Neil; Hellstrom, Wayne J G

2013-04-01

Inflatable penile prostheses (IPPs) are associated with excellent long-term outcomes and patient/partner satisfaction. A small percentage of patients remain dissatisfied, despite acceptable surgical results. This study aims to evaluate factors associated with patient satisfaction and dissatisfaction, define patient characteristics, which may identify elevated risk of postoperative dissatisfaction, and describe management strategies to optimize functional and psychological patient outcomes. A review of urologic and non-urologic cosmetic surgery literature was performed to identify factors associated with patient satisfaction/dissatisfaction. Emphasis was placed on articles defining "high risk" or psychologically challenging patients. Preoperative factors associated with patient satisfaction/dissatisfaction and character traits, which may identify elevated risk of postoperative dissatisfaction or otherwise indicate a psychologically challenging patient. Contemporary patient and partner satisfaction rates following IPP are 92-100% and 91-95%, respectively. Factors associated with satisfaction include decreased preoperative expectations, favorable female partner sexual function, body mass index ≤30, and absence of Peyronie's disease or prior prostatectomy. Determinants of dissatisfaction include perceived/actual loss of penile length, decreased glanular engorgement, altered erectile/ejaculatory sensation, pain, diminished cosmetic outcome, difficulty with device function, partner dissatisfaction and perception of unnatural sensation, complications, and extent of alternative treatments offered. Personality characteristics which may indicate psychologically challenging IPP patients include obsessive/compulsive tendencies, unrealistic expectations, patients undergoing revision surgery, those seeking multiple surgical opinions, feeling of entitlement, patients in denial of their prior erectile/sexual function and current disease status, or those with other psychiatric disorders. The mnemonic CURSED Patient is presented: "Compulsive/obsessive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric." Although the majority of IPP patients experience excellent, durable satisfaction and outcomes, a challenging subset of patients may be at increased risk of postoperative dissatisfaction. Appropriate recognition/prevention and management of this cohort may help to establish and strengthen relationships, reduce physical, emotional, and legal risk, and ultimately enhance patient satisfaction. © 2013 International Society for Sexual Medicine.

[Advanced epitheliomas of the face: when to stop?].

PubMed

Martin, D; Pélissier, P; Barthélémy, I; Mondié, J M

1998-08-01

Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage.

Acceptance of selective contracting: the role of trust in the health insurer

PubMed Central

2013-01-01

Background In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting. Methods An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Results Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. Conclusion This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop. PMID:24083663

Acceptance of selective contracting: the role of trust in the health insurer.

PubMed

Bes, Romy E; Wendel, Sonja; Curfs, Emile C; Groenewegen, Peter P; de Jong, Judith D

2013-10-02

In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees' trust in the health insurer on their acceptance of selective contracting. An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results. Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer. This study provides insight into factors that influence people's acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.

Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability.

PubMed

Burkow, Tatjana M; Vognild, Lars K; Østengen, Geir; Johnsen, Elin; Risberg, Marijke Jongsma; Bratvold, Astrid; Hagen, Tord; Brattvoll, Morten; Krogstad, Trine; Hjalmarsen, Audhild

2013-03-05

The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers.This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user's own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home.