10 CFR 54.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requiring aging management review in accordance with § 54.21(a) for license renewal have been identified and that the effects of aging on the functionality of such structures and components will be managed to.... Time-limited aging analyses, for the purposes of this part, are those licensee calculations and...

10 CFR 54.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... requiring aging management review in accordance with § 54.21(a) for license renewal have been identified and that the effects of aging on the functionality of such structures and components will be managed to.... Time-limited aging analyses, for the purposes of this part, are those licensee calculations and...

10 CFR 54.21 - Contents of application-technical information.

Code of Federal Regulations, 2013 CFR

2013-01-01

... delineated in § 54.4, identify and list those structures and components subject to an aging management review. Structures and components subject to an aging management review shall encompass those structures and... component identified in paragraph (a)(1) of this section, demonstrate that the effects of aging will be...

10 CFR 54.21 - Contents of application-technical information.

Code of Federal Regulations, 2012 CFR

2012-01-01

... delineated in § 54.4, identify and list those structures and components subject to an aging management review. Structures and components subject to an aging management review shall encompass those structures and... component identified in paragraph (a)(1) of this section, demonstrate that the effects of aging will be...

10 CFR 54.21 - Contents of application-technical information.

Code of Federal Regulations, 2014 CFR

2014-01-01

... delineated in § 54.4, identify and list those structures and components subject to an aging management review. Structures and components subject to an aging management review shall encompass those structures and... component identified in paragraph (a)(1) of this section, demonstrate that the effects of aging will be...

76 FR 2426 - Notice of Acceptance for Docketing of the Application and Notice of Opportunity for Hearing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

...) Managing the effects of aging during the period of extended operation on the functionality of structures and components that have been identified as requiring aging management review, and (2) time-limited aging analyses that have been identified as requiring review, such that there is reasonable assurance...

Changes in ground layer vegetation following timber harvests on the Missouri Ozark Forest Ecosystem Project

Treesearch

Jennifer K. Grabner; Eric K. Zenner

2002-01-01

The Missouri Ozark Forest Ecosystem Project (MOFEP) is a landscape-scale experiment to test for effects of the following three common forest management practices on upland forests: 1) even-aged management (EAM), 2) uneven-aged management (UAM), and 3) no-harvest management (NHM). The first round of harvesting treatments was applied on the nine MOFEP sites in 1996. One...

Effects of the weight management program based self-efficacy for body composition, blood lipid profile, weight self-efficacy lifestyles, depression in middle-aged obese women.

PubMed

Park, Nam Hee; An, Hye Gyung

2006-12-01

This study was done to determine the effects of weight management program using self-efficacy in middle-aged obese women. The study also attempted to measure the effects of the program on the weight efficacy lifestyle, body composition, and depression. The research design of this study was a nonequivalent control group pretest-posttest design. The experimental group consisted of 21 middle-aged obese women and another 21 middle-aged obese women in the control group. The women in the experimental group participated in the weight management program for 12 weeks using self-efficacy. The weight management program using self-efficacy included education on effects of exercise for weight control, aerobic exercise program, muscle training and counseling through the telephone. After 12 weeks of participation in the program, BMI (p<.0001), body fat % (p<.0001), abdominal fat (p<.0001), in the experimental group were significantly decreased compared to the control group. Weight self-efficacy lifestyle (p<.0001) and depression (p=.006) in the experimental group were significantly improved after the program compared to the control group. According to these findings, weight management program self-efficacy for middle-aged obese women could increase weight efficacy lifestyle, and decrease depression, BMI, body fat, and abdominal fat. The result also suggested that the increasing weight efficacy and lifestyle help the obese women to perform and continue exercise. This program could be used in the community such as public health center for weight care and mental health promotion of middle-aged obese women.

European Top Managers' Age-Related Workplace Norms and Their Organizations' Recruitment and Retention Practices Regarding Older Workers.

PubMed

Oude Mulders, Jaap; Henkens, Kène; Schippers, Joop

2017-10-01

Top managers guide organizational strategy and practices, but their role in the employment of older workers is understudied. We study the effects that age-related workplace norms of top managers have on organizations' recruitment and retention practices regarding older workers. We investigate two types of age-related workplace norms, namely age equality norms (whether younger and older workers should be treated equally) and retirement age norms (when older workers are expected to retire) while controlling for organizational and national contexts. Data collected among top managers of 1,088 organizations from six European countries were used for the study. Logistic regression models were run to estimate the effects of age-related workplace norms on four different organizational outcomes: (a) recruiting older workers, (b) encouraging working until normal retirement age, (c) encouraging working beyond normal retirement age, and (d) rehiring retired former employees. Age-related workplace norms of top managers affect their organizations' practices, but in different ways. Age equality norms positively affect practices before the boundary of normal retirement age (Outcomes a and b), whereas retirement age norms positively affect practices after the boundary of normal retirement age (Outcomes c and d). Changing age-related workplace norms of important actors in organizations may be conducive to better employment opportunities and a higher level of employment participation of older workers. However, care should be taken to target the right types of norms, since targeting different norms may yield different outcomes. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Li, Zhicheng; Cunich, Michelle M; Thomas, Tamsin H; Chenoweth, Lynn; Kendig, Hal L

2015-07-01

To evaluate the effectiveness of a leadership and management program in aged care. Double-blind cluster randomized controlled trial. Twelve residential and community-aged care sites in Australia. All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0.07-0.52; P = .01); and were rated higher on the overall leadership outcomes (mean difference 0.35, 95% CI 0.13-0.56; P = .001) as well as individual manager outcomes: extra effort (P = .004), effectiveness (P = .001), and satisfaction (P = .01). There was no evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety. While the CLiAC leadership program had direct impact on the primary process outcomes (management support, leadership actions, behaviors, and effects), this was insufficient to change the systems required to support care service quality and client safety. Nevertheless, the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost. Copyright © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Management of precancerous anal intraepithelial lesions in human immunodeficiency virus-positive men who have sex with men: Clinical effectiveness and cost-effectiveness.

PubMed

Deshmukh, Ashish A; Chiao, Elizabeth Y; Cantor, Scott B; Stier, Elizabeth A; Goldstone, Stephen E; Nyitray, Alan G; Wilkin, Timothy; Wang, Xiaojie; Chhatwal, Jagpreet

2017-12-01

Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM) are at disproportionately high risk for anal cancer. There is no definitive approach to the management of high-grade squamous intraepithelial lesions (HSIL), which are precursors of anal cancer, and evidence suggests that posttreatment adjuvant quadrivalent human papillomavirus (qHPV) vaccination improves HSIL treatment effectiveness. The objectives of this study were to evaluate the optimal HSIL management strategy with respect to clinical effectiveness and cost-effectiveness and to identify the optimal age for initiating HSIL management. A decision analytic model of the natural history of anal carcinoma and HSIL management strategies was constructed for HIV-positive MSM who were 27 years old or older. The model was informed by the Surveillance, Epidemiology, and End Results-Medicare database and published studies. Outcomes included the lifetime cost, life expectancy, quality-adjusted life expectancy, cumulative risk of cancer and cancer-related deaths, and cost-effectiveness from a societal perspective. Active monitoring was the most effective approach in patients 29 years or younger; thereafter, HSIL treatment plus adjuvant qHPV vaccination became most effective. When cost-effectiveness was considered (ie, an incremental cost-effectiveness ratio [ICER] < $100,000/quality-adjusted life-year), do nothing was cost-effective until the age of 38 years, and HSIL treatment plus adjuvant qHPV vaccination was cost-effective beyond the age of 38 years (95% confidence interval, 34-43 years). The ICER decreased as the age at HSIL management increased. Outcomes were sensitive to the rate of HSIL regression or progression and the cost of high-resolution anoscopy and biopsy. The management of HSIL in HIV-positive MSM who are 38 years old or older with treatment plus adjuvant qHPV vaccination is likely to be cost-effective. The conservative approach of no treatment is likely to be cost-effective in younger patients. Cancer 2017;123:4709-4719. © 2017 American Cancer Society. © 2017 American Cancer Society.

The Effects of Self-Management Education for School-Age Children on Asthma Morbidity: A Systematic Review

ERIC Educational Resources Information Center

Ahmad, Emily; Grimes, Deanna E.

2011-01-01

The effects of asthma self-management education for school-age children on number of school days missed, emergency department visits and hospital admissions were evaluated through a systematic review of the published research. A total of 9 studies on asthma education programs that were conducted in schools by school nurses and health educators and…

A randomized study of contingency management and spirometric lung age for motivating smoking cessation among injection drug users.

PubMed

Drummond, Michael B; Astemborski, Jacquie; Lambert, Allison A; Goldberg, Scott; Stitzer, Maxine L; Merlo, Christian A; Rand, Cynthia S; Wise, Robert A; Kirk, Gregory D

2014-07-28

Even after quitting illicit drugs, tobacco abuse remains a major cause of morbidity and mortality in former injection drug users. An important unmet need in this population is to have effective interventions that can be used in the context of community based care. Contingency management, where a patient receives a monetary incentive for healthy behavior choices, and incorporation of individual counseling regarding spirometric "lung age" (the age of an average healthy individual with similar spirometry) have been shown to improve cessation rates in some populations. The efficacy of these interventions on improving smoking cessation rates has not been studied among current and former injection drug users. In a randomized, factorial design study, we recruited 100 active smokers from an ongoing cohort study of current and former injection drug users to assess the impact of contingency management and spirometric lung age on smoking cessation. The primary outcome was 6-month biologically-confirmed smoking cessation comparing contingency management, spirometric lung age or both to usual care. Secondary outcomes included differences in self-reported and biologically-confirmed cessation at interim visits, number of visits attended and quit attempts, smoking rates at interim visits, and changes in Fagerstrom score and self-efficacy. Six-month biologically-confirmed smoking cessations rates were 4% usual care, 0% lung age, 14% contingency management and 0% for combined lung age and contingency management (p = 0.13). There were no differences in secondary endpoints comparing the four interventions or when pooling the lung age groups. Comparing contingency management to non-contingency management, 6-month cessation rates were not different (7% vs. 2%; p = 0.36), but total number of visits with exhaled carbon monoxide-confirmed abstinence were higher for contingency management than non-contingency management participants (0.38 vs. 0.06; p = 0.03), and more contingency management participants showed reduction in their Fagerstrom score from baseline to follow-up (39% vs. 18%; p = 0.03). While lung age appeared ineffective, contingency management was associated with more short-term abstinence and lowered nicotine addiction. Contingency management may be a useful tool in development of effective tobacco cessation strategies among current and former injection drug users. Clinicaltrials.gov NCT01334736 (April 12, 2011).

Composition and development of reproduction in two-age Appalachian hardwood stands: 20-year results

Treesearch

Gary W. Miller; James N. Kochenderfer; Desta Fekedulegn

2004-01-01

In the early 1980s, silviculturists with the Northeastern Research Station and Monongahela National Forest envisioned that managing some Appalachian hardwood stands to promote two-age structures would be part of an effective strategy for managing multi-use forests. Two-age stands provided the light and seedbed conditions necessary for regenerating numerous desirable...

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

2013-10-25

A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Australian New Zealand Clinical Trials Registry (ACTRN12611001070921).

20 years of intensive uneven-aged management: Effect on Growth, Yield, and Species Composition in Two hardwood Stands in West Virginia

Treesearch

George R., Jr. Trimble; George R. Trimble

1970-01-01

In 1948 a study of uneven-aged forest management, with individual tree-selection cuttings, was begun on two 31-acre stands of Appalachian hardwoods in West Virginia. Now, after 20 years, these stands are beginning to show how this kind of management affects growth, yield, and species composition.

Occupational health and safety management practices and musculoskeletal disorders in aged care.

PubMed

Oakman, Jodi; Bartram, Timothy

2017-05-15

Purpose The purpose of this paper is to examine whether occupational health and safety (OHS) management used to manage musculoskeletal disorders (MSDs) in the aged care sector reflects contemporary research evidence of best practice to reduce the incidence of these disorders. Design/methodology/approach In total, 58 interviews were conducted with managers and supervisors in the aged care sector across four organisations in Australia. Policies and procedures relating to MSDs were reviewed for each organisation. Findings Policies and procedures for managing MSDs do not reflect contemporary evidence, which supports a complex aetiology, related to a range of physical and psychosocial workplace factors. Despite strong evidence that psychosocial factors contribute to MSD development, these were not included in the policies and procedures reviewed. Findings from the interviews management practices including leadership and various components of HRM were functioning well but fragmentation was evident due to the challenging nature of the aged care sector. Practical implications To address the significant burden of MSDs in the aged care sector, policies and procedures need to include coverage of psychosocial and physical workplace factors. The development of systematic and integrated OHS management at the workplace level may play an important role in the effective management of MSDs. Originality/value This study offers insights into the previously unexplored area of MSD risk management and the role of management practices such as HRM in the aged care sector.

Impression Management in the Job Interview: An Effective Way of Mitigating Discrimination against Older Applicants?

PubMed

Gioaba, Irina; Krings, Franciska

2017-01-01

The increasingly aging population in most industrialized societies, coupled with the rather age-diverse current workforce makes discrimination against older employees a prevalent issue, especially in employment contexts. This renders research on ways for reducing this type of discrimination a particularly pressing concern. Drawing on theories of social identity and impression management, our research examines the role of impression management, aimed at refuting common older worker stereotypes, in diminishing bias against older job applicants during the job interview. The study consisted in an experimental hiring simulation conducted on a sample of 515 undergraduate students. Results show that older applicants who used impression management to contradict common older worker stereotypes were perceived as more hirable than those who did not. However, despite this positive effect, discrimination persisted: older applicants were consistently rated as less hirable than their younger counterparts when displaying the same IM behavior. Taken together, this research demonstrates that older job seekers can indeed ameliorate biased interview outcomes by engaging in impression management targeting common age stereotypes; however, it also shows that this strategy is insufficient for overcoming age discrimination entirely. The current study has important implications for theory, by expanding research on the use of impression management in mitigating age discrimination, as well as for practice, by offering older employees a hands-on strategy to reduce bias and stereotyping against them.

Impression Management in the Job Interview: An Effective Way of Mitigating Discrimination against Older Applicants?

PubMed Central

Gioaba, Irina; Krings, Franciska

2017-01-01

The increasingly aging population in most industrialized societies, coupled with the rather age-diverse current workforce makes discrimination against older employees a prevalent issue, especially in employment contexts. This renders research on ways for reducing this type of discrimination a particularly pressing concern. Drawing on theories of social identity and impression management, our research examines the role of impression management, aimed at refuting common older worker stereotypes, in diminishing bias against older job applicants during the job interview. The study consisted in an experimental hiring simulation conducted on a sample of 515 undergraduate students. Results show that older applicants who used impression management to contradict common older worker stereotypes were perceived as more hirable than those who did not. However, despite this positive effect, discrimination persisted: older applicants were consistently rated as less hirable than their younger counterparts when displaying the same IM behavior. Taken together, this research demonstrates that older job seekers can indeed ameliorate biased interview outcomes by engaging in impression management targeting common age stereotypes; however, it also shows that this strategy is insufficient for overcoming age discrimination entirely. The current study has important implications for theory, by expanding research on the use of impression management in mitigating age discrimination, as well as for practice, by offering older employees a hands-on strategy to reduce bias and stereotyping against them. PMID:28559869

Effectiveness of neurofeedback therapy for anxiety and stress in adults living with a chronic illness: a systematic review protocol.

PubMed

Blaskovits, Farriss; Tyerman, Jane; Luctkar-Flude, Marian

2017-07-01

The objective of this review is to systematically examine the effectiveness of neurofeedback therapy for managing anxiety and stress in adults living with a chronic illness.The specific objectives are to identify which neurofeedback systems and/or protocols demonstrate effectiveness and determine the level of supporting evidence.The review question is as follows: What is the effectiveness of neurofeedback therapy for managing anxiety and stress in an adult population aged 18 years of age or older living with a chronic illness?

Management guide to ecosystem restoration treatments: two-aged lodgepole pine forests of central Montana, USA

Treesearch

Sharon M. Hood; Helen Y. Smith; David K. Wright; Lance S. Glasgow

2012-01-01

Lodgepole pine is one of the most widely distributed conifers in North America, with a mixed-severity rather than stand-replacement fire regime throughout much of its range. These lodgepole pine forests are patchy and often two-aged. Fire exclusion can reduce two-aged lodgepole pine heterogeneity. This management guide summarizes the effects of thinning and prescribed...

Increasing On-Task Behavior in Students in a Regular Classroom: Effectiveness of a Self-Management Procedure Using a Tactile Prompt

ERIC Educational Resources Information Center

Moore, Dennis W.; Anderson, Angelika; Glassenbury, Michele; Lang, Russell; Didden, Robert

2013-01-01

Self-management strategies have been shown to be widely effective. However, limited classroom-based research exists involving low performing but developmentally normal high school-aged participants. This study examined the effectiveness of a self-management strategy aimed at increasing on-task behavior in general education classrooms with students…

Ageism in Studies on the Management of Osteoporosis.

PubMed

McGarvey, Caoimhe; Coughlan, Tara; O'Neill, Desmond

2017-07-01

To review the literature to assess whether the fact that osteoporosis is chiefly considered a disease of the older population was reflected in research in the area of the management of osteoporosis and to determine the extent of ageism in studies on the management of osteoporosis. Review. All randomized control trials on the management of osteoporosis entered in the Cochrane Library Database that reported mean age were included. Exclusion criteria were also examined. Of 284 randomized control trials identified, 102 were eligible for inclusion. Older adult trail participants. Mean age of participants and exclusion criteria used were analyzed. The mean age of all participants was 64.0, despite the fact that the average age at hip fracture is 83 for women and 84 for men. Overall, the mean age of those presenting with hip fractures is 84.8. Twenty-four (23%) of the 102 trials used older age as an exclusion factor. Other exclusion factors were long time since menopause, impaired cardiac or pulmonary function, dependent in ambulation, any severe comorbidity, dementia or any cognitive impairment, recent history of peptic ulcer disease or erosive gastric disease, uncontrolled hypertension, and psychiatric illness. These data show a distinct difference between the mean age of participants in studies of the management of osteoporosis and the mean age of those presenting with hip fractures. Given that osteoporosis is the leading cause of hip fractures, this finding could have a significant effect on future studies in this area. It would follow that future research should include a cohort of an age that is more reflective of those most likely to experience the adverse effects of osteoporosis. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Successful ingredients in the SMILE study: resident, staff, and management factors influence the effects of humor therapy in residential aged care.

PubMed

Brodaty, Henry; Low, Lee-Fay; Liu, Zhixin; Fletcher, Jennifer; Roast, Joel; Goodenough, Belinda; Chenoweth, Lynn

2014-12-01

To test the hypothesis that individual and institutional-level factors influence the effects of a humor therapy intervention on aged care residents. Data were from the humor therapy group of the Sydney Multisite Intervention of LaughterBosses and ElderClowns, or SMILE, study, a single-blind cluster randomized controlled trial of humor therapy conducted over 12 weeks; assessments were performed at baseline, week 13, and week 26. One hundred eighty-nine individuals from 17 Sydney residential aged care facilities were randomly allocated to the humor therapy intervention. Professional performers called "ElderClowns" provided 9-12 weekly humor therapy 2-hour sessions, augmented by trained staff, called "LaughterBosses." Outcome measures were as follows: Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and proxy-rated quality of life in dementia population scale. Facility-level measures were as follows: support of the management for the intervention, commitment levels of LaughterBosses, Environmental Audit Tool scores, and facility level of care provided (high/low). Resident-level measures were engagement, functional ability, disease severity, and time-in-care. Multilevel path analyses simultaneously modeled resident engagement at the individual level (repeated measures) and the effects of management support and staff commitment to humor therapy at the cluster level. Models indicated flow-on effects, whereby management support had positive effects on LaughterBoss commitment, and LaughterBoss commitment increased resident engagement. Higher resident engagement was associated with reduced depression, agitation, and neuropsychiatric scores. Effectiveness of psychosocial programs in residential aged care can be enhanced by management support, staff commitment, and active resident engagement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Aging and the Work Force: Human Resource Strategies. An Information Paper Prepared for Use by the Special Committee on Aging. United States Senate, Ninety-Seventh Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Special Committee on Aging.

This information paper explores the need for age-neutral functional criteria in the human resources management system and the need for managers to review currently accepted employment policies. Population patterns, labor force profiles, and labor force projections are reviewed. The paper examines the effect of retirement policies and considers…

Impact of Mother-Daughter Relationship on Hypertension Self-management and Quality of Life: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model.

PubMed

Shawler, Celeste; Edward, Jean; Ling, Jiying; Crawford, Tim N; Rayens, Mary Kay

Although hypertension (HTN) treatment rates are similar across age groups of women, effective control is significantly worse among older women. Only 20% of hypertensive women aged 70 to 79 years have controlled blood pressure. The purpose of this longitudinal study was to test the effects of the quality of mother-daughter relationship, inner strength, and control on HTN self-management and health-related quality of life (HRQOL) for both members of the dyad at 6 months. The Actor-Partner Interdependence Model was used to examine the direct ("actor") and indirect ("partner") effects of 46 dyads. The mothers' perceived relationship quality with daughters directly impacted their own self-management of HTN and HRQOL while also indirectly affecting their daughters' self-management. Similarly, the daughters' perceived strength of their relationship with their mothers directly influenced their self-management and HRQOL and indirectly affected their mothers' self-management and HRQOL.

Functional diversity response to hardwood forest management varies across taxa and spatial scales.

PubMed

Murray, Bryan D; Holland, Jeffrey D; Summerville, Keith S; Dunning, John B; Saunders, Michael R; Jenkins, Michael A

2017-06-01

Contemporary forest management offers a trade-off between the potential positive effects of habitat heterogeneity on biodiversity, and the potential harm to mature forest communities caused by habitat loss and perforation of the forest canopy. While the response of taxonomic diversity to forest management has received a great deal of scrutiny, the response of functional diversity is largely unexplored. However, functional diversity may represent a more direct link between biodiversity and ecosystem function. To examine how forest management affects diversity at multiple spatial scales, we analyzed a long-term data set that captured changes in taxonomic and functional diversity of moths (Lepidoptera), longhorned beetles (Coleoptera: Cerambycidae), and breeding birds in response to contemporary silvicultural systems in oak-hickory hardwood forests. We used these data sets to address the following questions: how do even- and uneven-aged silvicultural systems affect taxonomic and functional diversity at the scale of managed landscapes compared to the individual harvested and unharvested forest patches that comprise the landscapes, and how do these silvicultural systems affect the functional similarity of assemblages at the scale of managed landscapes and patches? Due to increased heterogeneity within landscapes, we expected even-aged silviculture to increase and uneven-aged silviculture to decrease functional diversity at the landscape level regardless of impacts at the patch level. Functional diversity responses were taxon-specific with respect to the direction of change and time since harvest. Responses were also consistent across patch and landscape levels within each taxon. Moth assemblage species richness, functional richness, and functional divergence were negatively affected by harvesting, with stronger effects resulting from uneven-aged than even-aged management. Longhorned beetle assemblages exhibited a peak in species richness two years after harvesting, while functional diversity metrics did not differ between harvested and unharvested patches and managed landscapes. The species and functional richness of breeding bird assemblages increased in response to harvesting with more persistent effects in uneven- than in even-aged managed landscapes. For moth and bird assemblages, species turnover was driven by species with more extreme trait combinations. Our study highlights the variability of multi-taxon functional diversity in response to forest management across multiple spatial scales. © 2017 by the Ecological Society of America.

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

Zarnoch, Stanley J.; Blake, John I.; Parresol, Bernard R.

Snags are standing dead trees that are an important component in the nesting habitat of birds and other species. Although snag availability is believed to limit populations in managed and non-managed forests, little data are available to evaluate the relative effect of stand conditions and management on snag occurrence. We analyzed point sample data from an intensive forest inventory within an 80,000 ha landscape for four major forest types to support the hypotheses that routine low-intensity prescribed fire would increase, and thinning would decrease, snag occurrence. We employed path analysis to define a priori causal relationships to determine the directmore » and indirect effects of site quality, age, relative stand density index and fire for all forest types and thinning effects for loblolly pine and longleaf pine. Stand age was an important direct effect for loblolly pine, mixed pine-hardwoods and hardwoods, but not for longleaf pine. Snag occurrence in loblolly pine was increased by prescribed fire and decreased by thinning which confirmed our initial hypotheses. Although fire was not important in mixed pine-hardwoods, it was for hardwoods but the relationship depended on site quality. For longleaf pine the relative stand density index was the dominant variable affecting snag occurrence, which increased as the density index decreased. Site quality, age and thinning had significant indirect effects on snag occurrence in longleaf pine through their effects on the density index. Although age is an important condition affecting snag occurrence for most forest types, path analysis revealed that fire and density management practices within certain forest types can also have major beneficial effects, particularly in stands less than 60 years old.« less

Factors complicating the diabetes management of visitors to Japan: advices from a Japanese National Center for overseas medical staff.

PubMed

Kishimoto, Miyako; Noda, Mitsuhiko

2016-01-01

Linguistic, cultural, and geographical differences might challenge the management of diabetes patients travelling in a culturally and linguistically homogeneous country. This article presents an instructive case and identifies various factors that can help in effective diabetes management of such cases. A Russian female patient aged 23 came to Japan and visited our hospital for a second opinion regarding glycemic control. She was diagnosed with type 1 diabetes at age three and started insulin injections and diet therapy with carbohydrate counting methods. Her HbA1c level was 11.0% with multiple daily insulin injections. She showed neuropathy, nephropathy, and blindness due to her progressed retinopathy. Because of the language barrier, suggestions for lifestyle modification were not effectively conveyed to the patient. We analyzed possible barriers to effective diabetes management in such foreign patients. In addition to language barriers and difficulties in diet therapy, dissimilar diabetes treatment guidelines, inadequate healthcare insurance, and stress-inducing conditions can be barriers to effective diabetes management. Foreign diabetes patients might face several barriers in effective management while travelling in Japan. Use of medical interpreters, adequate medical insurance, and trained medical staff will help in overcoming these barriers.

Limb deficiency and prosthetic management. 2. Aging with limb loss.

PubMed

Flood, Katherine M; Huang, Mark E; Roberts, Toni L; Pasquina, Paul F; Nelson, Virginia S; Bryant, Phillip R

2006-03-01

This self-directed learning module highlights the issues faced by people aging with limb loss. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the impact that limb loss has on health and physical function throughout the life span. Case examples are used to illustrate what effect limb loss in childhood or young adulthood has on the incidence and management of new impairments or disease processes commonly associated with aging. To discuss the impact of early-life limb loss on the incidence and management of physiologic and functional changes associated with aging.

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings: study protocol for a cluster randomized controlled trial.

PubMed

Roets-Merken, Lieve M; Graff, Maud J L; Zuidema, Sytse U; Hermsen, Pieter G J M; Teerenstra, Steven; Kempen, Gertrudis I J M; Vernooij-Dassen, Myrra J F J

2013-10-07

Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age. In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis. The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated. ClinicalTrials.gov, NCT01217502.

Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings: study protocol for a cluster randomized controlled trial

PubMed Central

2013-01-01

Background Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age. Methods/Design In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis. Discussion The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program’s potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an extensive process evaluation will take place which will offer insight in the quality and feasibility of the sampling and intervention process. If it is shown to be effective and feasible, this Self-Management Program could be widely disseminated. Clinical trials registration ClinicalTrials.gov, NCT01217502. PMID:24099315

A case history of all-age management

Treesearch

Richard M. Godman; Gilbert A. Mattson

1992-01-01

Single-tree selection "works" in sugar maple stands in the Lake States. This system of all-age management has been used for 31 years on the Argonne Experimental Forest. In 1953, researchers found that cutting according to basal area guides is both a convenient and effective way to regulate a stand. Later experience showed that achieving good stand structure...

School Nurse Interventions in Managing Functional Urinary Incontinence in School-Age Children

ERIC Educational Resources Information Center

Rivers, Charisse L.

2010-01-01

Uncomplicated urinary incontinence (UI) in school-age children is a prevalent yet underrecognized problem that has remained in the shadow of other concerns commonly perceived as more prominent or urgent. There is good evidence that functional UI in children can be treated and managed effectively. When there is no structural or neurologic…

Establishment and Data Collection of Vegetation-related Studies on the Missouri Ozark Forest Ecosystem Project Study Sites

Treesearch

Brian L. Brookshire; Daniel C. Dey

2000-01-01

The Missouri Ozark Forest Ecosystem Project (MOFEP) is an experiment designed to determine the effects of forest management practices on important ecosystem attributes. MOFEP treatments evaluated include even-aged, uneven-aged, and no management treatments. Forest vegetation provides a common ecological link among many organisms and ecological processes, and therefore...

The experimental design of the Missouri Ozark Forest Ecosystem Project

Treesearch

Steven L. Sheriff; Shuoqiong He

1997-01-01

The Missouri Ozark Forest Ecosystem Project (MOFEP) is an experiment that examines the effects of three forest management practices on the forest community. MOFEP is designed as a randomized complete block design using nine sites divided into three blocks. Treatments of uneven-aged, even-aged, and no-harvest management were randomly assigned to sites within each block...

10 CFR 54.37 - Additional records and recordkeeping requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... identified that would have been subject to an aging management review or evaluation of time-limited aging analyses in accordance with § 54.21. This FSAR update must describe how the effects of aging will be...

10 CFR 54.37 - Additional records and recordkeeping requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... identified that would have been subject to an aging management review or evaluation of time-limited aging analyses in accordance with § 54.21. This FSAR update must describe how the effects of aging will be...

10 CFR 54.37 - Additional records and recordkeeping requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... identified that would have been subject to an aging management review or evaluation of time-limited aging analyses in accordance with § 54.21. This FSAR update must describe how the effects of aging will be...

10 CFR 54.37 - Additional records and recordkeeping requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... identified that would have been subject to an aging management review or evaluation of time-limited aging analyses in accordance with § 54.21. This FSAR update must describe how the effects of aging will be...

10 CFR 54.37 - Additional records and recordkeeping requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... identified that would have been subject to an aging management review or evaluation of time-limited aging analyses in accordance with § 54.21. This FSAR update must describe how the effects of aging will be...

Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

PubMed Central

2012-01-01

Background Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes. Methods We searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented. Results Ten RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above. Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes. PMID:23151143

Testing a basic assumption of shrubland fire management: Does the hazard of burning increase with the age of fuels?

USGS Publications Warehouse

Moritz, Max A.; Keeley, Jon E.; Johnson, Edward A.; Schaffner, Andrew A.

2004-01-01

This year's catastrophic wildfires in southern California highlight the need for effective planning and management for fire-prone landscapes. Fire frequency analysis of several hundred wildfires over a broad expanse of California shrublands reveals that there is generally not, as is commonly assumed, a strong relationship between fuel age and fire probabilities. Instead, the hazard of burning in most locations increases only moderately with time since the last fire, and a marked age effect of fuels is observed only in limited areas. Results indicate a serious need for a re-evaluation of current fire management and policy, which is based largely on eliminating older stands of shrubland vegetation. In many shrubland ecosystems exposed to extreme fire weather, large and intense wildfires may need to be factored in as inevitable events.

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

PubMed Central

2013-01-01

Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. Discussion The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12611001070921) PMID:24160714

Variation in hematologic and serum biochemical values of belugas (Delphinapterus leucas) under managed care.

PubMed

Norman, Stephanie A; Beckett, Laurel A; Miller, Woutrina A; St Leger, Judy; Hobbs, Roderick C

2013-06-01

Blood analytes are critical for evaluating the general health of cetacean populations, so it is important to understand the intrinsic variability of hematology and serum chemistry values. Previous studies have reported data for follow-up periods of several years in managed and wild populations, but studies over long periods of time (> 20 yr) have not been reported. The study objective was to identify the influences of partitioning characteristics on hematology and serum chemistry analytes of apparently healthy managed beluga (Delphinapterus leucas). Blood values from 31 managed belugas, at three facilities, collected over 22 yr, were assessed for seasonal variation and aging trends, and evaluated for biologic variation among and within individuals. Linear mixed effects models assessed the relationship between the analytes and sex, age, season, facility location, ambient air temperature, and photoperiod. Sex differences in analytes and associations with increasing age were observed. Seasonal variation was observed for hemoglobin, hematocrit, mean corpuscular volume, monocytes, alkaline phosphatase, total bilirubin, cholesterol, and triglycerides. Facilities were associated with larger effects on analyte values compared to other covariates, whereas age, sex, and ambient temperature had smaller effects compared to facility and season. Present findings provide important baseline information for future health monitoring efforts. Interpretation of blood analytes and animal health in managed and wild populations over time is aided by having available typical levels for the species and reference intervals for the degree to which individual animals vary from the species average and from their own baseline levels during long-term monitoring.

Effects of RN Age and Experience on Transformational Leadership Practices.

PubMed

Herman, Susan; Gish, Mary; Rosenblum, Ruth; Herman, Michael

2017-06-01

This study reported the evolution of transformational leadership (TL) practices and behaviors across years of age, management experience, and professional nursing practice within a professional nursing leadership organization. Recent studies of CNO TL found valuations peak near age 60 years. This study reported on a wider range of management positions, correlating years of RN practice and management experience and age to TL metrics. This study used Kouzes and Posner's Leadership Practices Inventory-Self-Assessment (LPI-S) to survey a nursing leadership organization, the Association of California Nurse Leaders (ACNL). Anonymous responses were analyzed to identify leadership trends in age and years of professional service. On average, LPI-S metrics of leadership skills advance through years of management, RN experience, and age. The TL scores are statistically higher in most LPI-S categories for those with more than 30 years of RN or management experience. Decade-averaged LPI-S TL metrics in the ACNL survey evolve linearly throughout age before peaking in the decade from age 60 to 69 years. A similar evolution of TL metrics is seen in decades of either years of management experience or years of RN experience. Transformational leadership increased with nursing maturity particularly for LPI-S categories of "inspire a shared vision," "challenge the process," and "enable others to act." In the ACNL population studied, decade-averaged leadership metrics advanced. Leadership evolution with age in the broader RN population peaked in age bracket 60 to 69 years. The LPI-S averages declined when older than 70 years, coinciding with a shift from full-time work toward retirement and part-time employment.

Are prescribed fire and thinning dominant processes affecting snag occurrence at a landscape scale?

DOE PAGES

Zarnoch, Stanley J.; Blake, John I.; Parresol, Bernard R.

2014-11-01

Snags are standing dead trees that are an important component in the nesting habitat of birds and other species. Although snag availability is believed to limit populations in managed and non-managed forests, little data are available to evaluate the relative effect of stand conditions and management on snag occurrence. We analyzed point sample data from an intensive forest inventory within an 80,000 ha landscape for four major forest types to support the hypotheses that routine low-intensity prescribed fire would increase, and thinning would decrease, snag occurrence. We employed path analysis to define a priori causal relationships to determine the directmore » and indirect effects of site quality, age, relative stand density index and fire for all forest types and thinning effects for loblolly pine and longleaf pine. Stand age was an important direct effect for loblolly pine, mixed pine-hardwoods and hardwoods, but not for longleaf pine. Snag occurrence in loblolly pine was increased by prescribed fire and decreased by thinning which confirmed our initial hypotheses. Although fire was not important in mixed pine-hardwoods, it was for hardwoods but the relationship depended on site quality. For longleaf pine the relative stand density index was the dominant variable affecting snag occurrence, which increased as the density index decreased. Site quality, age and thinning had significant indirect effects on snag occurrence in longleaf pine through their effects on the density index. Although age is an important condition affecting snag occurrence for most forest types, path analysis revealed that fire and density management practices within certain forest types can also have major beneficial effects, particularly in stands less than 60 years old.« less

The demographic consequences of growing older and bigger in oyster populations.

PubMed

Moore, Jacob L; Lipcius, Romuald N; Puckett, Brandon; Schreiber, Sebastian J

2016-10-01

Structured population models, particularly size- or age-structured, have a long history of informing conservation and natural resource management. While size is often easier to measure than age and is the focus of many management strategies, age-structure can have important effects on population dynamics that are not captured in size-only models. However, relatively few studies have included the simultaneous effects of both age- and size-structure. To better understand how population structure, particularly that of age and size, impacts restoration and management decisions, we developed and compared a size-structured integral projection model (IPM) and an age- and size-structured IPM, using a population of Crassostrea gigas oysters in the northeastern Pacific Ocean. We analyzed sensitivity of model results across values of local retention that give populations decreasing in size to populations increasing in size. We found that age- and size-structured models yielded the best fit to the demographic data and provided more reliable results about long-term demography. Elasticity analysis showed that population growth rate was most sensitive to changes in the survival of both large (>175 mm shell length) and small (<75 mm shell length) oysters, indicating that a maximum size limit, in addition to a minimum size limit, could be an effective strategy for maintaining a sustainable population. In contrast, the purely size-structured model did not detect the importance of large individuals. Finally, patterns in stable age and stable size distributions differed between populations decreasing in size due to limited local retention and populations increasing in size due to high local retention. These patterns can be used to determine population status and restoration success. The methodology described here provides general insight into the necessity of including both age- and size-structure into modeling frameworks when using population models to inform restoration and management decisions. © 2016 by the Ecological Society of America.

Promoting normal development and self-efficacy in school-age children managing chronic conditions.

PubMed

Mickley, Kristyn L; Burkhart, Patricia V; Sigler, April N

2013-06-01

Chronic conditions can affect school-age children in more ways than just physically. Normal childhood maturation is critical at this age, yet daily management of chronic symptoms can be challenging. This article describes 4 common childhood chronic illnesses (asthma, seizure disorders, diabetes, and cystic fibrosis), and the impact these conditions have on the developing child. Self-efficacy, the belief that one can effectively perform necessary skills, is essential to self-management of chronic conditions and contributes in a positive way to the child's normal development. Implications for clinical practice and future research are discussed. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparative evaluation of the effectiveness of audio and audiovisual distraction aids in the management of anxious pediatric dental patients.

PubMed

Kaur, Rajwinder; Jindal, Ritu; Dua, Rohini; Mahajan, Sandeep; Sethi, Kunal; Garg, Sunny

2015-01-01

The aim of this study was to evaluate and compare audio and audiovisual distraction aids in management of anxious pediatric dental patients of different age groups and to study children's response to sequential dental visits with the use of distraction aids. This study was conducted on two age groups, that is, 4-6 years and 6-8 years with 30 patients in each age group on their first dental visit. The children of both the age groups were divided into 3 subgroups, the control group, audio distraction group, audiovisual distraction group with 10 patients in each subgroup. Each child in all the subgroups had gone through three dental visits. Child anxiety level at each visit was assessed by using a combination of anxiety measuring parameters. The data collected was tabulated and subjected to statistical analysis. Tukey honest significant difference post-hoc test at 0.05% level of significance revealed audiovisual group showed statistically highly significant difference from audio and control group, whereas audio group showed the statistically significant difference from the control group. Audiovisual distraction was found to be a more effective mode of distraction in the management of anxious children in both the age groups when compared to audio distraction. In both the age groups, a significant effect of the visit type was also observed.

Chronic oedema: its prevalence, effects and management.

PubMed

Cooper, Garry

2016-10-01

Ageing affects not only individuals but also society. It occurs throughout the western world. The ageing process may lead to the development of conditions, such as chronic oedema, as well as comorbidities such as osteoarthritis. These comorbidities can make the management of chronic oedema even more difficult. This is an especially important consideration when tailoring individualised care plans, such as exercise, as conditions such as rheumatoid arthritis can limit patients' ability to manage their oedema. Despite challenges, education can improve patient outcomes when evidence-based practice is used.

Differential Responses of Herbivores and Herbivory to Management in Temperate European Beech

PubMed Central

Gossner, Martin M.; Pašalić, Esther; Lange, Markus; Lange, Patricia; Boch, Steffen; Hessenmöller, Dominik; Müller, Jörg; Socher, Stephanie A.; Fischer, Markus; Schulze, Ernst-Detlef; Weisser, Wolfgang W.

2014-01-01

Forest management not only affects biodiversity but also might alter ecosystem processes mediated by the organisms, i.e. herbivory the removal of plant biomass by plant-eating insects and other arthropod groups. Aiming at revealing general relationships between forest management and herbivory we investigated aboveground arthropod herbivory in 105 plots dominated by European beech in three different regions in Germany in the sun-exposed canopy of mature beech trees and on beech saplings in the understorey. We separately assessed damage by different guilds of herbivores, i.e. chewing, sucking and scraping herbivores, gall-forming insects and mites, and leaf-mining insects. We asked whether herbivory differs among different forest management regimes (unmanaged, uneven-aged managed, even-aged managed) and among age-classes within even-aged forests. We further tested for consistency of relationships between regions, strata and herbivore guilds. On average, almost 80% of beech leaves showed herbivory damage, and about 6% of leaf area was consumed. Chewing damage was most common, whereas leaf sucking and scraping damage were very rare. Damage was generally greater in the canopy than in the understorey, in particular for chewing and scraping damage, and the occurrence of mines. There was little difference in herbivory among differently managed forests and the effects of management on damage differed among regions, strata and damage types. Covariates such as wood volume, tree density and plant diversity weakly influenced herbivory, and effects differed between herbivory types. We conclude that despite of the relatively low number of species attacking beech; arthropod herbivory on beech is generally high. We further conclude that responses of herbivory to forest management are multifaceted and environmental factors such as forest structure variables affecting in particular microclimatic conditions are more likely to explain the variability in herbivory among beech forest plots. PMID:25119984

Productivity of early successional shrubland birds in clearcuts and groupcuts in an eastern deciduous forest

Treesearch

David I. King; Richard M. DeGraaf; Curtice R. Griffin

2001-01-01

Uneven-aged forest management has been advocated as a silvicultural practice because of concerns about the negative effects of even-aged management on birds that dwell in mature forests. Recent evidence, however, indicates that in the northeastern United States, bird species that inhabit early successional habitats may be experiencing more widespread declines than...

Effects of uneven-aged and diameter-limit management on West Virginia tree and wood quality

Treesearch

Michael C. Wiemann; Thomas M. Schuler; John E. Baumgras

2004-01-01

Uneven-aged and diameter-limit management were compared with an unmanaged control on the Fernow Experimental Forest near Parsons, West Virginia, to determine how treatment affects the quality of red oak (Quercus rubra L.), sugar maple (Acer saccharum Marsh.), and yellow-poplar (Liriodendron tulipifera L.). Periodic harvests slightly increased stem lean, which often...

Effects of Pine and Hardwood Basal Areas After Uneven-Aged Silvicultural Treatments on Wildlife Habitat

Treesearch

Darren A. Miller; Bruce D. Leopold; L. Mike Conner; Michael G. Shelton

1999-01-01

Uneven-aged management (UEAM) is becoming increasingly popular in the southeastern United States. However, effects of UEAM on wildlife habitat have not been adequately documented. We examined response of habitat within stands of varying levels of pine and hardwood basal area under an uneven-aged managegement regime in southern Mississippi. Summer and winter trends in...

Family Involvement in School-Based Dysphagia Management

ERIC Educational Resources Information Center

Angell, Maureen E.; Bailey, Rita L.; Nicholson, Joanna K.; Stoner, Julia B.

2009-01-01

This article provides a practitioner-friendly synthesis of existing literature on family involvement in the management of dysphagia for school-age. Research reviewed includes family perspectives on programs, therapists, and characteristics that comprise effective family involvement in school-based dysphagia management programs. Also included are…

The Use of Silviculture and Prescribed Fire to Manage Stand Structure and Fuel Profiles in a Multi-aged Lodgepole Pine Forest

Treesearch

Colin C. Hardy; Helen Y. Smith; Ward McCaughey

2006-01-01

This paper presents several components of a multi-disciplinary project designed to evaluate the ecological and biological effects of two innovative silvicultural treatments coupled with prescribed fire in an attempt to both manage fuel profiles and create two-aged stand structures in lodgepole pine. Two shelterwood silvicultural treatments were designed to replicate as...

Influence of residual basal area on longleaf pine (Pinus palustris Mill.) first year germination and establishment under selection silviculture

Treesearch

Ferhat Kara; Edward F. Loewenstein

2015-01-01

Even-aged silvicultural methods have been successfully used to manage longleaf pine (Pinus palustris Mill.) forests for wood production; however, successful use of uneven-aged methods to manage this ecosystem is less well documented. In this study, the effects of varying levels of residual basal area (RBA) (9.2, 13.8, and 18.4 m2...

Space/age forestry: Implications of planting density and rotation age in SRIC management decisions

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

Merriam, R.A.; Phillips, V.D.; Liu, W.

1993-12-31

Short-rotation intensive-culture (SRIC) of promising tree crops is being evaluated worldwide for the production of methanol, ethanol, and electricity from renewable biomass resources. Planting density and rotation age are fundamental management decisions associated with SRIC energy plantations. Most studies of these variables have been conducted without the benefit of a unifying theory of the effects of growing space and rotation age on individual tree growth and stand level productivity. A modeling procedure based on field trials of Eucalyptus spp. is presented that evaluates the growth potential of a tree in the absence and presence of competition of neighboring trees inmore » a stand. The results of this analysis are useful in clarifying economic implications of different growing space and rotation age decisions that tree plantation managers must make. The procedure is readily applicable to other species under consideration for SRIC plantations at any location.« less

Participation, Retention, and Utilization of a Web-Based Chronic Disease Self-Management Intervention Among Older Adults.

PubMed

Portz, Jennifer Dickman; LaMendola, Walter F

2018-05-21

Web-based self-management (web-based SM) interventions provide a potential resource for older adults to engage in their own chronic disease management. The purpose of this study is to investigate the effect of age on participation, retention, and utilization of a web-based SM intervention. This study reports the results of a secondary data analysis of the effects of age in a randomized trial of a web-based diabetes SM intervention. Participation, reasons for nonenrollment, retention, reasons for disenrollment, and website utilization were examined by age using discriminant function, survival analysis, and multivariate analysis of variance as appropriate. Website utilization by all participants dropped after 6 months but did not vary significantly with age. Though older adults (>60 of age) were less likely to choose to participate (F = 57.20, p < 0.001), a slight majority of participants in the experiment (53%) were over 66 years of age. Enrolled older adults utilized website management tools at a rate equivalent to younger participants. At termination, they often reported the experiment as burdensome, but tended to stay in the study longer than younger participants. Web-based SM offers a feasible approach for older adults with chronic disease to engage in their health management, but it needs to be improved. Those older adults who passed the rigorous screens for this experiment and chose to participate may have been more likely than younger participants to utilize web-based SM intervention tools. They were more persistent in their use of the web-based SM to try to improve health outcomes and formed definitive opinions about its utility before termination.

Managing Liability. Employment Discrimination: A Risk Management Strategy.

ERIC Educational Resources Information Center

McMullan, Sandra H.

This booklet discusses the risks that educational institutions face in regard to employment discrimination litigation and outlines a program to effectively manage such risks. Institutions need to address three main types of employment discrimination issues: sexual harassment, disability-based discrimination, and age discrimination. To deal with…

The effect of age on the pharmacological management of ambulatory patients treated with depot neuroleptic medications for schizophrenia and related psychotic disorders.

PubMed

Mamo, David C; Sweet, Robert A; Chengappa, K N Roy; Reddy, Ravinder R; Jeste, Dilip V

2002-11-01

Cross-sectional studies indicate that, in comparison to younger patients, older schizophrenic patients have a higher risk for neuroleptic-induced Parkinsonism and tardive dyskinesia (TD). It has been suggested, therefore, that older patients with schizophrenia could be maintained on reduced doses of conventional neuroleptics. We examined the effect of age on psychopharmacological management in a naturalistic study of a group of 165 patients with a clinical diagnosis of schizophrenia or a related psychotic disorder (age range = 21-84 years; subjects > or = 1;45 years n = 86) treated with either haloperidol decanoate or fluphenazine decanoate. Increasing age was not correlated with total daily dose of neuroleptics or anticholinergic medication. However, a modest negative correlation of age with daily neuroleptic dose was found in patients aged 45 years and older. The results of this study highlight the need for prospective assessments of depot neuroleptic dose requirements in older patients suffering from primary psychotic disorders. Copyright 2002 John Wiley & Sons, Ltd.

Integrated IMR for Psychiatric and General Medical Illness for Adults Aged 50 or Older With Serious Mental Illness

PubMed Central

Bartels, Stephen J.; Pratt, Sarah I.; Mueser, Kim T.; Naslund, John A.; Wolfe, Rosemarie S.; Santos, Meghan; Xie, Haiyi; Riera, Erik G.

2016-01-01

Objectives Self-management is promoted as a strategy for improving outcomes for serious mental illness as well as for chronic general medical conditions. This study evaluated the feasibility and effectiveness of an eight-month program combining training in self-management for both psychiatric and general medical illness, including embedded nurse care management. Methods Participants were 71 middle-aged and older adults (mean age=60.3±6.5) with serious mental illness and chronic general medical conditions who were randomly assigned to receive integrated Illness Management and Recovery (I-IMR) (N=36) or usual care (N=35). Feasibility was determined by attendance at I-IMR and nurse sessions. Effectiveness outcomes were measured two and six months after the intervention (ten- and 14-month follow-ups) and included self-management of psychiatric and general medical illness, participation in psychiatric and general medical encounters, and self-reported acute health care utilization. Results I-IMR participants attended 15.8±9.5 I-IMR and 8.2±5.9 nurse sessions, with 75% attending at least ten I-IMR and five nurse sessions. Compared with usual care, I-IMR was associated with greater improvements in participant and clinician ratings for psychiatric illness self-management, greater diabetes self-management, and an increased preference for detailed diagnosis and treatment information during primary care encounters. The proportion of I-IMR participants with at least one psychiatric or general medical hospitalization decreased significantly between baseline and ten- and 14-month follow-ups. Conclusions I-IMR is a feasible intervention for this at-risk group and demonstrated potential effectiveness by improving self-management of psychiatric illness and diabetes and by reducing the proportion of participants requiring psychi atric or general medical hospitalizations. PMID:24292559

Perceived consequences of ageing with late effects of polio and strategies for managing daily life: a qualitative study.

PubMed

Sjödahl Hammarlund, Catharina; Lexell, Jan; Brogårdh, Christina

2017-08-09

New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life. Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation. The latent analysis resulted in three categories 'Various consequences of ageing with LEoP', 'Limitations in everyday activities and participation restrictions', and 'Strategies for managing daily life when ageing with LEoP' and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance. Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP.

Clinical Implications From an Exploratory Study of Postural Management of Breech Presentation

PubMed Central

Founds, Sandra A.

2013-01-01

The results from an exploratory study of the effectiveness of maternal knee-chest posture for producing cephalic version of breech presentation are shown. Methods are briefly described and clinical implications are presented. Among 25 women, fewer who performed the maternal knee-chest postural intervention experienced fetal cephalic version than women in the control group who did nothing to influence breech presentation. Despite limitations of the underpowered findings, trends in the data may indicate that parity and gestational age were potentially relevant covariates of version. Postural management is not an evidence-based practice. This exploratory study indicates that maternal knee-chest posture may work opposite to the expected direction, but the small sample size precludes generalizations about efficacy of knee-chest postural management. At least one adequately powered trial that controls for parity and gestational age is needed to determine whether knee-chest postural management results in no effect, a small, or small to moderate clinically significant effect. PMID:16814225

Managing aging effects on dry cask storage systems for extended long-term storage and transportation of used fuel - rev. 0

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

Chopra, O.K.; Diercks, D.; Fabian, R.

The cancellation of the Yucca Mountain repository program in the United States raises the prospect of extended long-term storage (i.e., >120 years) and deferred transportation of used fuel at operating and decommissioned nuclear power plant sites. Under U.S. federal regulations contained in Title 10 of the Code of Federal Regulations (CFR) 72.42, the initial license term for an Independent Spent Fuel Storage Installation (ISFSI) must not exceed 40 years from the date of issuance. Licenses may be renewed by the U.S. Nuclear Regulatory Commission (NRC) at the expiration of the license term upon application by the licensee for a periodmore » not to exceed 40 years. Application for ISFSI license renewals must include the following: (1) Time-limited aging analyses (TLAAs) that demonstrate that structures, systems, and components (SSCs) important to safety will continue to perform their intended function for the requested period of extended operation; and (2) a description of the aging management program (AMP) for management of issues associated with aging that could adversely affect SSCs important to safety. In addition, the application must also include design bases information as documented in the most recent updated final safety analysis report as required by 10 CFR 72.70. Information contained in previous applications, statements, or reports filed with the Commission under the license may be incorporated by reference provided that those references are clear and specific. The NRC has recently issued the Standard Review Plan (SRP) for renewal of used-fuel dry cask storage system (DCSS) licenses and Certificates of Compliance (CoCs), NUREG-1927, under which NRC may renew a specific license or a CoC for a term not to exceed 40 years. Both the license and the CoC renewal applications must contain revised technical requirements and operating conditions (fuel storage, surveillance and maintenance, and other requirements) for the ISFSI and DCSS that address aging effects that could affect the safe storage of the used fuel. The information contained in the license and CoC renewal applications will require NRC review to verify that the aging effects on the SSCs in DCSSs/ ISFSIs are adequately managed for the period of extended operation. To date, all of the ISFSIs located across the United States with more than 1,500 dry casks loaded with used fuel have initial license terms of 20 years; three ISFSIs (Surry, H.B. Robinson and Oconee) have received their renewed licenses for 20 years, and two other ISFSIs (Calvert Cliffs and Prairie Island) have applied for license renewal for 40 years. This report examines issues related to managing aging effects on the SSCs in DCSSs/ISFSIs for extended long-term storage and transportation of used fuels, following an approach similar to that of the Generic Aging Lessons Learned (GALL) report, NUREG-1801, for the aging management and license renewal of nuclear power plants. The report contains five chapters and an appendix on quality assurance for aging management programs for used-fuel dry storage systems. Chapter I of the report provides an overview of the ISFSI license renewal process based on 10 CFR 72 and the guidance provided in NUREG-1927. Chapter II contains definitions and terms for structures and components in DCSSs, materials, environments, aging effects, and aging mechanisms. Chapter III and Chapter IV contain generic TLAAs and AMPs, respectively, that have been developed for managing aging effects on the SSCs important to safety in the dry cask storage system designs described in Chapter V. The summary descriptions and tabulations of evaluations of AMPs and TLAAs for the SSCs that are important to safety in Chapter V include DCSS designs (i.e., NUHOMS{reg_sign}, HI-STORM 100, Transnuclear (TN) metal cask, NAC International S/T storage cask, ventilated storage cask (VSC-24), and the Westinghouse MC-10 metal dry storage cask) that have been and continue to be used by utilities across the country for dry storage of used fuel to date. The goal of this report is to help establish the technical basis for extended long-term storage and transportation of used fuel.« less

Associations between management practices and major reproductive parameters of Holstein-Friesian replacement heifers.

PubMed

Fodor, I; Baumgartner, W; Abonyi-Tóth, Zs; Lang, Zs; Ózsvári, L

2018-01-01

The aim of this study was to assess the relationship between the reproductive management practices and the performance of replacement heifers on large commercial dairy farms. The individual data of 14,763 heifers, first inseminated in 2014, were analysed from 33 Holstein-Friesian dairy herds in Hungary. The relationships between management practices and major reproductive parameters (age at first service, AFS; age at first calving, AFC; conception risk to first insemination, CR1; and pregnancy status at 20 months of age) were examined by mixed-effects models, with the herd as the random effect. The results showed that farms using oestrus detection aids experienced reduced AFS (p<0.001) and AFC (p=0.001). Observation of oestrus for shorter periods instead of continuously showed a tendency towards lower AFC (p=0.057) and was associated with higher odds of pregnancy at 20 months of age (p=0.020). Heifers on farms using sexed semen had younger AFS, but poorer CR1, compared to those using conventional semen exclusively (p<0.05). In addition, the odds of heifers being pregnant by 20 months of age was higher on farms with more experience using sexed semen (p=0.020). Frequent pregnancy diagnosis (i.e. more than once per week) was associated with younger AFC (p=0.023). Our results suggest the use of certain advanced reproductive management practices for heifer reproductive management in large dairy herds (e.g. oestrus detection aids), which can improve reproductive efficiency considerably, but are currently used only to a limited extent. Copyright © 2017 Elsevier B.V. All rights reserved.

Yogurt for treating acute gastroenteritis in children: Systematic review and meta-analysis.

PubMed

Patro-Gołąb, Bernadeta; Shamir, Raanan; Szajewska, Hania

2015-10-01

In May 2014, the updated guidelines for the management of acute gastroenteritis (AGE) were published. The use of yogurt in the nutritional management of AGE was not addressed, although it is frequently used in many countries for this purpose. We aimed to systematically evaluate the efficacy of yogurt consumption for the management of AGE in children. In this systematic review, a number of databases, including MEDLINE, EMBASE, and the Cochrane Library, with no language restrictions, were searched up to July 2014 for randomized controlled trials (RCTs) evaluating the effect of yogurt consumption in children with AGE. The risk of bias was assessed using the Cochrane risk of bias tool. Four RCTs (n = 448) that were generally low in methodological quality, all performed in hospital setting, were included. Compared with placebo/no intervention, yogurt consumption had no significant effect on stool volume. The data on the effect of yogurt consumption on the duration of diarrhea and stool frequency were not consistent. The chance of treatment success (or failure) was similar in both groups. Compared with placebo, the duration of hospitalization was shorter in children who received yogurt, but the difference was of a borderline significance. Total weight gain increased for those treated with yogurt. The consumption of yogurt had a positive effect on weight gain, but no consistent effect on AGE outcomes in hospitalized children. Given the limited data and the methodological limitations of the included trials, the evidence should be viewed with caution. The effect of yogurt consumption in the ambulatory setting is unknown. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Nursing Case Management and Glycemic Control Among Brazilians With Type 2 Diabetes: Pragmatic Clinical Trial.

PubMed

Moreira, Ricardo Castanho; Mantovani, Maria de Fátima; Soriano, José Verdú

2015-01-01

Type 2 diabetes mellitus is a chronic condition that requires ongoing, life-long care in order to be controlled. The aims of the study were to assess the effect of nursing case management on glycated hemoglobin (HbA1c) levels compared to usual care in people with type 2 diabetes mellitus and to determine if effects of nursing case management varied by gender, age, duration of disease, education, and income. This is a pragmatic clinical trial, conducted in the municipality of Bandeirantes, Paraná, Brazil, in 2011 and 2012. Eighty individuals were recruited and randomized equally to receive nursing case management or usual care. Covariates were sociodemographic and clinical factors. The outcome was HbA1c measured at baseline, 6 months, and 12 months. The sample consisted predominately of women; most had been diagnosed with type 2 diabetes mellitus within the previous 5 years. Mean age was 50.14 (SD = 7.00), with 5.27 (SD = 4.39) years of schooling and an average HbA1c of 9.90% (SD = 2.49). Hemoglobin A1c was reduced from an average of 10.33% to 9.0% (p < .01) in the nursing case management group and from 9.57% to 8.93% (p = .05) in the usual care group; the group by time effect was not significant. Case management effects varied by younger age (p = .05), duration of type 2 diabetes less than 5 years (p = .03), up to 4 years of schooling (p = .04), and being in the lowest-income stratum (p = .02). Both groups showed a statistically significant reduction of HbA1c at 6 and 12 months following baseline. The difference in proportional reduction of HbA1c between groups was not statistically significant.

Breeding birds of even- and uneven-aged pine forests of eastern Texas

Treesearch

Ronald E. Thill; Nancy E. Koerth

2005-01-01

While single-tree selection, uneven-aged management is being used increasingly on southern national forests as an alternative to clearcutting and planting of pine, its effects on wildlife are largely unknown. We compared breeding season bird abundance, species richness, diversity, and composition among uneven-aged stands and six seral stages of even-aged stands in...

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

USGS Publications Warehouse

Juracek, Kyle E.

2015-01-01

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

Quality use of antipsychotic medicines inresidential aged care facilities in New Zealand.

PubMed

Ndukwe, Henry C; Nishtala, Prasad S; Wang, Ting; Tordoff, June M

2016-12-01

INTRODUCTION Antipsychotic medicines are used regularly or when required in residential aged care facilities to treat symptoms of dementia, but have been associated with several adverse effects. AIM The aim of this study was to examine 'quality use' of antipsychotic medicines in residential aged care facilities in New Zealand, by surveying nurse managers. METHODS A cross-sectional survey was mailed to 318 nurse managers working in a nationally representative sample of aged care facilities. A purpose-developed, pre-tested, 22-item structured questionnaire was used to explore practice related to the quality use of antipsychotic medicines. RESULTS Overall, 31.4% of nurse managers responded to the survey. They mostly (88%) had ≥ 1 year's relevant work experience and 83% of facilities provided care for those within the range of 21 to 100 residents. Respondents reported that staff education on dementia management occurred early in employment. Two-thirds of participants reported non-pharmacological interventions were commonly used for managing challenging behaviours, while less than half (45%) cited administering antipsychotic medicine. Respondents reported 'managing behavioural symptoms' (81%) as one of the main indications for antipsychotic use. Frequently identified adverse effects of antipsychotic medicines were drowsiness or sedation (64%) and falls (61%). Over 90% reported general practitioners reviewed antipsychotic use with respect to residents' target behaviour 3-monthly, and two-thirds used an assessment tool to appraise residents' behaviour. DISCUSSION Staff education on dementia management soon after employment and resident 3-monthly antipsychotic medicine reviews were positive findings. However, a wider use of behavioural assessment tools might improve the care of residents with dementia and the quality use of antipsychotic medicines.

Multimodal Evaluation and Management of Children with Concussion: Using our heads and available evidence

PubMed Central

Gioia, Gerard A.

2015-01-01

Significant attention has been focused on concussions in children but a dearth of research evidence exists supporting clinical evaluation and management. The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for children as young as age five. We review our CDC-funded research program including the development of tools for post-concussion symptom assessment involving the child and parent, measurement of specific neurocognitive functions, and assessment of dynamic cognitive exertional effects. A clinical approach to active, individualized, moderated concussion rehabilitation management is presented, including a ten step guide to symptom management, with a specific focus on the school challenges faced by the recovering student. To better inform concussion practice across the developmental age spectrum, a significant need exists for further research evidence to refine our clinical assessment methods and develop effective treatment approaches. PMID:25356518

Classroom Age Composition and Vocabulary Development Among At-Risk Preschoolers

PubMed Central

Guo, Ying; Tompkins, Virginia; Justice, Laura; Petscher, Yaacov

2016-01-01

Research Findings The purpose of this exploratory study was to examine the relationship between classroom age composition and preschoolers’ vocabulary gains over an academic year and also to examine whether these relations were moderated by classroom quality. In this study (N = 130 children in 16 classrooms representing a subset of all children enrolled in these classrooms), results showed a significant cross-level interaction between classroom age composition and children’s age, suggesting positive effects of greater variance in classroom age composition for younger but not older children. The interaction between behavior management (1 dimension of classroom quality) and classroom age composition was also significant, indicating that a wider distribution of classroom age composition was positively related to children’s vocabulary gains within classrooms characterized by better behavior management. Practice or Policy Findings underscore the importance of children’s social interactions with more knowledgeable conversational partners in promoting their vocabulary development and signify the need to help teachers learn how to manage children’s behaviors so as to provide a classroom that is optimal for child learning. PMID:27660399

Multidisciplinary care management has a positive effect on paediatric obesity and social and individual factors are associated with better outcomes.

PubMed

Carriere, C; Cabaussel, C; Bader, C; Barberger-Gateau, P; Barat, P; Thibault, H

2016-11-01

The RePPOP Aquitaine network, which was established in south-west France to prevent and treat paediatric obesity, has developed a multidisciplinary approach based on multicomponent lifestyle interventions and family-based actions. This study assessed the impact of its care management programme and investigated the factors associated with better outcomes. The impact of the RePPOP care management programme was assessed by changes in the body mass index (BMI) Z score, between baseline and the end-of-care management. We focused on 982 overweight or obese children (59.9% girls) with a mean age of 10.64 years and a range of 2.4-17.9 years. A multivariate analysis examined the independent factors associated with better outcomes. At the end-of-care management programme, 75.5% of children had decreased their BMI Z score. Initial characteristics significantly associated with better outcomes were as follows: the age at baseline between five years and 15 years of age, playing sport at a club, being followed up by RePPOP for longer than 10 months, no parental obesity and no academic difficulties. This study confirmed that multidisciplinary treatment had a significant positive effect on paediatric obesity and that social and individual factors affected the efficiency of the care management. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Family Perceptions of Facilitators and Inhibitors of Effective School-Based Dysphagia Management

ERIC Educational Resources Information Center

Angell, Maureen E.; Bailey, Rita L.; Stoner, Julia B.

2008-01-01

Purpose: This qualitative study focused on the perceptions of family members of children with dysphagia by asking what the family-identified factors are that facilitate or inhibit effective school-based management of pediatric dysphagia. Method: Semistructured interviews of 7 family members of 6 children with dysphagia, ages 2 through 11 years,…

Consensus recommendations for managing osteoarthritic pain with topical NSAIDs in Asia-Pacific.

PubMed

Rafanan, Bonifacio S; Valdecañas, Benedict F; Lim, Boon Ping; Malairungsakul, Anan; Tassanawipas, Warat; Shiyi, Chen; Tse, Lung Fung; Luong, Tuan Khanh

2018-03-01

Osteoarthritis prevalence is expected to increase markedly in the Asia-Pacific region due to rapid population aging. Identifying effective and safe therapeutic options to manage osteoarthritic pain is viewed as a priority. The Asia-Pacific Experts on Topical Analgesics Advisory Board developed consensus statements for use of topical NSAIDs in musculoskeletal pain. Evidence supporting these statements in osteoarthritic pain was reviewed. Best available evidence indicates that topical NSAIDs have a moderate effect on relief of osteoarthritic pain, comparable to that of oral NSAIDs but with a better risk-to-benefit ratio. International clinical practice guidelines recommend topical NSAIDs on par with or ahead of oral NSAIDs for pain management in patients with knee and hand osteoarthritis, and as the first-line choice in persons aged ≥75 years.

Comparison of silvicultural and natural disturbance effects on terrestrial salamanders in northern hardwood forests

Treesearch

Daniel J. Hocking; Kimberly J. Babbitt; Mariko Yamasaki

2013-01-01

In forested ecosystems timber harvesting has the potential to emulate natural disturbances, thereby maintaining the natural communities adapted to particular disturbances. We compared the effects of even-aged (clearcut and patch cut) and uneven-aged (group cut, single-tree selection) timber management techniques with natural ice-storm damage and unmanipulated reference...

Effects of edge contrast on redback salamander distribution in even-aged northern hardwoods

Treesearch

Richard M. DeGraaf; Mariko Yamasaki

2002-01-01

Terrestrial salamanders are sensitive to forest disturbance associated with even-aged management. We studied the distribution of redback salamanders (Plethodon cinereus) for 4 yr at edges between even-aged northern hardwood stands along three replicate transects in each of three edge contrast types: regeneration/mature, sapling/mature, and...

Ageing Holocaust survivors in Australia.

PubMed

Paratz, Elizabeth D; Katz, Benny

2011-02-21

In recent years, a phenomenon of "late effects of the Holocaust" has emerged, with impacts on the psychological and physical health of ageing Holocaust survivors. As Holocaust survivors age, they may experience heightened anxiety around normal processes of ageing, worsened post-traumatic stress disorder with cognitive decline, and fear of the medical system. Holocaust survivors are at increased risk of osteoporosis, cardiometabolic disease due to hypothalamic-pituitary-adrenal axis dysfunction, cancer, and sequelae of Nazi medical experiments. From existing medical literature on this topic, practical principles of management are derived to create a framework for sensitive medical management of Holocaust survivors in Australia. The issues discussed are also relevant to the wider geriatric refugee or prisoner-of-war experience.

Life prolonging of disease management programs in patients with type 2 diabetes is cost-effective.

PubMed

Drabik, A; Büscher, G; Sawicki, P T; Thomas, K; Graf, C; Müller, D; Stock, S

2012-02-01

Our objective was to examine the cost-effectiveness of disease management programs (DMPs) for type 2 diabetes mellitus (T2DM) taking into account their life prolonging effect. We compared real life costs in 19,888 propensity score matched pairs of T2DM DMP participants and T2DM patients in routine care (RC) according to sickness funds data. We estimated mean annual costs for survivors, last year of life costs for decedents, the influence of ageing on costs, incremental cost-effectiveness ratio and effects on hospitalization. Annual costs for survivors were 3,318€ (DMP) and 3,570€ (RC). The mean costs in the last year of life were 16,911€ (DMP) and 15,763€ (RC). Ageing had a cost triggering effect for survivors (30€/36€ per year in DMP-/RC-group; p<0.001) and a cost decreasing effect in the last year of life (546€/483€ per year in DMP-/RC-group; p<0.001). The incremental cost-effectiveness ratio of the DMP vs. RC was -1396€ per life-year gained. Hospitalizations increased with age in case of survival and decreased with age in case of death but were always lower in the DMP-group. Despite increase in costs due to longer life DMPs are cost-effective. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Effect of comanagement with internal medicine on hospital stay of patients admitted to the Service of Otolaryngology.

PubMed

Montero Ruiz, Eduardo; Rebollar Merino, Ángela; Rivera Rodríguez, Teresa; García Sánchez, Marta; Agudo Alonso, Rosa; Barbero Allende, José Maria

2015-01-01

Patients admitted to the Department of Otolaryngology (ENT) are increasing in age, comorbidity and complexity, leading to increased consultations/referrals to Internal Medicine (IM). An alternative to consultations/referrals is co-management. We studied the effect of co-management on length of stay (LoS) in hospital for patients admitted to ENT. This was a retrospective observational study including patients ≥14 years old discharged from ENT between 1/1/2009 and 30/06/2013, with co-management from May/2011. We analysed age, sex, type of admission, whether the patient was operated, administrative weight associated with DRG, total number of discharge diagnoses, Charlson comorbidity index (CCI), deaths, readmissions and LoS. There were statistically significant differences between both groups in age (4.5 years; 95% confidence interval [95% CI] 2.8-6.3), emergency admissions (odds ratio [OR] 1.4; 95% CI 1.1-1.8), administrative weight (0.3637; 95% CI 0.0710-0.6564), number of diagnoses (1.3; 95% CI 1-1.6), CCI (0.4; 95% CI 0.2-0.6) and deaths (OR 4.1; 95% CI 1.1-15.7). On adjustment, co-management reduced ENT LoS in hospital by 28.6%, 0.8 days (95% CI 0.1-1.6%; P=.038). This reduction represents an ENT savings of at least €165,893. Co-management patients admitted to ENT are increasing in age, comorbidity and complexity. Co-management is associated with reduced LoS and costs in ENT, similar to those observed in other surgical services. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

A Fair Go for All? The Impact of Intragroup Diversity and Diversity-Management Skills on Student Experiences and Outcomes in Team-Based Class Projects

ERIC Educational Resources Information Center

Shaw, James B.

2004-01-01

A longitudinal study of 390 students in 64 Practical Organizational Behavior Education (PROBE) project teams was conducted on the effects of intragroup diversity and student diversity-management skills. The impact of gender, age, and nationality variables on student grades, cognitive processes, perceptions of team effectiveness, and satisfaction…

The Effects of a Stress Management Course on Counselors-in-Training

ERIC Educational Resources Information Center

Abel, Holly; Abel, Annette; Smith, Robert L.

2012-01-01

The effects of a stress management course on the stress knowledge and coping techniques of 101 graduate students in counseling were examined. Participants, drawn from various racial groups, were typically female (79%) and 21 to 55 years of age. Seven of the 8 null hypotheses were rejected. There were significant differences on 6 of the 7 dependent…

Carbon stocks across a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands

USGS Publications Warehouse

Powers, Matthew D.; Kolka, Randall K.; Bradford, John B.; Palik, Brian J.; Fraver, Shawn; Jurgensen, Martin F.

2012-01-01

Forests function as a major global C sink, and forest management strategies that maximize C stocks offer one possible means of mitigating the impacts of increasing anthropogenic CO2 emissions. We studied the effects of thinning, a common management technique in many forest types, on age-related trends in C stocks using a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands ranging from 9 to 306 years old. Live tree C stocks increased with age to a maximum near the middle of the chronosequence in unmanaged stands, and increased across the entire chronosequence in thinned stands. C in live understory vegetation and C in the mineral soil each declined rapidly with age in young stands but changed relatively little in middle-aged to older stands regardless of management. Forest floor C stocks increased with age in unmanaged stands, but forest floor C decreased with age after the onset of thinning around age 40 in thinned stands. Deadwood C was highly variable, but decreased with age in thinned stands. Total ecosystem C increased with stand age until approaching an asymptote around age 150. The increase in total ecosystem C was paralleled by an age-related increase in total aboveground C, but relatively little change in total belowground C. Thinning had surprisingly little impact on total ecosystem C stocks, but it did modestly alter age-related trends in total ecosystem C allocation between aboveground and belowground pools. In addition to characterizing the subtle differences in C dynamics between thinned and unmanaged stands, these results suggest that C accrual in red pine stands continues well beyond the 60–100 year management rotations typical for this system. Management plans that incorporate longer rotations and thinning in some stands could play an important role in maximizing C stocks in red pine forests while meeting other objectives including timber extraction, biodiversity conservation, restoration, and fuel reduction goals.

Economics of Home Monitoring for Apnea in Late Preterm Infants.

PubMed

Montenegro, Brian L; Amberson, Michael; Veit, Lauren; Freiberger, Christina; Dukhovny, Dmitry; Rhein, Lawrence M

2017-01-01

Apnea of prematurity affects a small proportion but large absolute number of late preterm infants, with out-patient management variably utilized despite relative clinical equipoise and potential for improved cost-effectiveness. Over a 5-y period, from 2009 to 2013, infants born at ≥34 weeks gestational age at a level IIIB academic center in Boston, Massachusetts, with discharge-delaying apnea, bradycardia, and desaturation (ABD) events were identified. In-patient costs for discharge-delaying ABD events were compared with hypothetical out-patient management. Out-patient costs took into account 4-10 d of in-patient observation for ABD events before caffeine initiation, 3-5 d of additional in-patient observation before discharge, daily caffeine until 43 weeks corrected gestational age, home pulse oximetry monitoring until 44 weeks corrected gestational age, and consideration of variable readmission rates ranging from 0 to 10%. A total of 425 late preterm and term infants were included in our analysis. Utilization of hypothetical out-patient management resulted in cost savings per eligible patient ranging from $2,422 to $62, dependent upon variable periods of in-patient observation. Sensitivity analysis demonstrated few instances of decreased relative cost-effectiveness. Out-patient management of discharge-delaying ABD events in a late preterm and term population was a cost-effective alternative to prolonged in-patient observation. Copyright © 2017 by Daedalus Enterprises.

Age of menarche and knowledge about menstrual hygiene management among adolescent school girls in Amhara province, Ethiopia: implication to health care workers & school teachers.

PubMed

Gultie, Teklemariam; Hailu, Desta; Workineh, Yinager

2014-01-01

Effective menstrual hygiene has direct and indirect effect on achieving millennium development goals two (universal education), three (gender equality and women empowerment) and, five (improving maternal health). However, in Ethiopiait is an issue which is insufficiently acknowledged in the reproductive health sector. The objective of this study therefore, is to assess the age of menarche and knowledge of adolescents about menstrual hygiene management in Amhara province. School based cross sectional study was conducted from November 2012 to June 2013. Multistage stage sampling technique was used. The school was first clustered in to grades & sections and thenparticipants were selected by lottery method. A pretested &structured questionnaire was used. Data were entered, cleaned and analyzed using SPSS version 16.0. Finally, multivariate analysis was used to assess independent effect of predictors. In this study, 492 students were included, making a response rate of 100%. Mean age at menarche was 14.1±1.4 years. The main sources of information about menstrual hygiene management were teachers for 212 (43.1%). Four hundred forty six (90.7%) respondents had high level knowledge about menstrual hygiene management. Most of the respondents 457 (92.9%) and 475 (96.5%) had access for water and toilet facility respectively. Place of residence (AOR = 1.8, 95%CI: [1.42-1.52]) and educational status of their mothers' (AOR = 95%CI: [1.15-13.95]) were independent predictors of knowledge about menstrual hygiene management. Knowledge of respondents about menstrual hygiene management was very high. School teachers were the primary source of information. Place of residence and their mother's educational status were independent predictors of menstrual hygiene management. Thus, the government of Ethiopia in collaboration with its stalk holders should develop and disseminatereproductive health programmes on menstrual hygiene management targeting both parents and their adolescents. Moreover, parents should be made aware about the need to support their children with appropriate sanitary materials.

Assessing the effects of catch and release regulations on a quality adfluvial brook trout population using a computer based age-structure model

USGS Publications Warehouse

Risley, Casey A.L.; Zydlewski, Joseph D.

2011-01-01

Assessing the Effects of Catch-and-Release Regulations on a Brook Trout Population Using an Age-Structured Model: North American Journal of Fisheries Management: Vol 30, No 6 var _prum=[['id','54ff88bcabe53dc41d1004a5'],['mark','firstbyte',(new Date()).getTime()

Aged care nurses' job control influence satisfaction and mental health.

PubMed

Elliott, Kate-Ellen J; Rodwell, John; Martin, Angela J

2017-10-01

Relationships exist between aged care nurses' perceptions of psychosocial work characteristics, job satisfaction and mental health, suggesting these characteristics may be important for the management of aged care services. An expanded demand-control-support model that included justice perceptions was examined to determine its impact on multiple types of psychological and organisational well-being outcomes (i.e. job satisfaction, psychological distress and depression). Data were collected from a sample of 173 aged care nurses using a self-report survey and analysed using hierarchical multiple regression. A significant proportion (27-28%) of the variance in aged care nurses' satisfaction, depression and psychological distress was explained by the psychosocial factors included in the model. Job control had the most consistent impact with direct effects on job satisfaction, psychological distress and depression. Informational justice was associated with both psychological distress and depression. Targeting job control may provide the biggest response for nurse managers in aged care, as it is likely to influence nurses' job satisfaction, psychological distress and depression. Facility managers should implement organisational policies and procedures that promote higher levels of control over how nurses perform their work in order to improve nurse well-being in aged care settings. © 2017 John Wiley & Sons Ltd.

Managed care and inpatient mortality in adults: effect of primary payer.

PubMed

Hines, Anika L; Raetzman, Susan O; Barrett, Marguerite L; Moy, Ernest; Andrews, Roxanne M

2017-02-08

Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor. This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. A cross-sectional design was used to examine the association between managed care and inpatient mortality for four common inpatient conditions. Data from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases for 11 states were linked to data from the American Hospital Association Annual Survey Database. Hospital discharges were categorized as managed care or fee for service. A phased approach to multivariate logistic modeling examined the likelihood of inpatient mortality when adjusting for individual patient and hospital characteristics and for county fixed effects. Results showed different effects of managed care for Medicare and privately insured patients. Privately insured patients in managed care had an advantage over their fee-for-service counterparts in inpatient mortality for acute myocardial infarction, stroke, pneumonia, and congestive heart failure; no such advantage was found for the Medicare managed care population. To the extent that the study showed a protective effect of privately insured managed care, it was driven by individuals aged 65 years and older, who had consistently better outcomes than their non-managed care counterparts. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS. Additional research is needed to understand the role of patient selection, hospital quality, and differences among county populations in the decreased odds of inpatient mortality among patients in private managed care and to determine why this result does not hold for Medicare.

The Impact of E-Learning on Adherence to Guidelines for Acute Gastroenteritis: A Single-Arm Intervention Study.

PubMed

Nicastro, Emanuele; Lo Vecchio, Andrea; Liguoro, Ilaria; Chmielewska, Anna; De Bruyn, Caroline; Dolinsek, Jernej; Doroshina, Elena; Fessatou, Smaragdi; Pop, Tudor Lucian; Prell, Christine; Tabbers, Merit Monique; Tavares, Marta; Urenden-Elicin, Pinar; Bruzzese, Dario; Zakharova, Irina; Sandhu, Bhupinder; Guarino, Alfredo

2015-01-01

E-learning is a candidate tool for clinical practice guidelines (CPG) implementation due to its versatility, universal access and low costs. We aimed to assess the impact of a five-module e-learning course about CPG for acute gastroenteritis (AGE) on physicians' knowledge and clinical practice. This work was conceived as a pre/post single-arm intervention study. Physicians from 11 European countries registered for the online course. Personal data, pre- and post-course questionnaires and clinical data about 3 to 5 children with AGE managed by each physician before and after the course were collected. Primary outcome measures included the proportion of participants fully adherent to CPG and number of patients managed with full adherence. Among the 149 physicians who signed up for the e-learning course, 59 took the course and reported on their case management of 519 children <5 years of age who were referred to their practice because of AGE (281 and 264 children seen before and after the course, respectively). The course improved knowledge scores (pre-course 8.6 ± 2.7 versus post-course 12.8 ± 2.1, P < 0.001), average adherence (from 87.0 ± 7.7% to 90.6 ± 7.1%, P = 0.001) and the number of patients managed in full adherence with the guidelines (from 33.6 ± 31.7% to 43.9 ± 36.1%, P = 0.037). E-learning is effective in increasing knowledge and improving clinical practice in paediatric AGE and is an effective tool for implementing clinical practice guidelines.

The Impact of a Telephone-Based Chronic Disease Management Program on Medical Expenditures.

PubMed

Avery, George; Cook, David; Talens, Sheila

2016-06-01

The impact of a payer-provided telephone-based chronic disease management program on medical expenditures was evaluated using claims data from 126,245 members in employer self-ensured health plans (16,224 with a chronic disease in a group enrolled in the self-management program, 13,509 with a chronic disease in a group not participating in the program). A random effects regression model controlling for retrospective risk, age, sex, and diagnosis with a chronic disease was used to determine the impact of program participation on market-adjusted health care expenditures. Further confirmation of results was obtained by an ordinary least squares model comparing market- and risk-adjusted costs to the length of participation in the program. Participation in the program is associated with an average annual savings of $1157.91 per enrolled member in health care expenditures. Savings increase with the length of participation in the program. The results support the use of telephone-based patient self-management of chronic disease as a cost-effective means to reduce health care expenditures in the working-age population. (Population Health Management 2016;19:156-162).

Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia

PubMed Central

Badawy, Sherif M; Morrone, Kerry; Thompson, Alexis; Palermo, Tonya M

2018-01-01

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including: evaluating the effects of using computer and mobile technology interventions for medication adherence and disease management on health and behavioural outcomes;identifying and assessing the effects of computer and mobile technology interventions specific to different age groups (children, adolescents and adults) and type of modality (e.g. cell phone, the Internet). PMID:29861660

Models to compare management options for a protogynous fish.

PubMed

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

2006-02-01

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

In Control: A Skill-Building Program for Teaching Young Adolescents To Manage Anger.

ERIC Educational Resources Information Center

Kellner, Millicent H.

This program guide was written to help teach young people effective anger management skills. Geared toward adolescents of middle school age and intended for in-class use, the sessions are readily adaptable for use in small group or individual contexts. The main goal is to help youngsters gain the awareness and skills to manage their anger so that…

Parent and Teacher Perceptions of the Impact of School Nurse Interventions on Children's Self-Management of Diabetes

ERIC Educational Resources Information Center

Peery, Annette I.; Engelke, Martha Keehner; Swanson, Melvin S.

2012-01-01

Diabetes is a common chronic illness among school-age children. The school nurse collaborates with the student, parents, and teachers to help the child manage their diabetes effectively. Very little is known about the relationship between school nurse interventions and parent/teacher perceptions of the child's self-management. We examined this…

Species diversity of polyporoid and corticioid fungi in northern hardwood forests with differing management histories

Treesearch

Daniel L. Lindner; Harold H., Jr. Burdsall; Glen R. Stanosz

2006-01-01

Effects of forest management on fungal diversity were investigated by sampling fruit bodies of polyporoid and corticioid fungi in forest stands that have different management histories. Fruit bodies were sampled in 15 northern hardwood stands in northern Wisconsin and the upper peninsula of Michigan. Sampling was conducted in five old-growth stands, five uneven-age...

Effects of feeding strategy and age on live animal performance, carcass characteristics, and economics of short-term feeding programs for culled beef cows.

PubMed

Sawyer, J E; Mathis, C P; Davis, B

2004-12-01

To evaluate production and economic effects of feeding management strategy and age on intensively managed culled beef cows, a study was conducted using 125 cows of British breeding blocked by age (Young = 3 and 4 yr olds; LowMid = 5 and 6 yr olds; HighMid = 7 and 8 yr olds; and Aged = 9 yr and older) and assigned to one of three steam-flaked corn based feeding strategies. Treatments were as follows: Conservative (CSV), 30% roughage throughout; Standard (STD), decrease roughage from 30 to 10% over 20 d; and Aggressive (AGR), decrease roughage from 30 to 10% over 10 d. There were four pens per treatment in a randomized complete block design. Cows were fed for a total of 54 d, and BW was measured on d 0, 14, 28, 42, and 54. Half the cows from each pen were randomly selected and slaughtered at a commercial abattoir, and carcass data were collected. Average daily gain, daily DMI, and G:F during each weigh period and across the entire feeding period were calculated. Over the 54-d feeding period, strategies that employed more energy-dense diets numerically increased ADG (1.28, 1.63, and 1.55 +/- 0.14 kg/d for CSV, STD, and AGR; P = 0.26) and decreased DMI (11.91, 10.74, and 10.89 +/- 0.27 kg/d for CSV, STD, and AGR; P = 0.05), such that G:F was lower for CSV than for STD or AGR (0.105, 0.150, and 0.141 +/- 0.010; P = 0.05). Carcass weight was least for the CSV strategy (298 kg) and greatest for STD (328 kg); AGR resulted in intermediate carcass weight (317 +/- 6 kg; P = 0.04). Total cost of gain was over 30% greater for CSV strategy than for STD or AGR strategies (P < 0.01). In many cases, block effects (age) had a greater effect on responses than treatments. Average daily gain, DMI, and G:F decreased linearly with age (P < 0.01). Hot carcass weight, dressing percent, and fat thickness decreased linearly with age (P < 0.03); yield grade decreased and carcass maturity attributes increased linearly with age (P < 0.02). Performance and intake differences resulted in linear increases in total cost of gain (P < 0.01) and breakeven price (P = 0.03) with increasing age. These data indicate advantages to more aggressive feeding management strategies for culled beef cows, although maximal intake may be achieved with higher-roughage diets. Despite management effects, an increase in market price above purchase price may be required for intensive feeding of culled beef cows to be a profitable enterprise.

The Effectiveness of the Instructional Programs Based on Self-Management Strategies in Acquisition of Social Skills by the Children with Intellectual Disabilities

ERIC Educational Resources Information Center

Avcioglu, Hasan

2012-01-01

The purpose of this study is to evaluate the effectiveness of self-management skills training program, based on self-control strategies, on students with intellectual disabilities. A multiple-probe design across subjects single-subject research methodology was used in this study. Nine students with intellectual disabilities, whose ages are between…

A density management diagram for Scots pine (Pinus sylvestris L.): A tool for assessing the forest's protective effect

Treesearch

Giorgio Vacchiano; Renzo Motta; James N. Long; John D. Shaw

2008-01-01

Density management diagrams (DMD) are graphical tools used in the design of silvicultural regimes in even-aged forests. They depict the relationship between stand density, average tree size, stand yield and dominant height, based upon relevant ecological and allometric relationships such as the self-thinning rule, the yield-density effect, and site index curves. DMD...

Cost-Effectiveness of Surgical Versus Conservative Treatment for Thoracolumbar Burst Fractures.

PubMed

Aras, Efe Levent; Bunger, Cody; Hansen, Ebbe Stender; Søgaard, Rikke

2016-02-01

Historical, register-based cohort study following 85 patients in the course of a time frame extending from 2 years before to 2 years after trauma occurrence. To investigate the cost-effectiveness of surgery versus conservative management for thoracolumbar burst fractures. Despite the prevalence of thoracolumbar burst fractures, consensus has still not been reached in terms of their clinical management and whereas from a health policy point of view, efficient use of resources is equally important, literature pertaining to this aspect is limited. Consecutive patients who were admitted to a university clinic between 2004 and 2008 because of CT-verified AO type A3 fractures (T11-L2), age 18 to 65 years Patients with neurological compromise, osteoporosis, or malignancy were not included. The cost parameter defined primary and secondary health-care use (2010 &OV0556;) and the effect parameter was based on three alternative measures of pain medication: morphine milligram and defined daily doses (DDD) of narcotic and nonnarcotic analgesics. For cost-effectiveness analysis, we employed a difference-in-difference approach, including control for treatment selection (age, sex, and fracture type). Nonparametric bootstrapping was used to estimate conventional 95% confidence intervals of mean estimates. When taking into consideration all health-care consumption, surgical management was observed to cost an additional &OV0556;10,734 (4215; 15,144) as compared with conservative management. The differences on morphine at 527(-3031; 6,016) milligram, narcotic analgesics at -8(-176; 127) DDD, and nonnarcotic analgesics at -3(-72; 58) DDD were all insignificant The probability for surgery being cost-effective did not exceed 50% for any value of willingness to pay for effect. Surgical management does not seem to be a cost-effective strategy as compared with conservative management for traumatic thoracolumbar burst fractures without neurological deficits. In addition, higher-volume studies examining the clinical effect of alternative management strategies would be valuable. 3.

78 FR 21980 - Aging Management of Internal Surfaces, Service Level III and Other Coatings, Atmospheric Storage...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-12

... NUCLEAR REGULATORY COMMISSION [NRC-2013-0068] Aging Management of Internal Surfaces, Service Level... Interim Staff Guidance (LR-ISG), LR-ISG-2012-02, ``Aging Management of Internal Surfaces, Service Level... proposes to revise NRC staff-recommended aging management programs (AMP) and aging management review (AMR...

Topical retinoids in the management of photodamaged skin: from theory to evidence-based practical approach.

PubMed

Darlenski, R; Surber, C; Fluhr, J W

2010-12-01

Skin, being exposed directly to the environment, represents a unique model for demonstrating the synergistic effects of intrinsic and extrinsic factors on the ageing process. Ultraviolet radiation (UVR) is the major factor among exogenous stressors responsible for premature skin ageing. The problem of skin ageing has captured public attention and has an important social impact. Different therapeutic approaches have been developed to treat cutaneous ageing and to diminish or prevent the negative effects of UVR. Topical retinoids represent an important and powerful class of molecules in the dermatologist's hands for the treatment of photodamaged skin. Since their introduction more than 20 years ago, topical retinoids have shown beneficial efficacy and good safety profiles in the management of photodamaged skin, and as therapeutic anti-ageing agents. This review provides a brief retrospective of the development of topical retinoids in the treatment of photodamaged skin, elucidates their mechanism of action, delineates their use and addresses clinical, pharmaceutical and regulatory issues in connection with their intended use. © 2010 The Authors. BJD © 2010 British Association of Dermatologists.

Alcohol and Tobacco Sales to Underage Buyers in Dutch Supermarkets: Can the Use of Age Verification Systems Increase Seller's Compliance?

PubMed

Roodbeen, Ruud T J; Schelleman-Offermans, Karen; Lemmens, Paul H H M

2016-06-01

Age limits are effective in reducing alcohol- and tobacco-related harm, however, their effectiveness depends on the extent to which they are complied with. This study aimed to investigate the effectiveness of different age verification systems (AVSs) implemented by 400 Dutch supermarkets on requesting a valid age verification (ID) and on sellers' compliance. A mixed method design was used. Compliance was measured by 800 alcohol and tobacco purchase attempts by 17-year-old mystery shoppers. To analyze the effectiveness of AVSs, logistic regression analyses were performed. Insight into facilitating and hindering factors in the purchase process was obtained by 13 interviews with supermarket managers. Only a tendency toward a positive effect of the presence of the keying-on-date-of-birth AVS or ID swiper/checker was found on ID request for both alcohol and tobacco purchase attempts. The use of the keying-on-date-of-birth AVS or ID swiper/checker significantly increased the odds for compliance after an ID was requested, for both alcohol and tobacco purchase attempts. Managers indicated that ID requests and compliance could be facilitated by providing cashiers with sufficient managerial support, technical support, and regular training about the purchase process and use of the AVS. The usage of AVSs calculating and confirming whether the customer reached the legal purchase age for cashiers significantly increases the odds for cashiers to comply with age limits of alcohol and tobacco. Future research should gain insight into how usage of effective AVSs can be improved and explore the feasibility of implementation and effectiveness in other outlets. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Factors influencing breeding success, ovarian cyclicity, and cub survival in zoo-managed tigers (Panthera tigris).

PubMed

Saunders, Sarah P; Harris, Tara; Traylor-Holzer, Kathy; Beck, Karen Goodrowe

2014-01-10

Understanding factors that influence reproduction and offspring survival in zoo populations is critical for management of threatened and endangered species. Examination of long-term data (1989-2011) compiled from the Association of Zoos and Aquarium's zoo-managed tiger breeding program provides the basis for a more thorough understanding of reproduction and scientifically based decisions for effective population management in this endangered felid. Biological and management-related factors that could influence tiger breeding success and cub survival were evaluated using logistic mixed models. Breeding success improved with female age until approximately age five, then declined thereafter. Experienced female breeders had greater breeding success than inexperienced females. Litter size was most predictive of cub survival, with average-sized litters (3-4 cubs) experiencing the highest proportional survival. Management-related factors, such as whether the breeding institution had a recent tiger litter and whether both animals were already located at the same institution, also influenced breeding success and cub survival. These results highlight the importance of institutional husbandry experience and the need to retain knowledge through staff turnovers to achieve optimal reproductive success. Using fecal estrogen data, frequency of ovarian cyclicity and mean cycle length did not differ by female age or parity; thus, lack of cyclicity and/or increased cycle duration are not likely explanations for declining breeding success with age. These results provide valuable reproductive information that should improve scientific management of zoo-based tiger populations. Copyright © 2013 Elsevier B.V. All rights reserved.

A comparison of strength-training, self-management and the combination for early osteoarthritis of the knee

PubMed Central

McKnight, Patrick E.; Kasle, Shelley; Going, Scott; Villaneuva, Isidro; Cornett, Michelle; Farr, Josh; Wright, Jill; Streeter, Clara; Zautra, Alex

2010-01-01

Objective To assess the relative effectiveness of combining self-management and strength-training for improving functional outcomes in early knee osteoarthritis patients. Methods A randomized intervention trial lasting 24 months conducted at an academic medical center. Community dwelling middle-aged adults (N=273), aged 34 to 65 with knee osteoarthritis, pain and self-reported physical disability completed a strength-training program, a self-management program, or a combined program. Outcomes included five physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and two self-reported measures of pain and disability. Results A total of 201 (73.6 %) participants completed the 2-year trial. Overall compliance was modest - strength-training (55.8 %), self-management (69.1 %), and combined (59.6 %) programs. The three groups showed a significant and large increase from pre- to post-treatment in all physical functioning measures including leg press (d =.85), range of motion (d=1.00), work capacity (d=.60), balance (d=.59), and stair climbing (d=.59). Additionally, all three groups showed decreased self-reported pain (d=-.51) and disability (d=-.55). There were no significant differences among groups. Conclusions Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength-training, self-management, and the combination. These results suggest that both strength-training and self-management are suitable treatments for early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis. PMID:20191490

Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system.

PubMed

Cook, David J; Moradkhani, Anilga; Douglas, Kristin S Vickers; Prinsen, Sharon K; Fischer, Erin N; Schroeder, Darrell R

2014-04-01

The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery. Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.

Understanding and managing the effects of battery charger and inverter aging

NASA Astrophysics Data System (ADS)

Gunther, W.; Aggarwal, S.

An aging assessment of battery chargers and inverters was conducted under the auspices of the NRC's Nuclear Plant Aging Research (NPAR) Program. The intentions of this program are to resolve issues related to the aging and service wear of equipment and systems at operating reactor facilities and to assess their impact on safety. Inverters and battery chargers are used in nuclear power plants to perform significant functions related to plant safety and availability. The specific impact of a battery charger or inverter failure varies with plant configuration. Operating experience data have demonstrated that reactor trips, safety injection system actuations, and inoperable emergency core cooling systems have resulted from inverter failures; and dc bus degradation leading to diesel generator inoperability or loss of control room annunication and indication have resulted from battery and battery charger failures. For the battery charger and inverter, the aging and service wear of subcomponents have contributed significantly to equipment failures. This paper summarizes the data and then describes methods that can be used to detect battery charger and inverter degradation prior to failure, as well as methods to minimize the failure effects. In both cases, the managing of battery charger and inverter aging is emphasized.

Self-management of older adolescents with inflammatory bowel disease: a pilot study of behavior and knowledge as prelude to transition.

PubMed

Fishman, Laurie N; Barendse, Renée M; Hait, Elizabeth; Burdick, Cynthia; Arnold, Janis

2010-12-01

Patients gradually assume responsibility for self-management. This study sought to determine whether adolescents with inflammatory bowel disease (IBD) have developed key skills of self-management prior to the age at which many transfer to adult care. Adolescents aged 16 to 18 years old in the Children's Hospital Boston IBD database (94 total) received a mailed survey assessing knowledge and confidence of their own health information and behaviors. Respondents (43%) could name medication and dose with confidence but had very poor knowledge of important side effects. Most patients deferred responsibility mostly or completely to parents for scheduling appointments (85%), requesting refills (75%), or contacting provider between visits (74%). Older adolescents with IBD have good recall of medications but not of side effects. Parents remain responsible for the majority of tasks related to clinic visits and the acquisition of medications.

The cardiometabolic effect of current management of polycystic ovary syndrome: strategies of prevention and treatment.

PubMed

Baldani, Dinka Pavicic; Skrgatic, Lana; Ougouag, Roya; Kasum, Miro

2018-02-01

Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder amongst women of reproductive age, which is characterized by reproductive and cardiometabolic disturbances with long-term health repercussions. Insulin resistance (IR), impaired glucose tolerance, type 2 diabetes mellitus (DM2), obesity and dyslipidemia occur more in women with PCOS than in age-comparable women without PCOS. Long term data regarding risks or benefits of medical intervention for metabolic dysfunction of PCOS are lacking. Therapies, such as oral contraceptives (OCPs) and anti-androgenic medications used to manage the reproductive manifestations of PCOS, may themselves be the cause of cardiometabolic perturbations. Hence, strategies regarding the management of reproductive issues in PCOS encompass a patient-specific tailored approach. Factors that influence the cardiometabolic side effects arising during treatment of the reproductive manifestations of PCOS (hirsutism/anovulation) are also discussed in this paper in order to build future strategies to minimize the overall cardiometabolic risk.

Self-management of health-behaviors among older and younger workers with chronic illness.

PubMed

Munir, Fehmidah; Khan, Hafiz T A; Yarker, Joanna; Haslam, Cheryl; Long, Helen; Bains, Manpreet; Kalawsky, Katryna

2009-10-01

To examine the self-management of health behaviors carried out by older (aged 50-69 years) and younger workers (aged 20-49 years) with a chronic illness. Questionnaire data was collected from 759 employees with a diagnosed chronic illness. Four categories of self-managing health behaviors were examined: using prescribed medication, monitoring and responding to symptoms, managing an appropriate diet and exercising. The majority of participants (56-97%) reported being advised to carry out health behaviors at home and at work. Controlling for confounding factors, medication use was associated with younger and older workers. Managing an appropriate diet was associated with younger workers with asthma, musculoskeletal pain or diabetes. Exercising was associated with younger workers with asthma and with older workers with heart disease, arthritis and rheumatism or diabetes. The findings indicate that there are differences in diet and exercise activities among younger and older workers. To increase self-management in health behaviors at work, improved communication and understanding between the different health professions and the patient/employee is required so that different tailored approaches can be effectively targeted both by age and within the context of the working environment, to those managing asthma, heart disease, diabetes and arthritis and rheumatism. 2009 Elsevier Ireland Ltd.

Effect of butorphanol on thermal nociceptive threshold in healthy pony foals.

PubMed

McGowan, K T; Elfenbein, J R; Robertson, S A; Sanchez, L C

2013-07-01

Pain management is an important component of foal nursing care, and no objective data currently exist regarding the analgesic efficacy of opioids in foals. To evaluate the somatic antinociceptive effects of 2 commonly used doses of intravenous (i.v.) butorphanol in healthy foals. Our hypothesis was that thermal nociceptive threshold would increase following i.v. butorphanol in a dose-dependent manner in both neonatal and older pony foals. Seven healthy neonatal pony foals (age 1-2 weeks), and 11 healthy older pony foals (age 4-8 weeks). Five foals were used during both age periods. Treatments, which included saline (0.5 ml), butorphanol (0.05 mg/kg bwt) and butorphanol (0.1 mg/kg bwt), were administered i.v. in a randomised crossover design with at least 2 days between treatments. Response variables included thermal nociceptive threshold, skin temperature and behaviour score. Data within each age period were analysed using a 2-way repeated measures ANOVA, followed by a Holm-Sidak multiple comparison procedure if warranted. There was a significant (P<0.05) increase in thermal threshold, relative to Time 0, following butorphanol (0.1 mg/kg bwt) administration in both age groups. No significant time or treatment effects were apparent for skin temperature. Significant time, but not treatment, effects were evident for behaviour score in both age groups. Butorphanol (0.1 mg/kg bwt, but not 0.05 mg/kg bwt) significantly increased thermal nociceptive threshold in neonatal and older foals without apparent adverse behavioural effects. Butorphanol shows analgesic potential in foals for management of somatic painful conditions. © 2012 EVJ Ltd.

Disaster management and the critical thinking skills of local emergency managers: correlations with age, gender, education, and years in occupation.

PubMed

Peerbolte, Stacy L; Collins, Matthew Lloyd

2013-01-01

Emergency managers must be able to think critically in order to identify and anticipate situations, solve problems, make judgements and decisions effectively and efficiently, and assume and manage risk. Heretofore, a critical thinking skills assessment of local emergency managers had yet to be conducted that tested for correlations among age, gender, education, and years in occupation. An exploratory descriptive research design, using the Watson-Glaser Critical Thinking Appraisal-Short Form (WGCTA-S), was employed to determine the extent to which a sample of 54 local emergency managers demonstrated the critical thinking skills associated with the ability to assume and manage risk as compared to the critical thinking scores of a group of 4,790 peer-level managers drawn from an archival WGCTA-S database. This exploratory design suggests that the local emergency managers, surveyed in this study, had lower WGCTA-S critical thinking scores than their equivalents in the archival database with the exception of those in the high education and high experience group. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

National Study of Chronic Disease Self-Management: Age Comparison of Outcome Findings

ERIC Educational Resources Information Center

Ory, Marcia G.; Smith, Matthew Lee; Ahn, SangNam; Jiang, Luohua; Lorig, Kate; Whitelaw, Nancy

2014-01-01

Introduction: The adult population is increasingly experiencing one or more chronic illnesses and living with such conditions longer. The Chronic Disease Self-Management Program (CDSMP) helps participants cope with chronic disease-related symptomatology and improve their health-related quality of life. Nevertheless, the long-term effectiveness of…

The Effects of Secure Attachments on Preschool Children's Conflict Management Skills.

ERIC Educational Resources Information Center

Kesner, John

This study examined the relationship between the security of children's attachment relationships to parents and teachers and how children negotiate and manage conflicts. Sixty-six preschool-aged children participated in story completion tasks regarding their attachment relationship with parents and teachers, and in hypothetical situations…

Effect of pest management system on 'Empire' apple leaf phyllosphere populations

USDA-ARS?s Scientific Manuscript database

The phyllosphere of plant tissues is varied and dynamic. Pest management, time of sampling, proximity to immigration sources, tissue and tissue status such as leaf/fruit age and location within the canopy, and other environmental and biological factors interact to influence the composition and abun...

Caring for children with special healthcare needs in the managed care environment.

PubMed

Hawkins, Michelle R; Diehl-Svrjcek, Beth; Dunbar, Linda J

2006-01-01

Dramatic medical and technological advances over the past 15 years have resulted in the survival into adulthood of children with chronic health conditions. As this population subset has increased, the demand of caring for these children in the managed care arena has become challenging from a clinical, fiscal, and member satisfaction perspective. A disease management program was designed for children, ages birth through age 18, identified as having special needs at the time of birth or at any point throughout childhood related to disease processes such as diabetes, sickle cell disease, genetic aberrations, or the multiple complications of extreme prematurity. Components of the program included identification of the population, coordinated risk assessment, and ongoing case management interventions. Most important, outcome indicators were tracked to demonstrate program effectiveness. The formulation and function of a dedicated disease management database is also discussed.

The Impact of E-Learning on Adherence to Guidelines for Acute Gastroenteritis: A Single-Arm Intervention Study

PubMed Central

Nicastro, Emanuele; Lo Vecchio, Andrea; Liguoro, Ilaria; Chmielewska, Anna; De Bruyn, Caroline; Dolinsek, Jernej; Doroshina, Elena; Fessatou, Smaragdi; Pop, Tudor Lucian; Prell, Christine; Tabbers, Merit Monique; Tavares, Marta; Urenden-Elicin, Pinar; Bruzzese, Dario; Zakharova, Irina; Sandhu, Bhupinder; Guarino, Alfredo

2015-01-01

Objective E-learning is a candidate tool for clinical practice guidelines (CPG) implementation due to its versatility, universal access and low costs. We aimed to assess the impact of a five-module e-learning course about CPG for acute gastroenteritis (AGE) on physicians’ knowledge and clinical practice. Study design This work was conceived as a pre/post single-arm intervention study. Physicians from 11 European countries registered for the online course. Personal data, pre- and post-course questionnaires and clinical data about 3 to 5 children with AGE managed by each physician before and after the course were collected. Primary outcome measures included the proportion of participants fully adherent to CPG and number of patients managed with full adherence. Results Among the 149 physicians who signed up for the e-learning course, 59 took the course and reported on their case management of 519 children <5 years of age who were referred to their practice because of AGE (281 and 264 children seen before and after the course, respectively). The course improved knowledge scores (pre-course 8.6 ± 2.7 versus post-course 12.8 ± 2.1, P < 0.001), average adherence (from 87.0 ± 7.7% to 90.6 ± 7.1%, P = 0.001) and the number of patients managed in full adherence with the guidelines (from 33.6 ± 31.7% to 43.9 ± 36.1%, P = 0.037). Conclusions E-learning is effective in increasing knowledge and improving clinical practice in paediatric AGE and is an effective tool for implementing clinical practice guidelines. PMID:26148301

8 Different approaches needed to manage ED demand among different age-groups.

PubMed

Rimmer, Melanie; Ablard, Suzanne; O'Keeffe, Colin; Mason, Suzanne

2017-12-01

A variety of interventions have been proposed to manage rising demand for Emergency and Urgent Care, described by an NHS England review as unsustainable in the long term. However it is unlikely that any suggested approach will be equally suitable for the diverse population of ED users.We aimed to understand the patterns of demand amongst different types of patients attending ED. We also sought to understand the intended and unintended effects of demand management initiatives. Our study combined insights from routine data, a survey of ED patients, and qualitative interviews with ED staff. This paper describes the results of our analysis of the interviews. We conducted semi-structured interviews with 25 ED and Urgent Care Centre staff across 7 hospital sites in Yorkshire and Humber between 25 April and 11 July 2016. The interview topic guide asked about 4 broad areas; job role, description of patients and their impact on demand, description of inappropriate attendance, and current/future initiatives to deal with rising demand. Interviews were transcribed verbatim and analysed using framework analysis. We analysed the results to identify groups of patients with different patterns of use of ED services. We also explored ED staff experiences of demand management initiatives, and their suggestions for future initiatives. Although we did not ask specifically about patients' age, our analysis revealed that ED staff categorised attenders as children and young people, working age people, and older people. These groups had different reasons for attendance, different routes to the ED, different rate of non-urgent attendance, and different issues driving demand. Staff also described variation in the time taken to treat patients of different ages, with the oldest and youngest patients described as requiring the most time.There was no consensus amongst staff about the effectiveness of initiatives for managing demand. A strikingly wide variety of initiatives were mentioned including patient education, co-location of other services with ED ('ED hubs'), and extending community-based services. ED staff attribute distinctly different patterns of ED attendance to patients of different age groups, including reasons for attending ED, the route to the ED, and the rate of non-urgent attendance. Given this variation, proposed demand management interventions are likely to impact differently on different age groups, and one solution is unlikely to be optimal for all ages. Therefore a number of different approaches will be needed to manage ED demand among different age groups. © 2017, 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.

[Managment of head and neck cancers during pregnancy].

PubMed

Kiciński, Krzysztof; Skorek, Andrzej; Stankiewicz, Czesław

2011-01-01

The coincidence of malignant disease during pregnancy is uncommon. The incidence of cancer in pregnancy has increased, due to the tendency to postpone childbirth to an older age. Cancer complicates approximately 0.1% of all pregnancies. Managing head and neck cancers during pregnancy requires additional pregnancy-related understanding of the aetiological effect of pregnancy on cancer, knowledge of the direct and indirect effects of cancer on pregnancy, and the effect of diagnostic and treatment modalities on pregnancy. The timing of treatment is an important determinant on foetal wellbeing. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. Clinicians must be cognizant with the ethical dilemmas of treatment. In head and neck cancers, pregnancy has no effect on maternal prognosis when compared to non-pregnant patients matched by age, cancer stage and treatment. Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.

Uncertainty in age-specific harvest estimates and consequences for white-tailed deer management

USGS Publications Warehouse

Collier, B.A.; Krementz, D.G.

2007-01-01

Age structure proportions (proportion of harvested individuals within each age class) are commonly used as support for regulatory restrictions and input for deer population models. Such use requires critical evaluation when harvest regulations force hunters to selectively harvest specific age classes, due to impact on the underlying population age structure. We used a stochastic population simulation model to evaluate the impact of using harvest proportions to evaluate changes in population age structure under a selective harvest management program at two scales. Using harvest proportions to parameterize the age-specific harvest segment of the model for the local scale showed that predictions of post-harvest age structure did not vary dependent upon whether selective harvest criteria were in use or not. At the county scale, yearling frequency in the post-harvest population increased, but model predictions indicated that post-harvest population size of 2.5 years old males would decline below levels found before implementation of the antler restriction, reducing the number of individuals recruited into older age classes. Across the range of age-specific harvest rates modeled, our simulation predicted that underestimation of age-specific harvest rates has considerable influence on predictions of post-harvest population age structure. We found that the consequence of uncertainty in harvest rates corresponds to uncertainty in predictions of residual population structure, and this correspondence is proportional to scale. Our simulations also indicate that regardless of use of harvest proportions or harvest rates, at either the local or county scale the modeled SHC had a high probability (>0.60 and >0.75, respectively) of eliminating recruitment into >2.5 years old age classes. Although frequently used to increase population age structure, our modeling indicated that selective harvest criteria can decrease or eliminate the number of white-tailed deer recruited into older age classes. Thus, we suggest that using harvest proportions for management planning and evaluation should be viewed with caution. In addition, we recommend that managers focus more attention on estimation of age-specific harvest rates, and modeling approaches which combine harvest rates with information from harvested individuals to further increase their ability to effectively manage deer populations under selective harvest programs. ?? 2006 Elsevier B.V. All rights reserved.

Cultural intensity and planting density effects on individual tree stem growth, stand and crown attributes, and stand dynamics in thinned loblolly pine plantations during the age 12- to age 15- year period in the Upper Coastal Plain and Piedmont of the Southeastern United States

Treesearch

Evan Johnson; Michael Kane; Dehai Zhao; Robert Teskey

2015-01-01

Three existing loblolly pine (Pinus taeda L.) installations in the Plantation Management Research Cooperative's Upper Coastal Plain/Piedmont Culture Density Study were used to examine the effects of two cultural intensities, four initial planting densities, and their interactions on stem growth at the individual tree level from age 12 to 15 years and at the stand...

Do Aging Factors Influence the Clinical Presentation and Management of Chronic Rhinosinusitis?

PubMed

Renteria, Axel E; Mfuna Endam, Leandra; Desrosiers, Martin

2017-04-01

Objective/Hypothesis Chronic rhinosinusitis (CRS) is a complex inflammatory disease of the upper respiratory airways resulting from the dysregulation of immunity and epithelial defenses. More recently, the contribution of an altered nasal microbiome to the development of CRS has also been proposed. However, the impact of aging on the development of CRS has been long overlooked. Here we propose, in a hypothesis piece, that aging can influence the physiopathology of CRS and its subsequent management in an elderly population. Data Sources We summarize the recent literature findings supporting that elderly patients with CRS could be a distinct population from those with adult CRS and might require different or adjunct therapeutic approaches. Methods Review of recent literature of the effect of aging and its possible effects in CRS using 3 different databases. Conclusions Age-dependent decrease in the levels of the S100 family proteins involved in epithelial proliferation, repair, and defenses combined with chronic inflammation might lead to an increased risk of abnormal microbial colonization and loss of microbiota diversity. Ultimately, these changes could have the potential to alter the physiopathology of CRS in the elderly. Implications Unlike in adults, in whom CRS T h 2-skewed responses with eosinophilia are thought to play a critical role, in aging populations, a microbiome and epithelial barrier dysfunctions may instead be the pivotal agents of disease development and persistence. This supports that therapies for elderly patients may require a different management or additional targeted therapies to control the disease. Prospective studies, however, are necessary to validate this concept.

Anesthesia, Microcirculation and Wound Repair in Aging

PubMed Central

Bentov, Itay; Reed, May J.

2014-01-01

Age related changes in skin contribute to impaired wound healing after surgical procedures. Changes in skin with age include decline in thickness and composition, a decrease in the number of most cell types and diminished microcirculation. The microcirculation provides tissue perfusion, fluid homeostasis, and delivery of oxygen and other nutrients. It also controls temperature and the inflammatory response. Surgical incisions cause further disruption of the microvasculature of aged skin. Perioperative management can be modified to minimize insults to aged tissues. Judicious use of fluids, maintenance of normal body temperature, pain control and increased tissue oxygen tension are examples of adjustable variables that support the microcirculation. Anesthetic agents influence the microcirculation from a combination of effects on cardiac output, arterial pressure and local micro-vascular changes. We examine the role of anesthetic management in optimizing the microcirculation and potentially improving post-operative wound repair in older persons. PMID:24195972

How Immunocontraception Can Contribute to Elephant Management in Small, Enclosed Reserves: Munyawana Population as a Case Study

PubMed Central

Druce, Heleen C.; Mackey, Robin L.; Slotow, Rob

2011-01-01

Immunocontraception has been widely used as a management tool to reduce population growth in captive as well as wild populations of various fauna. We model the use of an individual-based rotational immunocontraception plan on a wild elephant, Loxodonta africana, population and quantify the social and reproductive advantages of this method of implementation using adaptive management. The use of immunocontraception on an individual, rotational basis stretches the inter-calving interval for each individual female elephant to a management-determined interval, preventing exposing females to unlimited long-term immunocontraception use (which may have as yet undocumented negative effects). Such rotational immunocontraception can effectively lower population growth rates, age the population, and alter the age structure. Furthermore, such structured intervention can simulate natural process such as predation or episodic catastrophic events (e.g., drought), which regulates calf recruitment within an abnormally structured population. A rotational immunocontraception plan is a feasible and useful elephant population management tool, especially in a small, enclosed conservation area. Such approaches should be considered for other long-lived, social species in enclosed areas where the long-term consequences of consistent contraception may be unknown. PMID:22174758

Age estimation of burbot using pectoral fin rays, brachiostegal rays, and otoliths

USGS Publications Warehouse

Klein, Zachary B.; Terrazas, Marc M.; Quist, Michael C.

2014-01-01

Throughout much of its native distribution, burbot (Lota lota) is a species of conservation concern. Understanding dynamic rate functions is critical for the effective management of sensitive burbot populations, which necessitates accurate and precise age estimates. Managing sensitive burbot populations requires an accurate and precise non-lethal alternative. In an effort to identify a non-lethal ageing structure, we compared the precision of age estimates obtained from otoliths, pectoral fin rays, dorsal fin rays and branchiostegal rays from 208 burbot collected from the Green River drainage, Wyoming. Additionally, we compared the accuracy of age estimates from pectoral fin rays, dorsal fin rays and branchiostegal rays to those of otoliths. Dorsal fin rays were immediately deemed a poor ageing structure and removed from further analysis. Age-bias plots of consensus ages derived from branchiostegal rays and pectoral fin rays were appreciably different from those obtained from otoliths. Exact agreement between readers and reader confidence was highest for otoliths and lowest for branchiostegal rays. Age-bias plots indicated that age estimates obtained from branchiostegal rays and pectoral fin rays were substantially different from age estimates obtained from otoliths. Our results indicate that otoliths provide the most precise age estimates for burbot.

Evaluating the impact of two training interventions to improve diagnosis and case-management of malaria and pneumonia in Uganda.

PubMed

Ssebuliba, D M; Ouifki, R; Pretorius, C; Burnett, S M; Mbonye, M K; Naikoba, S; Willis, K; Weaver, M R

2017-01-01

We present an age-structured mathematical model of malaria and pneumonia to study the effect of two capacity-building interventions: Integrated Management of Infectious Diseases (IMID) and On-site Support Services (OSS). IMID leads to a reduction in malaria prevalence by more than 2·4% across the [0,5), [5,14) and [14,50) age groups. IMID + OSS reduces it by more than 16·0% across all age groups. IMID decreases pneumonia prevalence by more than 3·0% across all age groups while IMID + OSS decreases it by more than 1·0% across all age groups. The number of malaria and pneumonia deaths is reduced by 7·8% by IMID across all age groups and IMID + OSS decreases this number by 30·5% across all age groups, which translates to saving a life of a child per month. Prevalence of malaria-pneumonia for the [0,5) age group is 0·52% at baseline, and IMID and IMID + OSS reduce it by 6·6% and 23·6%, respectively. There is no change in incidence of malaria or pneumonia disease episodes. The results also indicate that triaging of children contributes more than 50% to the effect of the interventions in reduction of deaths and a range of 14-91% in reduction of disease cases.

[The Utilization of Health-Related Applications in Chronic Disease Self-Management].

PubMed

Kao, Chi-Wen; Chuang, Hui-Wan; Chen, Ting-Yu

2017-08-01

The dramatic increase in smartphone usage has spurred the development of many health-related mobile applications (apps). On the other hand, population aging and the associated rise in the incidence of chronic disease is increasing the demand for long-term care. Effective chronic disease self-management has been shown to help patients improve their health condition. Numerous smartphone applications currently support patient self-management of chronic disease, facilitating health management and health promotion. The purpose of the present article was to introduce the definition, contents, and types of health-related apps; to discuss the effectiveness of self-management health-related apps in promoting chronic disease management; and to assess and evaluate these apps. We hope that the present article helps give to healthcare professionals and patients who are willing to manage their diseases a general understanding of health-related apps and their potential to facilitate the self-management of chronic diseases.

Stand dynamics in 60-year-old Allegheny hardwoods after thinning

Treesearch

Gary W. Miller

1997-01-01

Stand dynamics and tree growth in even-aged hardwood stands can be influenced by manipulating relative stand density, species composition, and stand structure. Land managers need quantitative information on the effect of vegetation manipulation to prescribe stand treatments that are appropriate for specific management objectives. Sixty-year-old stands composed of black...

Ecosystem management, forest health, and silviculture

Treesearch

Merrill R. Kaufmann; Claudia M. Regan

1995-01-01

Forest health issues include the effects of fire suppression and grazing on forest stands, reduction in amount of old-growth forests, stand structural changes associated with even-aged management, .changes in structure of the landscape mosaic, loss of habitat for threatened species, and the introduction of exotic species. The consequences of these impacts can be...

Economic evaluation of an internet-based weight management program

USDA-ARS?s Scientific Manuscript database

To determine whether a behavioral Internet treatment (BIT) program for weight management is a viable, cost-effective option compared with usual care (UC) in a diverse sample of overweight (average body mass index = 29 kg/m2), healthy adults (mean age = 34 years) serving in the US Air Force. Two-grou...

Managerial Effectiveness in Educational Administration: Concepts and Perspectives

ERIC Educational Resources Information Center

Farahbakhsh, Saeid

2007-01-01

This is the age of leadership and management. Every group activity requires some sort of leadership to organise and direct the group's effort toward some previously decided goals. Although management and leadership are different from each other, they are remarkably close too, especially in the dimension of human relationship. Leadership is the…

Effects of Culturally Adapted Parent Management Training on Latino Youth Behavioral Health Outcomes

ERIC Educational Resources Information Center

Martinez, Charles R.; Eddy, J. Mark

2005-01-01

A randomized experimental test of the implementation feasibility and the efficacy of a culturally adapted Parent Management Training intervention was conducted with a sample of 73 Spanish-speaking Latino parents with middle-school-aged youth at risk for problem behaviors. Intervention feasibility was evaluated through weekly parent satisfaction…

Age of Menarche and Knowledge about Menstrual Hygiene Management among Adolescent School Girls in Amhara Province, Ethiopia: Implication to Health Care Workers & School Teachers

PubMed Central

2014-01-01

Background Effective menstrual hygiene has direct and indirect effect on achieving millennium development goals two (universal education), three (gender equality and women empowerment) and, five (improving maternal health). However, in Ethiopiait is an issue which is insufficiently acknowledged in the reproductive health sector. The objective of this study therefore, is to assess the age of menarche and knowledge of adolescents about menstrual hygiene management in Amhara province. Method School based cross sectional study was conducted from November 2012 to June 2013. Multistage stage sampling technique was used. The school was first clustered in to grades & sections and thenparticipants were selected by lottery method. A pretested &structured questionnaire was used. Data were entered, cleaned and analyzed using SPSS version 16.0. Finally, multivariate analysis was used to assess independent effect of predictors. Findings In this study, 492 students were included, making a response rate of 100%. Mean age at menarche was 14.1±1.4 years. The main sources of information about menstrual hygiene management were teachers for 212 (43.1%). Four hundred forty six (90.7%) respondents had high level knowledge about menstrual hygiene management. Most of the respondents 457 (92.9%) and 475 (96.5%) had access for water and toilet facility respectively. Place of residence (AOR = 1.8, 95%CI: [1.42–1.52]) and educational status of their mothers’ (AOR = 95%CI: [1.15–13.95]) were independent predictors of knowledge about menstrual hygiene management. Conclusion Knowledge of respondents about menstrual hygiene management was very high. School teachers were the primary source of information. Place of residence and their mother’s educational status were independent predictors of menstrual hygiene management. Thus, the government of Ethiopia in collaboration with its stalk holders should develop and disseminatereproductive health programmes on menstrual hygiene management targeting both parents and their adolescents. Moreover, parents should be made aware about the need to support their children with appropriate sanitary materials. PMID:25268708

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...

Pesticide-related poison center exposures in children and adolescents aged ≤19 years in Texas, 2000-2013.

PubMed

Trueblood, Amber B; Forrester, Mathias B; Han, Daikwon; Shipp, Eva M; Cizmas, Leslie H

2016-11-01

Although national poison center data show that pesticides were the 8th most commonly reported substance category (3.27%) for children aged ≤5 years in 2014, there is limited information on childhood and adolescent pesticide exposures. This study assessed pesticide-related poison center exposures in children and adolescents aged ≤19 years from 2000-2013 in Texas to characterize the potential burden of pesticides. Pesticide-related poison center exposures among children and adolescents aged ≤19 years reported to Texas poison centers were identified. The distribution of exposures was estimated by gender, age category, medical outcome, management site, exposure route, and pesticide category. From 2000 to 2013, there were 61,147 pesticide-related poison center exposures in children and adolescents aged ≤19 years. The prevalence was highest among males at 864.24 per 100,000 population. The prevalence of unintentional exposures was highest among children aged ≤5 years at 2310.69 per 100,000 population, whereas the prevalence of intentional exposures was highest among adolescents aged 13-19 years at 13.82 per 100,000 population. A majority of medical outcomes reported were classified as having no effect (30.24%) and not followed, but minimal clinical effects possible (42.74%). Of all the exposures, 81.24% were managed on site. However, 57% of intentional exposures were referred to or treated at a health-care facility. The most common routes of exposure were ingestion (80.83%) and dermal (17.21%). The most common pesticide categories included rodenticides (30.02%), pyrethrins/pyrethroids (20.69%), and other and unspecified insecticides (18.14%). The study found differences in the frequency of exposures by intent for sex and age categories, and identified the most common medical outcomes, management site, exposure route, and pesticide category. Through characterizing pesticide-related poison center exposures, future interventions can be designed to address groups with higher prevalence of exposure.

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

Disease management positively affects patient quality of life.

PubMed

Walker, David R; Landis, Darryl L; Stern, Patricia M; Vance, Richard P

2003-04-01

Health care costs are spiraling upward. The population of the United States is aging, and many baby boomers will develop multiple chronic health conditions. Disease management is one method for reducing costs associated with chronic health conditions. Although these programs have been proven effective in improving patient health, detailed information about their effect on patient quality of life has been scarce. This article provides preliminary evidence that disease management programs for coronary artery disease, chronic obstructive pulmonary disease, diabetes, and heart failure lead to improved quality of life, which correlates with a healthier, more satisfied, and less costly patient.

Cost-Effectiveness of Social Work Services in Aging: An Updated Systematic Review

ERIC Educational Resources Information Center

Rizzo, Victoria M.; Rowe, Jeannine M.

2016-01-01

Objectives: This study examines the impact of social work interventions in aging on quality of life (QOL) and cost outcomes in four categories (health, mental health, geriatric evaluation and management, and caregiving). Methods: Systematic review methods are employed. Databases were searched for articles published in English between 2004 and 2012…

Two-aged silvicultural treatments in lodgepole pine stands can be economically viable

Treesearch

Ward W. McCaughey; Steven J. Martin; Dean A. Blomquist

2006-01-01

Economically viable silvicultural options are critical for management activities that provide wood products, reduce forest fuels, improve forest health, and enhance wildlife habitat. The Tenderfoot Research Project was developed in the late 1990s to evaluate and quantify ecological and biological effects of two-aged silvicultural treatments including prescribed fire in...

Patient Education Self-Management During Surgical Recovery: Combining Mobile (iPad) and a Content Management System

PubMed Central

Moradkhani, Anilga; Douglas, Kristin S. Vickers; Prinsen, Sharon K.; Fischer, Erin N.; Schroeder, Darrell R.

2014-01-01

Abstract Objective: The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and “just-in-time” education to older patients following cardiac surgery. Subjects and Methods: Patients were provided with iPad® (Apple®, Cupertino, CA) tablets that delivered educational modules as part of a daily “to do” list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. Results: A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. Conclusions: We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and “just-in-time” education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models. PMID:24443928

Temporal Management of the Writing Process: Effects of Genre and Organizing Constraints in Grades 5, 7, and 9

ERIC Educational Resources Information Center

Beauvais, Lucie; Favart, Monik; Passerault, Jean-Michel; Beauvais, Caroline

2014-01-01

We investigated changes across grades in the cognitive demands associated with the organizing subprocess of writing. A total of 85 fifth (age M = 10.8), 88 seventh (age M = 12.9), and 79 ninth (age M = 14.6) graders composed either a procedural text or an expository description on a digital tablet, on the basis of a "scrambled ideas"…

Improving the management of asthma in older adults.

PubMed

Carnegie, Elaine; Jones, Angela

Older people with asthma are a discrete patient group that requires specialist nursing skills and knowledge. They have specific and sometimes hidden needs that will affect their quality of life unless these are addressed by caring and competent nurses who have an interest in asthma. It is necessary to focus on both asthma and ageing to help older people achieve good asthma outcomes. This article discusses the complex physical, social and psychological issues affecting people with asthma aged 64 or older, age-related risk factors for poor control, age-related barriers to assessment and treatment, the scope of pharmacological and non-pharmacological approaches, and principal treatment outcomes. Providing high quality services and information will equip older people to manage their asthma more effectively, attain physical and mental wellbeing, and lead to fewer hospitalisations and fatal episodes in this group.

Health-care district management information system plan: Review of operations analysis activities during calendar year 1975 and plan for continued research and analysis activities

NASA Technical Reports Server (NTRS)

Nielson, G. J.; Stevenson, W. G.

1976-01-01

Operations research activities developed to identify the information required to manage both the efficiency and effectiveness of the Veterans Administration (VA) health services as these services relate to individual patient care are reported. The clinical concerns and management functions that determine this information requirement are discussed conceptually. Investigations of existing VA data for useful management information are recorded, and a diagnostic index is provided. The age-specific characteristics of diseases and lengths of stay are explored, and recommendations for future analysis activities are articulated. The effect of the introduction of new technology to health care is also discussed.

Job strain in nursing homes-Exploring the impact of leadership.

PubMed

Backman, Annica; Sjögren, Karin; Lövheim, Hugo; Edvardsson, David

2018-04-01

To explore the association between nursing home managers' leadership, job strain and social support as perceived by direct care staff in nursing homes. It is well known that aged care staff experience high levels of job strain, and that aged care staff experiencing job strain are exposed to increased risk for adverse health effects. Leadership styles have been associated with job strain in the literature; however, the impact of perceived leadership on staff job strain and social support has not been clarified within nursing home contexts. This study had a cross-sectional design. Participating staff (n = 3,605) completed surveys which included questions about staff characteristics, valid and reliable measures of nursing home managers' leadership, perceived job strain and social support. Statistical analyses of correlations and multiple regression analysis with interaction terms were conducted. Nursing home managers' leadership were significantly associated with lower level of job strain and higher level of social support among direct care staff. A multiple regression analysis including an interaction term indicated individual and joint effects of nursing home managers' leadership and social support on job strain. Nursing home managers' leadership and social support were both individually and in combination associated with staff perception of lesser job strain. Thus, nursing home managers' leadership are beneficial for the working situation and strain of staff. Promoting a supporting work environment through leadership is an important implication for nursing home managers as it can influence staff perception of job strain and social support within the unit. By providing leadership, offering support and strategies towards a healthy work environment, nursing home managers can buffer adverse health effects among staff. © 2017 John Wiley & Sons Ltd.

77 FR 27815 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0256] Aging Management of Stainless Steel Structures and... Guidance (LR-ISG), LR-ISG-2011-01, ``Aging Management of Stainless Steel Structures and Components in...) Report for the aging management of stainless steel structures and components exposed to treated borated...

77 FR 74883 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water; Revision 1

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-18

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0256] Aging Management of Stainless Steel Structures and..., ``Aging Management of Stainless Steel Structures and Components in Treated Borated Water,'' which was... Staff Guidance LR-ISG-2011-01, ``Aging Management of Stainless Steel Structures and Components in...

Spatial variation in the effects of size and age on reproductive dynamics of common coral trout Plectropomus leopardus.

PubMed

Carter, A B; Russ, G R; Tobin, A J; Williams, A J; Davies, C R; Mapstone, B D

2014-04-01

The effects of size and age on reproductive dynamics of common coral trout Plectropomus leopardus populations were compared between coral reefs open or closed (no-take marine reserves) to fishing and among four geographic regions of the Great Barrier Reef (GBR), Australia. The specific reproductive metrics investigated were the sex ratio, the proportion of vitellogenic females and the spawning fraction of local populations. Sex ratios became increasingly male biased with length and age, as expected for a protogyne, but were more male biased in southern regions of the GBR (Mackay and Storm Cay) than in northern regions (Lizard Island and Townsville) across all lengths and ages. The proportion of vitellogenic females also increased with length and age. Female P. leopardus were capable of daily spawning during the spawning season, but on average spawned every 4·3 days. Mature females spawned most frequently on Townsville reserve reefs (every 2·3 days) and Lizard Island fished reefs (every 3·2 days). Females on Mackay reefs open to fishing showed no evidence of spawning over 4 years of sampling, while females on reserve reefs spawned only once every 2-3 months. No effect of length on spawning frequency was detected. Spawning frequency increased with age on Lizard Island fished reefs, declined with age on Storm Cay fished reefs, and declined with age on reserve reefs in all regions. It is hypothesized that the variation in P. leopardus sex ratios and spawning frequency among GBR regions is primarily driven by water temperature, while no-take management zones influence spawning frequency depending on the region in which the reserve is located. Male bias and lack of spawning activity on southern GBR, where densities of adult P. leopardus are highest, suggest that recruits may be supplied from central or northern GBR. Significant regional variation in reproductive traits suggests that a regional approach to management of P. leopardus is appropriate and highlights the need for considering spatial variation in reproduction where reserves are used as fishery or conservation management tools. © 2014 The Fisheries Society of the British Isles.

The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population

PubMed Central

Tatlisumak, Ertugrul; Asirdizer, Mahmut; Bora, Aydin; Hekimoglu, Yavuz; Etli, Yasin; Gumus, Orhan; Keskin, Siddik

2017-01-01

Objectives: To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations. Methods: Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses. Results: We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older. Conclusion: We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements. PMID:28042629

Menopause and work: an electronic survey of employees' attitudes in the UK.

PubMed

Griffiths, Amanda; MacLennan, Sara Jane; Hassard, Juliet

2013-10-01

This study explored women's experiences of working through menopausal transition in the UK. It aimed to identify the perceived effects of menopausal symptoms on working life, to outline the perceived effects of work on menopausal symptoms, and to provide recommendations for women, healthcare practitioners and employers. An electronic questionnaire was distributed to women aged 45-55 in professional, managerial and administrative (non-manual) occupations in 10 organisations. Items included: age, age and gender of line manager, educational level, job satisfaction; menopausal status; symptoms that were problematic for work; hot flushes; working conditions; work performance, disclosure to line managers; individual coping strategies; and, effective workplace adjustments and employer support. The final sample comprised 896 women. Menopausal transition caused difficulties for some women at work. The most problematic symptoms were: poor concentration, tiredness, poor memory, feeling low/depressed and lowered confidence. Hot flushes were particularly difficult. Some women felt work performance had been negatively affected. The majority of women were unwilling to disclose menopause-related health problems to line managers, most of whom were men or younger than them. Individual coping strategies were described. Four major areas for organisational-level support emerged: (i) greater awareness among managers about menopause as a possible occupational health issue, (ii) flexible working hours, (iii) access to information and sources of support at work, and (iv) attention to workplace temperature and ventilation. Employers and healthcare practitioners should be aware that menopausal transition causes difficulty for some women at work, and that much can be done to support them. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Effects of Social Development Intervention in Childhood Fifteen Years Later

PubMed Central

Hawkins, J. David; Kosterman, Rick; Catalano, Richard F.; Hill, Karl G.; Abbott, Robert D.

2008-01-01

Objective To examine long-term effects of a universal intervention in elementary schools in promoting positive functioning in school, work, and community, and preventing mental health problems, risky sexual behavior, substance misuse, and crime at ages 24 and 27. Design Nonrandomized controlled trial followed participants to age 27, 15 years after the intervention ended. Three intervention conditions were compared: a full intervention group, assigned to intervention in grades 1 through 6; a late intervention group, assigned to intervention in grades 5 and 6 only; and a no-treatment control group. Setting Fifteen public elementary schools serving diverse neighborhoods including high-crime neighborhoods of Seattle. Participants A gender-balanced and multiethnic sample of 598 participants at ages 24 and 27 (93% of original sample in these conditions). Interventions Teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. Outcome Measures Self-reports of functioning in school, work and community, mental health, sexual behavior, substance use, and crime, and court records. Results A significant multivariate intervention effect across all 16 primary outcome indices was found. Specific effects included significantly better educational and economic attainment, mental health, and sexual health by age 27 (all p < .05). Hypothesized effects on substance use and crime were not found at ages 24 or 27. Conclusions A universal intervention for urban elementary school children, focused on classroom management and instruction, children’s social competence, and parenting practices, positively affected educational and economic attainment, mental health, and sexual health 15 years following the intervention’s end. PMID:19047540

78 FR 37281 - Revisions to Environmental Review for Renewal of Nuclear Power Plant Operating Licenses

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

... protection regulations by updating the Commission's 1996 findings on the environmental effect of renewing the... effects will be adequately managed. The applicant must demonstrate that the effects of aging will be...; effects of dredging on surface water quality; groundwater use and quality; exposure of terrestrial...

Effects of farm management practices and transport duration on stress response and meat quality traits of suckling goat kids.

PubMed

Alcalde, M J; Suárez, M D; Rodero, E; Álvarez, R; Sáez, M I; Martínez, T F

2017-09-01

Studies aimed to assess up to what extent farming and transport previous to slaughtering might affect physiology and meat quality in young goat kids are needed, with the ultimate purpose of promoting practices that minimize stress in these animals. In this regard the effects of on-farm management and transport duration on some physiological responses and meat quality parameters in goat kids were assessed. Two farms representing 'high' and 'low' welfare-friendly management practices were selected. In total, 32 suckling kids were withdrawn from each farm, transported by road for 2 or 6 h, and then slaughtered. Blood samples were collected both on-farm and in the slaughterhouse, and biochemistry, cell counts and haematocrit were determined. After slaughtering, carcass quality parameters were measured. Longissimus dorsi muscle was dissected and pH, colour parameters, water holding capacity and shear force were measured throughout 8-day ageing period. Results indicate that, regardless its duration, transport caused significant effects on some blood parameters suggesting stress in live animals, like glucose, cortisol or creatine kinase. Despite the marked stress status in animals, this condition was not decisively reflected on L. dorsi quality parameters, but some effects were observed regarding fat cover in carcasses and colour parameters. The results suggest that postmortem changes throughout ageing were more decisive in terms of meat quality than stressful management either on-farm or during transport.

Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease.

PubMed

Hussain, Jamilla A; Mooney, Andrew; Russon, Lynne

2013-10-01

There are limited data on the outcomes of elderly patients with chronic kidney disease undergoing renal replacement therapy or conservative management. We aimed to compare survival, hospital admissions and palliative care access of patients aged over 70 years with chronic kidney disease stage 5 according to whether they chose renal replacement therapy or conservative management. Retrospective observational study. Patients aged over 70 years attending pre-dialysis clinic. In total, 172 patients chose conservative management and 269 chose renal replacement therapy. The renal replacement therapy group survived for longer when survival was taken from the time estimated glomerular filtration rate <20 mL/min (p < 0.0001), <15 mL/min (p < 0.0001) and <12 mL/min (p = 0.002). When factors influencing survival were stratified for both groups independently, renal replacement therapy failed to show a survival advantage over conservative management, in patients older than 80 years or with a World Health Organization performance score of 3 or more. There was also a significant reduction in the effect of renal replacement therapy on survival in patients with high Charlson's Comorbidity Index scores. The relative risk of an acute hospital admission (renal replacement therapy vs conservative management) was 1.6 (p < 0.05; 95% confidence interval = 1.14-2.13). A total of 47% of conservative management patients died in hospital, compared to 69% undergoing renal replacement therapy (Renal Registry data). Seventy-six percent of the conservative management group accessed community palliative care services compared to 0% of renal replacement therapy patients. For patients aged over 80 years, with a poor performance status or high co-morbidity scores, the survival advantage of renal replacement therapy over conservative management was lost at all levels of disease severity. Those accessing a conservative management pathway had greater access to palliative care services and were less likely to be admitted to or die in hospital.

Sustainable carbon uptake - important ecosystem service within sustainable forest management

NASA Astrophysics Data System (ADS)

Zorana Ostrogović Sever, Maša; Anić, Mislav; Paladinić, Elvis; Alberti, Giorgio; Marjanović, Hrvoje

2016-04-01

Even-aged forest management with natural regeneration under continuous cover (i.e. close to nature management) is considered to be sustainable regarding the yield, biodiversity and stability of forest ecosystems. Recently, in the context of climate change, there is a raising question of sustainable forest management regarding carbon uptake. Aim of this research was to explore whether current close to nature forest management approach in Croatia can be considered sustainable in terms of carbon uptake throughout the life-time of Pedunculate oak forest. In state-owned managed forest a chronosequence experiment was set up and carbon stocks in main ecosystem pools (live biomass, dead wood, litter and mineral soil layer), main carbon fluxes (net primary production, soil respiration (SR), decomposition) and net ecosystem productivity were estimated in eight stands of different age (5, 13, 38, 53, 68, 108, 138 and 168 years) based on field measurements and published data. Air and soil temperature and soil moisture were recorded on 7 automatic mini-meteorological stations and weekly SR measurements were used to parameterize SR model. Carbon balance was estimated at weekly scale for the growing season 2011 (there was no harvesting), as well as throughout the normal rotation period of 140 years (harvesting was included). Carbon stocks in different ecosystem pools change during a stand development. Carbon stocks in forest floor increase with stand age, while carbon stocks in dead wood are highest in young and older stands, and lowest in middle-aged, mature stands. Carbon stocks in mineral soil layer were found to be stable across chronosequence with no statistically significant age-dependent trend. Pedunculate Oak stand, assuming successful regeneration, becomes carbon sink very early in a development phase, between the age of 5 and 13 years, and remains carbon sink even after the age of 160 years. Greatest carbon sink was reached in the stand aged 53 years. Obtained results indicate that current harvesting practice has no detrimental effect on carbon stored in forest soil. Observed early and long-lasting carbon sink suggest that close to nature forest management can be considered sustainable in terms of carbon uptake. Also, observed carbon sink in the oldest stand is valuable information for potential debate on prolonging rotation period in this type of forest ecosystems.

Objective assessment of sperm motion characteristics of Malpura ram lambs raised under intensive management system in semiarid tropical environment.

PubMed

Kumar, Davendra; Joshi, Anil; Naqvi, S M K

2010-04-01

A study was conducted to evaluate the semen production and sperm motion characteristics of ram lambs by computer-aided semen analysis technique. Eight Malpura rams were raised under intensive management system and were trained for semen collection at a weekly interval from the age of 6 months. Rams were scheduled for semen collection at a weekly interval up to 1 year of age to assess their potential for semen production and objective evaluation of semen quality. The average age of ram lambs at the time of first ejaculation was 219 days ranging from 186 to 245 days. The age of ram lambs significantly (p < 0.05) influenced sperm concentration, sperm velocities, and beat frequency of spermatozoa, which were higher in 9-12-month-old compared to 6-9-month-old ram lambs. However, the effect of age was not significant on semen volume, percent motility, percent rapid, medium or slow motile spermatozoa, percent linearity, percent straightness, amplitude of lateral head displacement, percent elongation, and area of sperm head. The body weight of ram lambs was significantly (p < 0.01) and positively correlated (r = 0.46) with age. The results indicate that Malpura ram lambs of 9-12 months of age raised under the intensive management system in a semiarid tropical environment can produce good quality of semen.

Modeling the Cost-Effectiveness of Alternative Upper Age Limits for Breast Cancer Screening in England and Wales.

PubMed

Rafia, Rachid; Brennan, Alan; Madan, Jason; Collins, Karen; Reed, Malcolm W R; Lawrence, Gill; Robinson, Thompson; Greenberg, David; Wyld, Lynda

2016-06-01

Currently in the United Kingdom, the National Health Service (NHS) Breast Screening Programme invites all women for triennial mammography between the ages of 47 and 73 years (the extension to 47-50 and 70-73 years is currently examined as part of a randomized controlled trial). The benefits and harms of screening in women 70 years and older, however, are less well documented. The aim of this study was to examine whether extending screening to women older than 70 years would represent a cost-effective use of NHS resources and to identify the upper age limit at which screening mammography should be extended in England and Wales. A mathematical model that allows the impact of screening policies on cancer diagnosis and subsequent management to be assessed was built. The model has two parts: a natural history model of the progression of breast cancer up to discovery and a postdiagnosis model of treatment, recurrence, and survival. The natural history model was calibrated to available data and compared against published literature. The management of breast cancer at diagnosis was taken from registry data and valued using official UK tariffs. The model estimated that screening would lead to overdiagnosis in 6.2% of screen-detected women at the age of 72 years, increasing up to 37.9% at the age of 90 years. Under commonly quoted willingness-to-pay thresholds in the United Kingdom, our study suggests that an extension to screening up to the age of 78 years represents a cost-effective strategy. This study provides encouraging findings to support the extension of the screening program to older ages and suggests that further extension of the UK NHS Breast Screening Programme up to age 78 years beyond the current upper age limit of 73 years could be potentially cost-effective according to current NHS willingness-to-pay thresholds. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Classroom Management: The Perspectives of Teachers, Pupils, and Researcher.

ERIC Educational Resources Information Center

Wragg, Caroline M.

This paper reports on a study of effective classroom management in British primary schools, with particular emphasis on how teachers deal with deviant or disruptive behavior. The study was conducted through observation of 239 lessons and interviews with 60 teachers and through interviews with 430 pupils aged 5-12. The research found a lack of…

The application of the Yerkes-Dodson law in a childhood weight management program: Examining weight dissatisfaction

USDA-ARS?s Scientific Manuscript database

Our objective was to determine the effect of dissatisfaction with one's weight on outcomes in a weight management program. Participants included 149 children between the ages of 11 and 14 years who were enrolled in an intensive weight loss intervention. All participants had a body mass index (BMI) ...

Prevention of age-related macular degeneration.

PubMed

Wong, Ian Yat Hin; Koo, Simon Chi Yan; Chan, Clement Wai Nang

2011-02-01

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula.

Deferasirox : a review of its use in the management of transfusional chronic iron overload.

PubMed

Yang, Lily P H; Keam, Susan J; Keating, Gillian M

2007-01-01

Deferasirox (Exjade) is an oral, once-daily iron chelator widely approved for the treatment of transfusional chronic iron overload. In the EU, deferasirox is indicated in patients with beta-thalassaemia major aged > or =6 years and, in the US, in all transfusional chronic iron overload patients aged > or =2 years. Deferasirox is highly selective for iron as Fe3+. In approximately 1-year clinical trials of patients with transfusional chronic iron overload associated with beta-thalassaemia, sickle cell disease, myelodysplastic syndrome or other rare chronic anaemias, deferasirox 20 or 30 mg/kg/day had a beneficial effect on liver iron concentrations (LIC) and serum ferritin levels; tolerability issues were clinically manageable with regular patient monitoring. Although longer-term efficacy and tolerability data are required, in particular examining the prevention of iron overload-related complications and the effect of deferasirox on renal function, deferasirox is an easily administered iron chelator and is a valuable option in the management of transfusional chronic iron overload.

Uneven-aged management after a half-century of research on the Forest Service Fernow Experimental Forest in West Virgina

Treesearch

Thomas M. Schuler

2014-01-01

Uneven-age management in forestry refers to a system of management that periodically selects individual trees or small groups of trees for harvest. In general, the concept of uneven-age management entails the sustained yield of forest products while maintaining continuous forest cover. In North America, interest in uneven-age management grew in the second half of the...

The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting.

PubMed

Marino, Miguel; Killerby, Marie; Lee, Soomi; Klein, Laura Cousino; Moen, Phyllis; Olson, Ryan; Kossek, Ellen Ernst; King, Rosalind; Erickson, Leslie; Berkman, Lisa F; Buxton, Orfeu M

2016-12-01

To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting. Cluster randomized trial. Extended-care (nursing) facilities. US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention. A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention. In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.

The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting

PubMed Central

Marino, Miguel; Killerby, Marie; Lee, Soomi; Klein, Laura Cousino; Moen, Phyllis; Olson, Ryan; Kossek, Ellen Ernst; King, Rosalind; Erickson, Leslie; Berkman, Lisa F.; Buxton, Orfeu M.

2016-01-01

Objectives To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting. Design Cluster randomized trial. Setting Extended-care (nursing) facilities. Participants US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. Intervention The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Measurements Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention. Results A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention. Conclusion In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees’ sleep outcomes benefited more from the intervention. PMID:28239635

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.

Exercise, cognitive function, and aging

PubMed Central

2015-01-01

Increasing the lifespan of a population is often a marker of a country's success. With the percentage of the population over 65 yr of age expanding, managing the health and independence of this population is an ongoing concern. Advancing age is associated with a decrease in cognitive function that ultimately affects quality of life. Understanding potential adverse effects of aging on brain blood flow and cognition may help to determine effective strategies to mitigate these effects on the population. Exercise may be one strategy to prevent or delay cognitive decline. This review describes how aging is associated with cardiovascular disease risks, vascular dysfunction, and increasing Alzheimer's disease pathology. It will also discuss the possible effects of aging on cerebral vascular physiology, cerebral perfusion, and brain atrophy rates. Clinically, these changes will present as reduced cognitive function, neurodegeneration, and the onset of dementia. Regular exercise has been shown to improve cognitive function, and we hypothesize that this occurs through beneficial adaptations in vascular physiology and improved neurovascular coupling. This review highlights the potential interactions and ideas of how the age-associated variables may affect cognition and may be moderated by regular exercise. PMID:26031719

Value of Tree Measurements Made at Age 5 Years for Predicting the Height and Diameter Growth at Age 25 Years in Loblolly Pine Plantations

Treesearch

Allan E. Tiarks; Calvin E. Meier; V. Clark Baldwin; James D. Haywood

1998-01-01

Early growth measurements Of pine plantations are often used to predict the productivity of the stand later in the rotation when assessing the effect Of management on productivity. A loblolly pine (Pinus taeda L.) study established at 35 locations (2 to 3 plots/location) was used to test the relationship between height measurements at age 5 years...

Management considerations in heifer development and puberty.

PubMed

Patterson, D J; Perry, R C; Kiracofe, G H; Bellows, R A; Staigmiller, R B; Corah, L R

1992-12-01

Management of replacement beef heifers should focus on factors that enhance physiological processes that promote puberty. Age at puberty is important as a production trait when heifers are bred to calve as 2-yr-olds and in systems that impose restricted breeding periods. Calving by 24 mo of age is necessary to obtain maximum lifetime productivity. Because the reproductive system is the last major organ system to mature, factors that influence puberty are critical. The influence of environment on the sequence of events leading to puberty in the heifer is dictated largely by the nutritional status of the animal and related effects on growth rate and development. Management strategies have been designed to ensure that heifers reach a prebreeding target weight that supports optimum reproductive performance, and consequences of inadequate or excessive development have been evaluated. Those strategies are based on evidence linking postweaning nutritional development with key reproductive events that include age at puberty and first breeding, conception, pregnancy loss, incidence and severity of dystocia, and postpartum interval to estrus. Management alternatives that ultimately affect lifetime productivity and reproductive performance of heifers begin at birth and include decisions that involve growth-promoting implants, creep-feeding, breed type and(or) species, birth date and weaning weight, social interaction, sire selection, and exogenous hormonal treatments to synchronize or induce estrus. Basic and applied future research efforts should converge to match in a realistic manner the production potential of the animal with available resources. Strategies that incorporate consideration of nutrition, genetics, and emerging management techniques will need to be tested to enable producers to make decisions that result in profit. This review evaluates the current status of knowledge relating to management of the replacement beef heifer and serves to stimulate research needed to enhance management techniques to ensure puberty at an optimal age.

Acute Myocardial Infarction Population Incidence and Mortality Rates, and 28-day Case-fatality in Older Adults. The REGICOR Study.

PubMed

Vázquez-Oliva, Gabriel; Zamora, Alberto; Ramos, Rafel; Marti, Ruth; Subirana, Isaac; Grau, María; Dégano, Irene R; Marrugat, Jaume; Elosua, Roberto

2017-11-22

Our aims were to determine acute myocardial infarction (AMI) incidence and mortality rates, and population and in-hospital case-fatality in the population older than 74 years; variability in clinical characteristics and AMI management of hospitalized patients, and changes in the incidence and mortality rates, case-fatality, and management by age groups from 1996 to 1997 and 2007 to 2008. A population-based AMI registry in Girona (Catalonia, Spain) including individuals with suspected AMI older than 34 years. The incidence rate increased with age from 169 and 28 cases/100 000 per year in the group aged 35 to 64 years to 2306 and 1384 cases/100 000 per year in the group aged 85 to 94 years, in men and women, respectively. Population case-fatality also increased with age, from 19% in the group aged 35 to 64 years to 84% in the group aged 85 to 94 years. A lower population case-fatality was observed in the second period, mainly explained by a lower in-hospital case-fatality. The use of invasive procedures and effective drugs decreased with age but increased in the second period in all ages up to 84 years. Acute myocardial infarction incidence, mortality, and case-fatality increased exponentially with age. There is still a gap in the use of invasive procedures and effective drugs between younger and older patients. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Management of Musculoskeletal Conditions in Rural South Australia: A Randomised Controlled Trial.

PubMed

Dent, E; Hoon, E; Karnon, J; Kitson, A; Dollard, J; Newbury, J; Harvey, G; Gill, T; Beilby, J

2017-01-01

With age, the prevalence of musculoskeletal conditions increases markedly. This rural-based study determined the benefits of two approaches for managing musculoskeletal conditions: a multiple-component 'Self-management Plus' intervention, and usual care. The intervention combined self-management education with physical activity and health professional support. 6-month outcomes included: Clinical Global Impression-Improvement Scale (CGI-IS) and Quality of Life (QoL). A total of 145 people were recruited; mean (SD) age was 66.1 (11.1) and 63.3 (10.9) years for intervention and control groups respectively. The intervention resulted in greater improvements in global functioning (CGI-IS mean (SD) = 3.2 (1.3)) than usual care (CGI-IS mean (SD) = 4.2 (1.5)). There was no difference in QoL improvement between study groups. A multiple-component 'Self-management Plus' intervention had a positive effect on physical functioning for older adults with musculoskeletal conditions. However, recruitment and retention of participants was problematic, which raises questions about the intervention's feasibility in its current form.

Individual differences in temperament and behavioral management practices for nonhuman primates

PubMed Central

Coleman, Kristine

2011-01-01

Effective behavioral management plans are tailored to unique behavioral patterns of each individual species. However, even within a species behavioral needs of individuals can vary. Factors such as age, sex, and temperament can affect behavioral needs of individuals. While some of these factors, such as age and sex, are taken into account, other factors, such as an individual’s temperament, are rarely specifically provided for in behavioral management plans. However, temperament may affect how animals respond to socialization, positive reinforcement training and other forms of enrichment. This review will examine how individual differences in temperament might affect, or be affected by, behavioral management practices for captive primates. Measuring temperament may help us predict outcome of social introductions. It can also predict which animals may be difficult to train using traditional methods. Further, knowledge of temperament may be able to help identify individuals at risk for development of behavioral problems. Taken together, understanding individual differences in temperament of captive primates can help guide behavioral management decisions. PMID:22518067

76 FR 60937 - Draft License Renewal Interim Staff Guidance LR-ISG-2011-02; Aging Management Program for Steam...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

...-2011-02; Aging Management Program for Steam Generators AGENCY: Nuclear Regulatory Commission. ACTION... License Renewal Interim Staff Guidance (LR-ISG), LR-ISG-2011-02, ``Aging Management Program for Steam... using Revision 3 of NEI 97-06 to manage steam generator aging. The Draft LR-ISG revises the NRC staff's...

Proceedings of the second Missouri Ozark Forest Ecosystem Project Symposium: Post-treatment results of the landscape experiment

Treesearch

S.R. Shifley; J.M., eds. Kabrick

2002-01-01

Presents the short-term effects of even-aged, uneven-aged, and no-harvest management on forest ecosystems included in the Missouri Ozark Forest Project (MOFEP). Individual papers address study design, site history, species diversity, genetic diversity, woody vegetation, ground layer vegetation, stump sprouting, tree cavities, logging disturbance, avian communities,...

Career Anchors and the Effects of Downsizing: Implications for Generations and Cultures at Work. A Preliminary Investigation.

ERIC Educational Resources Information Center

Marshall, Verena; Bonner, Dede

2003-01-01

The relationships among career anchors, age, culture, gender, employment experience, and the impact of career planning on downsizing were examined with data from 423 management students (49% had been downsized). Lifestyle was the most valued anchor across age groups, stability/security the least; compared with Schein's earlier anchors research,…

Using silviculture to influence carbon sequestration in southern Appalachian spruce-fir forests

Treesearch

Patrick T. Moore; R. Justin DeRose; James N. Long; Helga van Miegroet

2012-01-01

Enhancement of forest growth through silvicultural modification of stand density is one strategy for increasing carbon (C) sequestration. Using the Fire and Fuels Extension of the Forest Vegetation Simulator, the effects of even-aged, uneven-aged and no-action management scenarios on C sequestration in a southern Appalachian red spruce-Fraser fir forest were modeled....

Port wine oxidation management: a multiparametric kinetic approach.

PubMed

Martins, Rui Costa; Monforte, Ana Rita; Silva Ferreira, António

2013-06-05

Port wine is a flagship fortified wine of Portugal, which undergoes a particularly long aging period, developing a dynamic sensory profile over time, responsible for several wine categories, which is dependent upon the type of aging (bottle or barrel). Therefore, the quality of the product is dependent upon the chemical mechanisms occurring during the aging process, such as oxidation or Maillard reactions. To attain the desired quality management, it is necessary to understand how technological parameters, such as temperature or oxygen exposure, affect the kinetics of the formation of key odorants, such as sotolon. There is a lack of information about the impact of the storage conditions (oxygen and temperature) on Port wine quality. In this study, the effect of these two parameters were investigated to increase the knowledge database concerning aging management of Port wines. It was found that sotolon formation is highly dependent upon oxygen and temperature. There is however a synergistic effect between these two parameters that could significantly increase the concentration. The kinetic parameters of oxygen, sotolon, and other compounds related to Port aging (cis- and trans-5-hydroxy-2-methyl-1,3-dioxan, 2-furfural, 5-hydroxy-methyl-furfural, and 5-methyl-furfural) are also reported. Kinetic models with Monte Carlo simulations, where the oxygen permeability dispersion and temperature are the parameters under evaluation, were applied. On the basis of the modeling predictions, it would seem that the temperature of a cellar would have a more significant impact on the Port wines stored in containers where the oxygen intake is higher (barrels) when compared to containers with low oxygen permeability (bottles using cork stoppers).

Use of the Hage framework for theory construction: Factors affecting glucose control in the college-aged student with type 1 diabetes.

PubMed

Meyer, Rebecca A; Fish, Anne F; Lou, Qinqing

2017-10-01

This article describes the Hage framework for theory construction and its application to the clinical problem of glycemic control in college-aged students with type 1 diabetes. College-aged students with type 1 diabetes struggle to self-manage their condition. Glycated hemoglobin (HbA1c), if controlled within acceptable limits (6-8%), is associated with the prevention or delay of serious diabetic complications such as kidney and cardiovascular disease. Diabetes educators provide knowledge and skills, but young adults must self-manage their condition on a daily basis, independent of parents. The Hage framework includes five tasks of theory construction: narrowing and naming the concepts, specifying the definitions, creating the theoretical statements, specifying the linkages, and ordering components in preparation for model building. During the process, concepts within the theory were revised as the literature was reviewed, and measures and hypotheses, foundational to research, were generated. We were successful in applying the framework and creating a model of factors affecting glycemic control, emphasizing that physical activity, thought of as a normal part of wellness, can be a two-edged sword producing positive effect but also serious negative effects in some college-aged students with type 1 diabetes. Contextual factors important to self-management in college-aged students are emphasized. The Hage framework, already used to a small extent in nursing curricula, deserves more attention and, because of its generic nature, may be used as a template for theory construction to examine a wide variety of nursing topics. Copyright © 2017 Elsevier Inc. All rights reserved.

Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

PubMed

Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-06-01

Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

Changes in upper gastrointestinal physiology with age.

PubMed

Newton, J L

2004-12-01

Diseases of the upper gastrointestinal tract such as peptic ulceration and gastric cancer become more common and more severe with advancing age. In the normal stomach and duodenum, there is a balance between mucosal protective mechanisms and endogenous (gastric acid and pepsin) and exogenous aggressive factors. The high incidence of gastrointestinal pathology seen in older age groups is not related to increase in the secretion of endogenous aggressive factors. Recent work suggests that gastrointestinal mucosal protective mechanisms are impaired with age. The roles in the gastrointestinal tract of molecules that have been implicated in mucosal repair, such as trefoil peptides and matrix components, are beginning to be elucidated and their study in older people is essential to ensure appropriate, efficient, cost-effective management of gastric pathology in the elderly. Strategies to improve the management of upper gastrointestinal diseases in older people will reduce mortality and improve quality of life.

Effects of a Hypertension Management Program by Seongcheon Primary Health Care Post in South Korea: An Analysis of Changes in the Level of Knowledge of Hypertension in the Period from 2004 to 2009

ERIC Educational Resources Information Center

Song, In Han; Kim, Sang-A; Park, Woong-Sub

2012-01-01

The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…

Cost-effectiveness of pulse-echo ultrasonometry in osteoporosis management.

PubMed

Soini, Erkki; Riekkinen, Ossi; Kröger, Heikki; Mankinen, Petri; Hallinen, Taru; Karjalainen, Janne P

2018-01-01

Osteoporosis is asymptomatic morbidity of the elderly which develops slowly over several years. Osteoporosis diagnosis has typically involved Fracture Risk Assessment (FRAX) followed by dual energy X-ray absorptiometry (DXA) in specialist care. Point-of-care pulse-echo ultrasound (PEUS) was developed to overcome DXA-related access issues and to enable faster fracture prevention treatment (FPT) initiation. The objective of this study was to evaluate the cost-effectiveness of two proposed osteoporosis management (POMs: FRAX→PEUS-if-needed→DXA-if-needed→FPT-if-needed) pathways including PEUS compared with the current osteoporosis management (FRAX→DXA-if-needed→FPT-if-needed). Event-based probabilistic cost-utility model with 10-year duration for osteoporosis management was developed. The model consists of a decision tree for the screening, testing, and diagnosis phase and is followed by a Markov model for the estimation of incidence of four fracture types and mortality. Five clinically relevant patient cohorts (potential primary FPT in women aged 75 or 85 years, secondary FPT in women aged 65, 75, or 85 years) were modeled in the Finnish setting. Generic alendronate FPT was used for those diagnosed with osteoporosis, including persistence overtime. Discounted (3%/year) incremental cost-effectiveness ratio was the primary outcome. Discounted quality-adjusted life-years (QALYs), payer costs (year 2016 value) at per patient and population level, and cost-effectiveness acceptability frontiers were modeled as secondary outcomes. POMs were cost-effective in all patient subgroups with noteworthy mean per patient cost savings of €121/76 (ranges €107-132/52-96) depending on the scope of PEUS result interpretation (test and diagnose/test only, respectively) and negligible differences in QALYs gained in comparison with current osteoporosis management. In the cost-effectiveness acceptability frontiers, POMs had 95%-100% probability of cost-effectiveness with willingness to pay €24,406/QALY gained. The results were robust in sensitivity analyses. Even when assuming a high cost of PEUS (up to €110/test), POMs were cost-effective in all cohorts. The inclusion of PEUS to osteoporosis management pathway was cost-effective.

Evaluation of Effectiveness and Cost‐Effectiveness of a Clinical Decision Support System in Managing Hypertension in Resource Constrained Primary Health Care Settings: Results From a Cluster Randomized Trial

PubMed Central

Anchala, Raghupathy; Kaptoge, Stephen; Pant, Hira; Di Angelantonio, Emanuele; Franco, Oscar H.; Prabhakaran, D.

2015-01-01

Background Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. Methods and Results We performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart‐based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was −6.59 mm Hg (95% confidence interval: −12.18 to −1.42; P=0.021). The cost‐effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively. Conclusion Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings. Clinical Trial Registration URL: http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476. PMID:25559011

An evaluation of sex-age-kill (SAK) model performance

USGS Publications Warehouse

Millspaugh, Joshua J.; Skalski, John R.; Townsend, Richard L.; Diefenbach, Duane R.; Boyce, Mark S.; Hansen, Lonnie P.; Kammermeyer, Kent

2009-01-01

The sex-age-kill (SAK) model is widely used to estimate abundance of harvested large mammals, including white-tailed deer (Odocoileus virginianus). Despite a long history of use, few formal evaluations of SAK performance exist. We investigated how violations of the stable age distribution and stationary population assumption, changes to male or female harvest, stochastic effects (i.e., random fluctuations in recruitment and survival), and sampling efforts influenced SAK estimation. When the simulated population had a stable age distribution and λ > 1, the SAK model underestimated abundance. Conversely, when λ < 1, the SAK overestimated abundance. When changes to male harvest were introduced, SAK estimates were opposite the true population trend. In contrast, SAK estimates were robust to changes in female harvest rates. Stochastic effects caused SAK estimates to fluctuate about their equilibrium abundance, but the effect dampened as the size of the surveyed population increased. When we considered both stochastic effects and sampling error at a deer management unit scale the resultant abundance estimates were within ±121.9% of the true population level 95% of the time. These combined results demonstrate extreme sensitivity to model violations and scale of analysis. Without changes to model formulation, the SAK model will be biased when λ ≠ 1. Furthermore, any factor that alters the male harvest rate, such as changes to regulations or changes in hunter attitudes, will bias population estimates. Sex-age-kill estimates may be precise at large spatial scales, such as the state level, but less so at the individual management unit level. Alternative models, such as statistical age-at-harvest models, which require similar data types, might allow for more robust, broad-scale demographic assessments.

The effects of fitness on the aging process.

PubMed

Vopat, Bryan G; Klinge, Stephen A; McClure, Philip K; Fadale, Paul D

2014-09-01

Decades of research support the fact that much age-related deterioration is the result of the effects of sedentary lifestyles and the development of medical conditions rather than of aging itself. Elite older athletes, who demonstrate enhanced performance compared with historic cohorts and even some younger peers, are models of this paradigm. Many non-elite middle-aged adults and older adults continue to remain increasingly active throughout middle age and beyond. A continually growing body of basic science and clinical evidence demonstrates how active persons modulate physical decline through training. An updated understanding of how active adults defy age helps orthopaedic surgeons not only manage their patients' performance but also improve their lives. A large segment of sedentary older adults will benefit from counseling that encourages the pursuit of more active and healthier lifestyles. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Cost-effective management alternatives for Snake River Chinook salmon: a biological-economic synthesis.

PubMed

Halsing, David L; Moore, Michael R

2008-04-01

The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can provide valuable tools for science-based policy and management.

Cost-effective management alternatives for Snake river chinook salmon: A biological-economic synthesis

USGS Publications Warehouse

Halsing, D.L.; Moore, M.R.

2008-01-01

The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can provide valuable tools for science-based policy and management.

Effectiveness of management interventions on forest carbon stock in planted forests in Nepal.

PubMed

Dangal, Shambhu Prasad; Das, Abhoy Kumar; Paudel, Shyam Krishna

2017-07-01

Nepal has successfully established more than 370,000 ha of plantations, mostly with Pinus patula, in the last three and a half decades. However, intensive management of these planted forests is very limited. Despite the fact that the Kyoto Convention in 1997 recognized the role of plantations for forest-carbon sequestration, there is still limited knowledge on the effects of management practices and stand density on carbon-sequestration of popular plantation species (i.e. Pinus patula) in Nepal. We carried out case studies in four community forests planted between 1976 and 1990 to assess the impacts of management on forest carbon stocks. The study found that the average carbon stock in the pine plantations was 217 Mg C ha -1 , and was lower in forests with intensively managed plantations (214.3 Mg C ha -1 ) than in traditionally managed plantations (219 Mg C ha -1 ). However, it was the reverse in case of soil carbon, which was higher (78.65 Mg C ha -1 ) in the forests with intensive management. Though stand density was positively correlated with carbon stock, the proportionate increment in carbon stock was lower with increasing stand density, as carbon stock increased by less than 25% with a doubling of stand density (300-600). The total carbon stock was higher in plantations aged between 25 and 30 years compared to those aged between 30 and 35 years. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pregnancy in inherited hypokalemic salt-losing renal tubular disorder.

PubMed

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

2011-02-01

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

The management of urinary tract infections in octogenarian women.

PubMed

Robinson, Dudley; Giarenis, Ilias; Cardozo, Linda

2015-07-01

Urinary Tract Infections are common in women of all ages and the incidence increases with age. Whilst they are a common cause of lower urinary tract symptoms in all women they may be associated with increased morbidity in the elderly. Appropriate investigation and treatment in primary and secondary care are essential to effectively manage urinary tract infection and decrease morbidity and hospitalisation rates. Loss of endogenous oestrogen at the time of the menopause is associated with the urogenital atrophy and an increased incidence of urinary tract infection. Consequently vaginal oestrogen therapy may offer a rationale for treatment and prevent of urinary tract infection. The aim of this paper is to review the clinical management of elderly women presenting with primary and recurrent urinary tract infection. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Dermatology practice management enhancement: implications for dermatology in the age of managed care.

PubMed

Nestor, M S

2000-09-01

Health care delivery in the United States has changed dramatically during the past 10 years. Dermatologists are faced with challenging changes in the way they learn new skills, practice, and provide dermatologic care. Dermatologists can survive and flourish in this environment if they learn proper management and enhancement skills. These skills include proper coding and documentation, regulatory compliance, and new levels of practice effectiveness and efficiency. Dermatologists can offer also the benefit of cosmetic procedures and ethical office-based dispensing to their patients. Greater future unification of this specialty will allow dermatology to flourish and show its need, efficiency, and cost-effectiveness.

A systematic review of self-management interventions for children and youth with physical disabilities

PubMed Central

Kingsnorth, Shauna; Mcdougall, Carolyn; Keating, Heather

2014-01-01

Purpose: Evidence shows that effective self-management behaviors have the potential to improve health outcomes, quality of life, self-efficacy and reduce morbidity, emergency visits and costs of care. A better understanding of self-management interventions (i.e. programs that help with managing symptoms, treatment, physical and psychological consequences) is needed to achieve a positive impact on health because most children with a disability now live well into adulthood. Method: A systematic review of self-management interventions for school age youth with physical disabilities was undertaken to assess their effectiveness. Comprehensive electronic searches using international web-based reference libraries were conducted for peer-reviewed and gray literature published between 1980 and January 2012. Eligible studies examined the effectiveness of self-management interventions for children and youth between 6 and 18 years of age with congenital or acquired physical disabilities. Studies needed to include a comparison group (e.g. single group pre/post-test design) and at least one quantifiable health-related outcome. Results: Of the 2184 studies identified, six met the inclusion criteria; two involved youth with spina bifida and four with juvenile arthritis. The majority of the interventions ran several sessions for at least 3 months by a trained interventionist or clinician, had one-to-one sessions and meetings, homework activities and parental involvement. Although outcomes varied between the studies, all of the interventions reported at least one significant improvement in either overall self-management skills or a specific health behavior. Conclusions: While self-management interventions have the potential to improve health behaviors, there were relatively few rigorously designed studies identified. More studies are needed to document the outcomes of self-management interventions, especially their most effective characteristics for children and youth with physical disabilities. Implications for Rehabilitation There is some evidence to suggest that self-management interventions for children and youth with spina bifida and arthritis can improve self-management behaviors and health outcomes. Parents’ involvement should be considered in encouraging self-management behaviors at different stages of their child’s development. Much work is needed to explore the longer term implications of self-management interventions for youth with physical disabilities as well as the impact on health care utilization. PMID:23614359

Stomach position in prediction of survival in left-sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion.

PubMed

Cordier, A-G; Jani, J C; Cannie, M M; Rodó, C; Fabietti, I; Persico, N; Saada, J; Carreras, E; Senat, M-V; Benachi, A

2015-08-01

To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1-4, stomach position on the four-chamber view of the heart with respect to thoracic structures. Logistic regression analysis was used to investigate the effect of management center (Paris, Brussels, Barcelona, Milan), stomach grading, observed-to-expected lung area-to-head circumference ratio (O/E-LHR), gestational age at delivery, birth weight in expectantly managed CDH, gestational ages at FETO and at removal and period of tracheal occlusion, on postnatal survival in CDH cases treated with FETO. We identified 67 expectantly managed CDH cases and 47 CDH cases that were treated with FETO. In expectantly managed CDH, stomach position and O/E-LHR predicted postnatal survival independently. In CDH treated with FETO, stomach position and gestational age at delivery predicted postnatal survival independently. In left-sided CDH with or without FETO, stomach position is predictive of postnatal survival. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Home/Work.

ERIC Educational Resources Information Center

Atkinson, William

1985-01-01

In the computer age, telecommuting programs can be an effective means of recruiting and retaining valuable employees. This article discusses how companies can select employee participants and how to manage people working at home. (Author/CT)

Management strategies of mothers of school-age children with autism: implications for practice.

PubMed

Joosten, Annette V; Safe, Anneleise P

2014-08-01

Mothering children with autism results in mothers spending more time on daily tasks as well as managing the disorder. The need for mothers to self-manage often increases when the child is school aged. Mothers develop strategies, and occupational therapists and other health professional rely on or expect mothers to be involved in meeting the extra needs of their children with autism and other family members. Little is known about the strategies adopted by the mothers. The aim of this study was to explore the strategies mothers used to manage their roles and emotions, and their child's behaviours. In-depth individual interviews were conducted with seven mothers and data were analysed in this qualitative study using phenomenological analysis. Findings revealed that the mothers had adopted strategies to manage their roles, their emotions and their child's behaviour. However, the strategies were often shaped by the expectations of others or circumstances beyond their control and at times added further to their stress. Mothers of children with autism developed strategies to self-manage their lives and their child's disorder. However, even when these strategies were effective, they sometimes placed further stress on the mothers. The mothers provided insights to how they coped but need help to consider the support they require and therapists need to consider the pressures of expecting mothers to self-manage their child's disorder, their own lives and their family. Family-centred practice emphasising collaboration with mothers needs to be maintained with school-aged children. © 2014 Occupational Therapy Australia.

Effect of seedbed preparation on natural reproduction of spruce and hemlock under dense shade

Treesearch

Grant Davis; Arthur C. Hart

1961-01-01

The cutting practices commonly recommended for spruce-fir stands in the Northeast involve uneven-aged management. The success of this type of management is predicated upon stand structures that have a range of size classes from seedlings to mature trees in intimate mixture. This kind of stand structure requires a continuous supply of reproduction of desirable species....

Self-Management Training for Chinese Obese Children at Risk for Metabolic Syndrome: Effectiveness and Implications for School Health

ERIC Educational Resources Information Center

Ling, Jiying; Anderson, Laura M.; Ji, Hong

2015-01-01

This article reviews the results of a school-based self-management intervention for Chinese obese children at risk for metabolic syndrome. Twenty-eight Chinese obese children (M age?=?10 years) and their parents participated in the study. Metabolic syndrome risk factors were measured pre- and post-intervention. The risk factors included Body Mass…

Does Parental Attributional Retraining and Anger Management Enhance the Effects of the Triple P-Positive Parenting Program with Parents at Risk of Child Maltreatment?

ERIC Educational Resources Information Center

Sanders, Matthew R.; Pidgeon, Aileen M.; Gravestock, Fred; Connors, Mark D.; Brown, Samantha; Young, Ross W.

2004-01-01

Ninety-eight parents experiencing significant difficulties in managing their own anger in their interactions with their preschool-aged children were randomly assigned either to an enhanced group-administered behavioral family intervention program based on the Triple P-Positive Parenting Program that incorporated attributional retraining and anger…

Carbon stocks across a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands

Treesearch

Matthew D. Powers; Randall K. Kolka; John B. Bradford; Brian J. Palik; Shawn Fraver; Martin F. Jurgensen

2012-01-01

Forests function as a major global C sink, and forest management strategies that maximize C stocks offer one possible means of mitigating the impacts of increasing anthropogenic CO2 emissions. We studied the effects of thinning, a common management technique in many forest types, on age-related trends in C stocks using a chronosequence of thinned...

Woody debris as a component of ecological diversity in thinned and unthinned northern hardwood forests

Treesearch

Christine E. Hura; Thomas R. Crow

2004-01-01

We examined the effects of management on coarse woody debris, both standing and downed, in thinned and unthinned northern hardwood forests in upper Michigan. The unthinned conditions included old growth and second growth, while the thinned conditions included both even- and uneven-aged management. The structural features analyzed were stem diameter, density, basal area...

Glenohumeral instability and rotator cuff tear.

PubMed

Porcellini, Giuseppe; Caranzano, Francesco; Campi, Fabrizio; Pellegrini, Andrea; Paladini, Paolo

2011-12-01

The prevalence of rotator cuff tears after traumatic dislocation increases with advancing age, a likely consequence of the age-associated deterioration of the structure and mechanical properties of the tendons of the rotator cuff. These are the effective stabilizers of the glenohumeral joint, compressing the humeral head in the 3-dimensional concavity of the glenohumeral joint. It is impossible to establish whether a lesion of the capsular-labrum complex or of the rotator cuff causes or follows a dislocation, regardless of whether it is anterior or posterior. A peripheral nerve or a brachial plexus injury can be associated with tendon lesion and instability, developing the "terrible triad" of the shoulder. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion.

An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in educational settings.

PubMed

Edwards, Deborah; Noyes, Jane; Lowes, Lesley; Haf Spencer, Llinos; Gregory, John W

2014-09-12

Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3-25 years in educational settings. Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.

Multi-aged Forest: an Optimal Management Strategy for Carbon Sequestration

NASA Astrophysics Data System (ADS)

Yao, L.; Tang, X.; Ma, M.

2017-12-01

Disturbances and climatic changes significantly affect forest ecosystem productivity, water use efficiency (WUE) and carbon (C) flux dynamics. A deep understanding of terrestrial feedbacks to such effects and recovery mechanisms in forests across contrasting climatic regimes is essential to predict future regional/global C and water budgets, which are also closely related to the potential forest management decisions. However, the resilience of multi-aged and even-aged forests to disturbances has been debated for more than 60 years because of technical measurement constraints. Here we evaluated 62 site-years of eddy covariance measurements of net ecosystem production (NEP), evapotranspiration (ET), the estimates of gross primary productivity (GPP), ecosystem respiration (Re) and ecosystem-level WUE, as well as the relationships with environmental controls in three chronosequences of multi- and even-aged coniferous forests covering the Mediterranean, temperate and boreal regions. Age-specific dynamics in multi-year mean annual NEP and WUE revealed that forest age is a key variable that determines the sign and magnitude of recovering forest C source-sink strength from disturbances. However, the trends of annual NEP and WUE across succession stages between two stand structures differed substantially. The successional patterns of NEP exhibited an inverted-U trend with age at the two even-aged chronosequences, whereas NEP of the multi-aged chronosequence increased steadily through time. Meanwhile, site-level WUE of even-aged forests decreased gradually from young to mature, whereas an apparent increase occurred for the same forest age in multi-aged stands. Compared with even-aged forests, multi-aged forests sequestered more CO2 with forest age and maintained a relatively higher WUE in the later succession periods. With regard to the available flux measurements in this study, these behaviors are independent of tree species, stand ages and climate conditions . We also found that distinctly different environmental factors controlled forest C and water fluxes under three climatic regimes.These findings will provide important implications for forest management strategies to mitigate global climate change.

Development of the ageing management database of PUSPATI TRIGA reactor

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

Ramli, Nurhayati, E-mail: nurhayati@nm.gov.my; Tom, Phongsakorn Prak; Husain, Nurfazila

Since its first criticality in 1982, PUSPATI TRIGA Reactor (RTP) has been operated for more than 30 years. As RTP become older, ageing problems have been seen to be the prominent issues. In addressing the ageing issues, an Ageing Management (AgeM) database for managing related ageing matters was systematically developed. This paper presents the development of AgeM database taking into account all RTP major Systems, Structures and Components (SSCs) and ageing mechanism of these SSCs through the system surveillance program.

Aging Water Infrastructure and Nutrient Control at WWTPs: U.S. Environmental Protection Agency Research Program

EPA Science Inventory

What are… the effects of major influencing factors (climate change, population dynamics, etc.) on future system demands? the innovative technologies that can cost-effectively improve performance and extend the life of existing systems? the new designs and management approaches...

Prevention of age-related macular degeneration

PubMed Central

Koo, Simon Chi Yan; Chan, Clement Wai Nang

2010-01-01

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula. PMID:20862519

Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units.

PubMed

McCann, Terence V; Baird, John; Muir-Cochrane, Eimear

2014-03-19

In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Aggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative factors contribute to the onset of this behaviour. Attitudes toward the management of aggression are complex and somewhat contradictory and can affect the way staff manage this behaviour; therefore, wide-ranging initiatives are needed to prevent and deal with this type of challenging behaviour.

Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

PubMed Central

2014-01-01

Background In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. Methods A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. Results Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. Conclusions Aggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative factors contribute to the onset of this behaviour. Attitudes toward the management of aggression are complex and somewhat contradictory and can affect the way staff manage this behaviour; therefore, wide-ranging initiatives are needed to prevent and deal with this type of challenging behaviour. PMID:24642026

Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study.

PubMed

Miller, Victoria A; Jawad, Abbas F

2018-05-17

To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.

Pilot Testing "Okay with Asthma"[TM]: An Online Asthma Intervention for School-Age Children

ERIC Educational Resources Information Center

Wyatt, Tami H.; Hauenstein, Emily J.

2008-01-01

Asthma is the leading cause of missed school days despite advancements in asthma treatment. This may be, in part, due to a lack of understanding about asthma. "Okay With Asthma"[TM], an online story with psychosocial management strategies for school-age children, was pilot tested to measure its effect on asthma knowledge and attitude. The online…

Harvest-associated disturbance in upland Ozark forests of the Missouri Ozark Forest Ecosystem Project

Treesearch

Johann N. Bruhn; James J. Wetteroff; Jeanne D. Mihail; Randy G. Jensen; James B. Pickens

2002-01-01

The Missouri Ozark Forest Ecosystem Project (MOFEP) is a long-term, multidisciplinary, landscape-based research program studying effects of even-aged (EAM), uneven-aged (UAM), and no-harvest (NHM) management on forest communities. The first MOFEP timber harvests occurred from May through November 1996. Harvest- related disturbance occurred on 69 of 180 permanent 0.2-ha...

The impact of aging on laboratory fire behaviour in masticated shrub fuelbeds of California and Oregon, USA

Treesearch

Jesse K. Kreye; J. Morgan Varner; Jeffrey M. Kane; Eric E. Knapp; Warren P. Reed

2016-01-01

Mastication of shrubs and small trees to reduce fire hazard has become a widespread management practice, yet many aspects of the fire behaviour of these unique woody fuelbeds remain poorly understood. To examine the effects of fuelbed aging on fire behaviour, we conducted laboratory burns with masticated Arctostaphylos spp. and Ceanothus...

Effects of even-aged management on forest birds at northern hardwood stand interfaces

Treesearch

Richard M. DeGraaf

1992-01-01

Breeding birds were counted along transects across edges of even-aged northern hardwood stands in the White Mountain National Forest, New Hampshire, U.S.A. Two replicate transects across each of 7 edge types representing 3 classes of contrast (abrupt, intermediate, and subtle) were sampled during June 1983-1985 to define species assemblages at stand edges and estimate...

Long-term cost-effectiveness of disease management in systolic heart failure.

PubMed

Miller, George; Randolph, Stephen; Forkner, Emma; Smith, Brad; Galbreath, Autumn Dawn

2009-01-01

Although congestive heart failure (CHF) is a primary target for disease management programs, previous studies have generated mixed results regarding the effectiveness and cost savings of disease management when applied to CHF. We estimated the long-term impact of systolic heart failure disease management from the results of an 18-month clinical trial. We used data generated from the trial (starting population distributions, resource utilization, mortality rates, and transition probabilities) in a Markov model to project results of continuing the disease management program for the patients' lifetimes. Outputs included distribution of illness severity, mortality, resource consumption, and the cost of resources consumed. Both cost and effectiveness were discounted at a rate of 3% per year. Cost-effectiveness was computed as cost per quality-adjusted life year (QALY) gained. Model results were validated against trial data and indicated that, over their lifetimes, patients experienced a lifespan extension of 51 days. Combined discounted lifetime program and medical costs were $4850 higher in the disease management group than the control group, but the program had a favorable long-term discounted cost-effectiveness of $43,650/QALY. These results are robust to assumptions regarding mortality rates, the impact of aging on the cost of care, the discount rate, utility values, and the targeted population. Estimation of the clinical benefits and financial burden of disease management can be enhanced by model-based analyses to project costs and effectiveness. Our results suggest that disease management of heart failure patients can be cost-effective over the long term.

Management of advanced colon cancer in a community hospital--impact of age on clinical management and survival.

PubMed

Mogili, Sujatha; Yousaf, Mobeen; Nadaraja, Nagendra; Woodlock, Timothy

2012-09-01

Colon cancer is more common in the elderly than in younger and middle-aged people. Cancer clinical trials focus more on younger patients and the management of elderly patients with advanced disease is still unclear. We studied all patients presenting with colon adenocarcinoma metastasis to liver at a community teaching hospital from Dec 2000 through Dec 2007 by a retrospective review of Tumor Registry data and patient chart review with focus on age, clinical management, decision making, and survival. Sixty-seven patients with a median age of 69 and a male to female ratio of 31:36 were identified. The patients with obstructive symptoms and Eastern Cooperative Oncology Group performance status on presentation though varied little by age, smaller proportion of elderly patients underwent resection of the primary bowel tumor in the presence of liver metastases with ten of 16 (63%) aged 80 or greater being managed without surgery. The percentage of patient's preference to physician's preference for patients not undergoing the primary bowel resection increased for older age group. Median survival decreased significantly with age (p < 0.05). Age-related clinical management, decision-making autonomy, and survival are apparent in this study, and there was an increasing trend of patient's involvement in decision making as the age increases and, thus, affecting the age-related clinical management.

Remote home management for chronic kidney disease: A systematic review.

PubMed

He, Ting; Liu, Xing; Li, Ying; Wu, Qiaoyu; Liu, Meilin; Yuan, Hong

2017-01-01

Background Remote home management is a new healthcare model that uses information technology to enhance patients' self-management of disease in a home setting. This study is designed to identify the effects of remote home management on patients with chronic kidney disease (CKD). Methods A comprehensive search of PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed in January 2015. The reference listings of the included articles in this review were also manually examined. Randomized controlled trials (RCTs) designed to evaluate the effects of remote home management on patients with CKD were included. Results Eight trials were identified. The results of this study suggest that the quality of life (QOL) enabled by remote home management was higher than typical care in certain dimensions. However, the effects of remote home management on blood pressure (BP) remain inconclusive. The studies that assessed health service utilization demonstrated a significant decrease in hospital readmission, emergency room visits, and number of days in the hospital. Another favorable result of this study is that regardless of their gender, age or nationality, patients tend to comply with remote home management programs and the use of related technologies. Conclusions The available data indicate that remote home management may be a novel and effective disease management strategy for improving CKD patients' QOL and influencing their attitudes and behaviors. And, relatively little is known about BP and cost-effectiveness, so future research should focus on these two aspects for the entire population of patients with CKD.

76 FR 69292 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0256] Aging Management of Stainless Steel Structures and... Stainless Steel Structures and Components in Treated Borated Water.'' This LR-ISG revises the guidance in...) and Generic Aging Lessons Learned (GALL) Report for the aging management of stainless steel structures...

Managing daily happiness: The relationship between selection, optimization, and compensation strategies and well-being in adulthood.

PubMed

Teshale, Salom M; Lachman, Margie E

2016-11-01

Past work on selective optimization and compensation (SOC) has focused on between-persons differences and its relationship with global well-being. However, less work examines within-person SOC variation. This study examined whether variation over 7 days in everyday SOC was associated with happiness in a sample of 145 adults ages 22-94. Age differences in this relationship, the moderating effects of health, and lagged effects were also examined. On days in which middle-age and older adults and individuals with lower health used more SOC, they also reported greater happiness. Lagged effects indicated lower happiness led to greater subsequent SOC usage. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Effects of increased discharge on spawning and age-0 recruitment of rainbow trout in the Colorado River at Lees Ferry, Arizona

USGS Publications Warehouse

Avery, Luke A.; Korman, Josh; Persons, William R.

2015-01-01

Negative interactions of Rainbow Trout Oncorhynchus mykiss with endangered Humpback Chub Gila cypha pose challenges to the operation of Glen Canyon Dam (GCD) to manage for both species in the Colorado River. Operations to enhance the Rainbow Trout tailwater fishery may lead to an increase in downstream movement of the trout to areas where they are likely to interact with Humpback Chub. We evaluated the effects of dam operations on age-0 Rainbow Trout in the tailwater fishery to inform managers about how GCD operations could benefit a tailwater fishery for Rainbow Trout; although this could affect a Humpback Chub population farther downstream. A near year-long increase in discharge at GCD in 2011 enabled us to evaluate whether high and stable flows led to increased spawning and production of age-0 Rainbow Trout compared with other years. Rainbow Trout spawning was monitored by fitting a model to observed redd counts to estimate the number of redds created over a spawning season. Data collected during electrofishing trips in July–September and November were used to acquire age-0 trout population and mortality rate estimates. We found that high and stable flows in 2011 resulted in 3,062 redds (1.7 times the mean of all survey years) and a population estimate of 686,000 age-0 Rainbow Trout (second highest on record). Despite high initial abundance, mortality remained low through the year (0.0043%/d) resulting in significant recruitment with a record high November population estimate of 214,000 age-0 Rainbow Trout. Recent monitoring indicates this recruitment event was followed by an increase in downstream migration, which may lead to increased interactions with downstream populations of Humpback Chub. Consequently, while our results indicate that manipulating flow at GCD can be used to manage Rainbow Trout spawning and recruitment, fisheries managers should use flow manipulation in moderation to minimize downstream migration in order to reduce negative interactions with other species in the Colorado River.

Randomized Trial of Labor Induction in Women 35 Years of Age or Older.

PubMed

Walker, Kate F; Bugg, George J; Macpherson, Marion; McCormick, Carol; Grace, Nicky; Wildsmith, Chris; Bradshaw, Lucy; Smith, Gordon C S; Thornton, James G

2016-03-03

The risk of antepartum stillbirth at term is higher among women 35 years of age or older than among younger women. Labor induction may reduce the risk of stillbirth, but it also may increase the risk of cesarean delivery, which already is common in this older age group. We conducted a randomized, controlled trial involving primigravid women who were 35 years of age or older. Women were randomly assigned to labor induction between 39 weeks 0 days and 39 weeks 6 days of gestation or to expectant management (i.e., waiting until the spontaneous onset of labor or until the development of a medical problem that mandated induction). The primary outcome was cesarean delivery. The trial was not designed or powered to assess the effects of labor induction on stillbirth. A total of 619 women underwent randomization. In an intention-to-treat analysis, there were no significant between-group differences in the percentage of women who underwent a cesarean section (98 of 304 women in the induction group [32%] and 103 of 314 women in the expectant-management group [33%]; relative risk, 0.99; 95% confidence interval [CI], 0.87 to 1.14) or in the percentage of women who had a vaginal delivery with the use of forceps or vacuum (115 of 304 women [38%] and 104 of 314 women [33%], respectively; relative risk, 1.30; 95% CI, 0.96 to 1.77). There were no maternal or infant deaths and no significant between-group differences in the women's experience of childbirth or in the frequency of adverse maternal or neonatal outcomes. Among women of advanced maternal age, induction of labor at 39 weeks of gestation, as compared with expectant management, had no significant effect on the rate of cesarean section and no adverse short-term effects on maternal or neonatal outcomes. (Funded by the Research for Patient Benefit Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN11517275.).

Developing recreational harvest regulations for an unexploited lake trout population

USGS Publications Warehouse

Lenker, Melissa A; Weidel, Brian C.; Jensen, Olaf P.; Solomon, Christopher T.

2016-01-01

Developing fishing regulations for previously unexploited populations presents numerous challenges, many of which stem from a scarcity of baseline information about abundance, population productivity, and expected angling pressure. We used simulation models to test the effect of six management strategies (catch and release; trophy, minimum, and maximum length limits; and protected and exploited slot length limits) on an unexploited population of Lake Trout Salvelinus namaycush in Follensby Pond, a 393-ha lake located in New York State’s Adirondack Park. We combined field and literature data and mark–recapture abundance estimates to parameterize an age-structured population model and used the model to assess the effects of each management strategy on abundance, catch per unit effort (CPUE), and harvest over a range of angler effort (0–2,000 angler-days/year). Lake Trout density (3.5 fish/ha for fish ≥ age 13, the estimated age at maturity) was similar to densities observed in other unexploited systems, but growth rate was relatively slow. Maximum harvest occurred at levels of effort ≤ 1,000 angler-days/year in all the scenarios considered. Regulations that permitted harvest of large postmaturation fish, such as New York’s standard Lake Trout minimum size limit or a trophy size limit, resulted in low harvest and high angler CPUE. Regulations that permitted harvest of small and sometimes immature fish, such as a protected slot or maximum size limit, allowed high harvest but resulted in low angler CPUE and produced rapid declines in harvest with increases in effort beyond the effort consistent with maximum yield. Management agencies can use these results to match regulations to management goals and to assess the risks of different management options for unexploited Lake Trout populations and other fish species with similar life history traits.

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.

Score distribution of the scoliosis research society-22 questionnaire in subgroups of patients of all ages with idiopathic scoliosis.

PubMed

Parent, Eric C; Dang, Rohan; Hill, Doug; Mahood, Jim; Moreau, Marc; Raso, Jim; Lou, Edmond

2010-03-01

Cross-sectional measurement study. To analyze the score distribution of the Scoliosis Research Society (SRS)-22 questionnaire domains and items for patients with idiopathic scoliosis (IS) of all ages. Scoliosis-related quality-of-life questionnaires have demonstrated high ceiling effects in younger patients. However, the score distribution has not been examined thoroughly in other clinically relevant IS subgroups. The SRS-22 was completed by 173 females with IS. The proportions of ceiling effects, floor effects, of patients scoring greater than or equal to 4 out of 5 and the box plots of the score distribution for each domain and item were compared between subgroups. Subgroups were formed based on age (k = 4), management (k = 6), curve severity (k = 3), and curve type (k = 4). Domain ceiling effects varied between 0% and 23.1%. Domain floor effects were observed only for Self-image (<7%) and Satisfaction (<12%). Only Pain and Satisfaction showed moderate (>20%) ceiling effects. Ceiling effects for Pain and Mental Health decreased with increasing age (P < 0.05). Pain ceiling effects decreased and Satisfaction ceiling effects increased from least to most invasive management (P < 0.05), but no differences were found among Cobb severity or curve types subgroups. Of the 22 items, 9 had major (>or=50%) ceiling effects and 11 had moderate ceiling effects. Most subgroups (14/16) had 4 to 6 items with major ceiling effects. The following items had major ceiling effects in the majority of subgroups: Function, 9 and 15; Pain, 11 and 17; and Self-image, 14. Most SRS-22 domains had acceptable levels of ceiling effects (<20%) in the majority of the subgroups examined. However, more sensitive measurements may be needed to supplement the SRS-22 in assessing Pain in patients below 18 years or Satisfaction after surgery.

Perceived Effectiveness and Reported Use of Career Strategies in a Service Organization.

ERIC Educational Resources Information Center

Bachiochi, Peter D.; Barnes-Farrell, Janet L.

A survey of 80 management, supervisory, and administrative level employees in a small private hospital (32 responses) in the northeastern United States examined beliefs about the relative effectiveness of different career strategies and worker characteristics, such as age, work experience, company experience, organizational level, and gender,…

Optimized management of heart failure patients aged 80 years or more improves outcomes versus usual care: The HF80 randomized trial.

PubMed

Vorilhon, Charles; Jean, Frédéric; Mulliez, Aurélien; Clerfond, Guillaume; Pereira, Bruno; Sapin, Vincent; Souteyrand, Géraud; Citron, Bernard; Motreff, Pascal; Lusson, Jean-René; Eschalier, Romain

2016-12-01

The prevalence and incidence of heart failure (HF) in elderly patients are increasing worldwide. Management of HF with reduced ejection fraction (HF-REF) in patients aged 80 years or more follows international guidelines, despite the lack of a dedicated study in this frail population. To determine whether optimized management of HF-REF in patients aged 80 years or more can improve quality of life at 6 months. Patients aged 80 years or more hospitalized for acute HF-REF were randomized prospectively into an optimized group or a control group (usual care). All patients benefitted from the same in-hospital management. Optimized group patients were also managed at 3, 6 and 9 weeks, and 3, 6, 9 and 12 months after initial hospitalization, to optimize HF-REF treatment. The primary endpoint was quality of life at 6 months. The trial was stopped prematurely, according to prespecified rules and an independent data monitoring board, after 34 patients were included (n=17 in each group). There was no difference in quality of life at baseline and at 6 months between the two groups (P=0.14 and 0.64, respectively), although a significant improvement was observed between baseline and 6 months in the optimized group compared with the control group: -20.2±25.2 (P=0.01) versus -9.9±19.0 (P=0.19). Mortality at 12 months was lower in the optimized group (17.7% vs 47.1%; P=0.03). There was no increase in acute renal failure, hyperkalaemia or falls in the optimized group (P=0.49, 1 and 1, respectively). Optimizing the management of HF-REF in patients aged 80 years or more, according to the modalities of the HF80 study, seems to be both effective and safe. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

PAHA study: Psychological Active and Healthy Aging: psychological wellbeing, proactive attitude and happiness effects of whole-body vibration versus Multicomponent Training in aged women: study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Evidence demonstrates that physical exercise and psychological wellbeing are closely interlinked, particularly in older-aged women. However, research investigating how different forms of exercise influence mental health in older-aged women is underdeveloped. Methods/Design A randomized controlled trial (N = 300) will assess the relative effectiveness of two different exercise programs (whole-body vibration and Multicomponent Training) for improving psychological wellbeing in older-aged women. The following outcomes will be assessed at three time points (that is, pre, post, and follow-up): psychological wellbeing, proactive attitude, quality of life, and happiness. Discussion Results will have important implications for preventing psychological and physiological disease in older-aged women and for managing health-related costs for this population group. Trial registration Number NCT01966562 on Clinical Gov database the 8 October 2013 PMID:24886107

2015 UK national guideline for the management of infection with Chlamydia trachomatis.

PubMed

Nwokolo, Nneka C; Dragovic, Bojana; Patel, Sheel; Tong, C Y William; Barker, Gary; Radcliffe, Keith

2016-03-01

This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of Chlamydia trachomatis genital infection. It covers the management of the initial presentation, as well the prevention of transmission and future infection. The guideline is aimed at individuals aged 16 years and older presenting to healthcare professionals working in departments offering Level 3 care in sexually transmitted infections management within the UK. However, the principles of the recommendations should be adopted across all levels, using local care pathways where appropriate. © The Author(s) 2016.

Effects of basal area on survival and growth of longleaf pine when practicing selection silviculture

Treesearch

Ferhat Kara; Edward F. Loewenstein; Dale G. Brockway

2017-01-01

Aim of study: Uneven-aged (UEA) management systems can achieve multiple-use objectives, however, use of UEA techniques to manage longleaf pine (Pinus palustris Mill.) forests are still open to question, because of the species’ intolerance of competition. It was our aim to examine the influence of different levels (9.2, 13.8 and...

Short-term responses of the small mammal communities to forest management within Missouri Ozark Forest Ecosystem Project sites

Treesearch

Debby K. Frantz; Rochelle B. Renken

2002-01-01

We conducted a capture-recapture study on the northeast-facing slopes of the MOFEP sites in south central Missouri to determine the initial effects of even- and uneven-aged forest management on species composition, species richness, and relative abundance of the small mammal communities. We compared changes between pre-treatment (1994-1995) and post-treatment (1998-...

Factors associated with the self-perceived ability of nursing staff to remain working until retirement: a questionnaire survey.

PubMed

Maurits, Erica E M; de Veer, Anke J E; van der Hoek, Lucas S; Francke, Anneke L

2015-09-02

It is important to learn how employers in European countries can prevent nursing staff from changing occupation or taking early retirement in order to counteract expected nursing shortages. However, to date research on nursing staff's ability to remain working until retirement age has been limited. The purpose of this study was to gain insight into the associations between different job and organisational characteristics, job satisfaction, occupational commitment and the self-perceived ability to continue working in the current line of work until the official retirement age. The questionnaire-based, cross-sectional study included 730 nursing staff members employed in Dutch hospitals, nursing homes, organisations for psychiatric care, homes for the elderly, care organisations for disabled people and home care organisations (mean age: 48; 89% female). Linear and logistic regression analyses and mediation analyses were applied to test hypothesised associations. Reducing work pressure and increasing appreciation by senior management in particular have positive consequences for nursing staff's self-perceived ability to continue working until the official retirement age. The job and organisational characteristics of autonomy, work pressure, supportive leadership, educational opportunities, communication within the organisation and appreciation of nursing staff by senior management together have substantial impact on nursing staff's job satisfaction. Job satisfaction in turn is related to the self-perceived ability to continue working until the retirement age. However, job satisfaction mainly summarises the joint effect of job and organisational characteristics and has no supplementary effect on the self-perceived ability to continue working. Employers should primarily focus on work pressure and the appreciation of nursing staff by senior management in order to retain nursing staff even as they get older.

Regeneration results using two-aged management

Treesearch

Arlyn W. Perkey; Gary W. Miller; Thomas M. Schuler

1999-01-01

Two-aged management is receiving increasing consideration by central Appalachian hardwood managers as a tool to accomplish multiple landowner goals. On non-industrial private forests where aesthetics are often important, two-aged management has the attribute of retaining some relatively large trees on the area at all times. For many landowners this is critical....

Uneven-aged management of longleaf pine forests: a scientist and manager dialogue

Treesearch

Dale G. Brockway; Kenneth W. Outcalt; James M. Guldin; William D. Boyer; Joan L. Walker; D. Craig Rudolph; Robert B. Rummer; James P. Barnett; Shibu Jose; Jarek Nowak

2005-01-01

Interest in appropriate management approaches for sustaining longleaf pine (Pinus palustris Mill.) forests has increased substantially during the recent decade. Although long-leaf pine can be managed using even-aged techniques, interest in uneven-aged methods has grown significantly as a result of concern for sustaining the wide range of ecological...

Managing Age Discrimination: An Examination of the Techniques Used when Seeking Employment

ERIC Educational Resources Information Center

Berger, Ellie D.

2009-01-01

Purpose: This article examines the age-related management techniques used by older workers in their search for employment. Design and Methods: Data are drawn from interviews with individuals aged 45-65 years (N = 30). Results: Findings indicate that participants develop "counteractions" and "concealments" to manage perceived age discrimination.…

Ageing doctors.

PubMed

Lillis, Steven; Milligan, Eleanor

2017-03-01

Doctors are neither more nor less susceptible than the general population to the effects of ageing. The relevance of deterioration with age depends on the nature of the work undertaken. Reduced muscle strength and visual and auditory deterioration can compromise clinical ability. Accumulation of chronic disease further reduces capacity. Cognitive decline is of particular importance, as good medical care requires considerable cognitive function. Patient safety is paramount, yet older doctors are an important part of the medical workforce and their value should be recognised. Changes in patient case mix, work place support systems and individual adjustments can assist safe practice. Deterioration in health should be acknowledged and requires proactive management. Current methods of ensuring competence are inadequate for supporting ageing doctors. A new initiative is recommended comprising collaboration between regulators, colleges and employing institutions to support the ageing doctor in providing safe and effective practice. © 2017 AJA Inc.

Effects of a self-management educational program for the control of childhood asthma.

PubMed

Pérez, M G; Feldman, L; Caballero, F

1999-01-01

The objective of the present study was to evaluate the effects of a self-management educational program on 29 children between 6 and 14 years old and their parents implemented in an office setting in Venezuela. Children were randomly assigned to experimental and control group. Children's asthma knowledge, self-management abilities, index morbidity, parents' asthma knowledge and management abilities were measured. The program consisted of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and an informative brochure for the parents. Results of t tests indicate that the experimental group experienced a statistical significant effects on children's asthma knowledge (P < 0.001) and practice of self-management abilities (P < 0.000) and in parents' knowledge (P < 0.008) compared to the control group. The educational Self-management program had a significant impact on the Morbidity Index of the study group at post-test (P < 0.05). Younger children benefited more from the program compared to older ones (P < 0.09). Children's age is highlighted as a critical variable in designing asthma educational programs. Results suggest the effectiveness on these programs independently of the cultural context.

Glycation, carbonyl stress and AGEs inhibitors: a patent review.

PubMed

Jahan, Humera; Choudhary, M Iqbal

2015-01-01

The glycation process, comprising a series of reactions, results in the formation of heterogeneous adducts, known as advanced glycation end products (AGEs). AGEs are involved in several pathologies, including diabetes-associated late complications, atherosclerosis, Alzheimer's disease and inflammatory arthritis. Several inhibitors of AGEs and/or reactive carbonyl species have been identified from various sources, including natural products and synthetic molecules, and have been investigated for their mechanism of action. This review covers the literature on AGEs inhibitors published as patents between 2001 and 2014. Initially, the earlier reported molecules with AGEs inhibitory properties, their mechanism of actions and reported adverse effects are discussed. The main focus has been on the chemical structures, methods for evaluation of the activity, modes of action, pharmacokinetics and therapeutic outcomes. The potential of these AGEs inhibitors in the treatment and management of a number of diseases are also discussed in this review. The reactive carbonyl species and AGEs have recently emerged as novel therapeutic targets for the prevention and treatment of several diseases. Currently, the major concerns with the use of AGEs inhibitors as therapeutic agents are low effectiveness, poor pharmacokinetics and undesirable side effects. Many of the AGEs inhibitors reviewed here possess potent antiglycation activity and are devoid of undesirable side effects. These small molecules inhibitors can, therefore, serve as scaffolds for the development and designing of new AGEs inhibitors as clinical agents.

Understanding cultural issues in the diabetes self-management behaviors of Korean immigrants.

PubMed

Cha, EunSeok; Yang, Kyeongra; Lee, Jia; Min, Jiwon; Kim, Kevin H; Dunbar, Sandra B; Jennings, Bonnie Mowinski

2012-01-01

The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds). A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants' preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings. The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship. Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors.

An investigation of the relationship between social support and coping with stress in women with breast cancer.

PubMed

Ozdemir, Deniz; Arslan, Fatma Tas

2018-06-15

Social support may play a role in effective stress management and make a positive contribution to the health of women with breast cancer. The aim of this study was to determine the ways of coping with stress and levels of perceived social support of women with breast cancer, as well as the associated factors. The descriptive and cross-sectional study was conducted with 100 women with breast cancer at a training and research hospital in Turkey. Data were collected using an information form including sociodemographic and disease characteristics, the Scale of Ways of Coping with Stress, and the Multidimensional Scale of Perceived Social Support. Effective ways of coping with stress were found to be significantly lower in women who were primary school graduates and who did not undergo surgery (p<0.05). The women's levels of effective coping with stress decreased with increasing age, and as the score of perceived social support from family and total score of perceived social support increased, so did the levels of effective coping with stress (p<0.05). It was determined that social support and age significantly predicted effective stress management (p<0.05). Social support given to women with breast cancer is a key reference point in effective stress mamangement, and increased age also has an important effect on women's ability to cope with stress. This article is protected by copyright. All rights reserved.

Intestinal Microbiota of Broiler Chickens As Affected by Litter Management Regimens

PubMed Central

Wang, Lingling; Lilburn, Mike; Yu, Zhongtang

2016-01-01

Poultry litter is a mixture of bedding materials and enteric bacteria excreted by chickens, and it is typically reused for multiple growth cycles in commercial broiler production. Thus, bacteria can be transmitted from one growth cycle to the next via litter. However, it remains poorly understood how litter reuse affects development and composition of chicken gut microbiota. In this study, the effect of litter reuse on the microbiota in litter and in chicken gut was investigated using 2 litter management regimens: fresh vs. reused litter. Samples of ileal mucosa and cecal digesta were collected from young chicks (10 days of age) and mature birds (35 days of age). Based on analysis using DGGE and pyrosequencing of bacterial 16S rRNA gene amplicons, the microbiota of both the ileal mucosa and the cecal contents was affected by both litter management regimen and age of birds. Faecalibacterium, Oscillospira, Butyricicoccus, and one unclassified candidate genus closely related to Ruminococcus were most predominant in the cecal samples, while Lactobacillus was predominant in the ileal samples at both ages and in the cecal samples collected at day 10. At days 10 and 35, 8 and 3 genera, respectively, in the cecal luminal microbiota differed significantly in relative abundance between the 2 litter management regimens. Compared to the fresh litter, reused litter increased predominance of halotolerant/alkaliphilic bacteria and Faecalibacterium prausnitzii, a butyrate-producing gut bacterium. This study suggests that litter management regimens affect the chicken GI microbiota, which may impact the host nutritional status and intestinal health. PMID:27242676

Older Patients’ Perspectives on Managing Complexity in CKD Self-Management

PubMed Central

Vandenberg, Ann E.; Phillips, Lawrence S.; McClellan, William M.; Johnson, Theodore M.; Echt, Katharina V.

2017-01-01

Background and objectives Patients with CKD are asked to perform self-management tasks including dietary changes, adhering to medications, avoiding nephrotoxic drugs, and self-monitoring hypertension and diabetes. Given the effect of aging on functional capacity, self-management may be especially challenging for older patients. However, little is known about the specific challenges older adults face maintaining CKD self-management regimens. Design, setting, participants, & measurements We conducted an exploratory qualitative study designed to understand the relationship among factors facilitating or impeding CKD self-management in older adults. Six focus groups (n=30) were held in August and September of 2014 with veterans≥70 years old with moderate-to-severe CKD receiving nephrology care at the Atlanta Veterans Affairs Medical Center. Grounded theory with a constant comparative method was used to collect, code, and analyze data. Results Participants had a mean age (range) of 75.1 (70.1–90.7) years, 60% were black, and 96.7% were men. The central organizing concept that emerged from these data were managing complexity. Participants typically did not have just one chronic condition, CKD, but a number of commonly co-occurring conditions. Recommendations for CKD self-management therefore occurred within a complex regimen of recommendations for managing other diseases. Participants identified overtly discordant treatment recommendations across chronic conditions (e.g., arthritis and CKD). Prioritization emerged as one effective strategy for managing complexity (e.g., focusing on BP control). Some patients arrived at the conclusion that they could group concordant recommendations to simplify their regimens (e.g., protein restriction for both gout and CKD). Conclusions Among older veterans with moderate-to-severe CKD, multimorbidity presents a major challenge for CKD self-management. Because virtually all older adults with CKD have multimorbidity, an integrated treatment approach that supports self-management across commonly occurring conditions may be necessary to meet the needs of these patients. PMID:28389529

Older Patients' Perspectives on Managing Complexity in CKD Self-Management.

PubMed

Bowling, C Barrett; Vandenberg, Ann E; Phillips, Lawrence S; McClellan, William M; Johnson, Theodore M; Echt, Katharina V

2017-04-03

Patients with CKD are asked to perform self-management tasks including dietary changes, adhering to medications, avoiding nephrotoxic drugs, and self-monitoring hypertension and diabetes. Given the effect of aging on functional capacity, self-management may be especially challenging for older patients. However, little is known about the specific challenges older adults face maintaining CKD self-management regimens. We conducted an exploratory qualitative study designed to understand the relationship among factors facilitating or impeding CKD self-management in older adults. Six focus groups ( n =30) were held in August and September of 2014 with veterans≥70 years old with moderate-to-severe CKD receiving nephrology care at the Atlanta Veterans Affairs Medical Center. Grounded theory with a constant comparative method was used to collect, code, and analyze data. Participants had a mean age (range) of 75.1 (70.1-90.7) years, 60% were black, and 96.7% were men. The central organizing concept that emerged from these data were managing complexity. Participants typically did not have just one chronic condition, CKD, but a number of commonly co-occurring conditions. Recommendations for CKD self-management therefore occurred within a complex regimen of recommendations for managing other diseases. Participants identified overtly discordant treatment recommendations across chronic conditions ( e.g., arthritis and CKD). Prioritization emerged as one effective strategy for managing complexity ( e.g. , focusing on BP control). Some patients arrived at the conclusion that they could group concordant recommendations to simplify their regimens ( e.g. , protein restriction for both gout and CKD). Among older veterans with moderate-to-severe CKD, multimorbidity presents a major challenge for CKD self-management. Because virtually all older adults with CKD have multimorbidity, an integrated treatment approach that supports self-management across commonly occurring conditions may be necessary to meet the needs of these patients. Copyright © 2017 by the American Society of Nephrology.

Effects of bull elk demographics on age categories of harem bulls

USGS Publications Warehouse

Bender, L.C.

2002-01-01

Many management strategies for elk (Cervus elaphus) emphasize increasing numbers of mature bulls in the population. These strategies are usually assumed to enhance productivity via increased breeding by mature bulls. I compared age classes of harem bulls during the peak of the rut under 4 bull harvest strategies that resulted in different bull:cow ratios, mature bull:cow ratios, bull mortality rates, and proportions of mature bulls in the autumn (pre-hunting season) population. Proportions of harems held by differing age classes of bulls [mature (P84% of harems only in populations where mature bull:cow ratios exceeded 21:100 in the autumn population. Interaction of mature bull ratios in the autumn population, harem size, and bull selectivity in the harvest strategy must be considered if increased breeding by mature harem bulls is a management goal.

Leadership development and succession planning in case management.

PubMed

Miodonski, Kathleen; Hines, Patricia

2013-01-01

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

The Development and Evaluation of a Professional Development Model to Build Meaningful and Effective IEPs for Transition-Aged Students

ERIC Educational Resources Information Center

Doren, Bonnie; Flannery, K. Brigid; Lombardi, Allison

2012-01-01

The purpose of the study was to examine the potential efficacy of a professional development training model targeting IEP case managers of transition-age students. A training model was developed and a pilot study conducted to understand the promise of the model to improve the development of critical components within the IEP document that support…

Thickened Saliva after Effective Management of Drooling with Botulinum Toxin A

ERIC Educational Resources Information Center

Erasmus, Corrie E.; van Hulst, Karen; van den Hoogen, Frank J. A.; van Limbeek, Jacques; Roeleveld, Nel; Veerman, Enno C. I.; Rotteveel, Jan J.; Jongerius, Peter H.

2010-01-01

Aim: The aim of this study was to evaluate the rheological properties of saliva after submandibular botulinum toxin type A (BoNT-A) injections. Method: We enrolled 15 children (11 males and six females; age range 3-17y, mean age 9y 10mo) diagnosed with spastic (n=9) or dyskinetic (n=6) quadriplegic cerebral palsy (CP); Gross Motor Function…

The Effect of Trust in Leader on Job Satisfaction and Intent to Leave Present Job in the Context of the Nursing Profession

ERIC Educational Resources Information Center

Gibson, William David

2011-01-01

Three research questions made up the focus of the study. First, after controlling for demographic variables of age, gender, and tenure in organization, to what extent does trust in leader (nurse manager) relate to job satisfaction? Second, after controlling for demographic variables of age, gender, and tenure in organization, to what extent does…

Estimation of Energy Consumption and Greenhouse Gas Emissions considering Aging and Climate Change in Residential Sector

NASA Astrophysics Data System (ADS)

Lee, M.; Park, C.; Park, J. H.; Jung, T. Y.; Lee, D. K.

2015-12-01

The impacts of climate change, particularly that of rising temperatures, are being observed across the globe and are expected to further increase. To counter this phenomenon, numerous nations are focusing on the reduction of greenhouse gas (GHG) emissions. Because energy demand management is considered as a key factor in emissions reduction, it is necessary to estimate energy consumption and GHG emissions in relation to climate change. Further, because South Korea is the world's fastest nation to become aged, demographics have also become instrumental in the accurate estimation of energy demands and emissions. Therefore, the purpose of this study is to estimate energy consumption and GHG emissions in the residential sectors of South Korea with regard to climate change and aging to build more accurate strategies for energy demand management and emissions reduction goals. This study, which was stablished with 2010 and 2050 as the base and target years, respectively, was divided into a two-step process. The first step evaluated the effects of aging and climate change on energy demand, and the second estimated future energy use and GHG emissions through projected scenarios. First, aging characteristics and climate change factors were analyzed by using the logarithmic mean divisia index (LMDI) decomposition analysis and the application of historical data. In the analysis of changes in energy use, the effects of activity, structure, and intensity were considered; the degrees of contribution were derived from each effect in addition to their relations to energy demand. Second, two types of scenarios were stablished based on this analysis. The aging scenarios are business as usual and future characteristics scenarios, and were used in combination with Representative Concentration Pathway (RCP) 2.6 and 8.5. Finally, energy consumption and GHG emissions were estimated by using a combination of scenarios. The results of these scenarios show an increase in energy consumption and GHG emissions from 2010 to 2050. This growth is caused by increases in heating energy because the elderly generally spend more time at home, and cooling energy owing to rising temperatures. This study will be useful in the preparation of energy demand management policies and the establishment and attainability of GHG emissions reduction goals.

Species diversity of polyporoid and corticioid fungi in northern hardwood forests with differing management histories.

PubMed

Lindner, Daniel L; Burdsall, Harold H; Stanosz, Glen R

2006-01-01

Effects of forest management on fungal diversity were investigated by sampling fruit bodies of polyporoid and corticioid fungi in forest stands that have different management histories. Fruit bodies were sampled in 15 northern hardwood stands in northern Wisconsin and the upper peninsula of Michigan. Sampling was conducted in five old-growth stands, five uneven-age stands, three even-age unthinned stands and two even-age thinned stands. Plots 100 m x 60 m were established and 3000 m2 within each plot was sampled during the summers of 1996 and 1997. A total of 255 polyporoid and corticioid morphological species were identified, 46 (18%) of which could not be assigned to a described species. Species accumulation curves for sites and management classes differed from straight lines, although variability from year to year suggests that more than 2 y of sampling are needed to characterize annual variation. Mean species richness and diversity index values did not vary significantly by management class, although mean richness on large diameter wood (> or = 15 cm diam) varied with moderate significance. Richness values on small diameter debris varied significantly by year, indicating that a large part of year-to-year variability in total species richness is due to small diameter debris. Ten species had abundance levels that varied by management class. Two of these species. Changes in the diversity and species composition of the wood-inhabiting fungal community could have significant implications for the diversity, health and productivity of forest ecosystems.

A Lagrangian model for the age of tracer in surface water

NASA Astrophysics Data System (ADS)

Ding, Yu; Liu, Haifei; Yi, Yujun

The age of tracer is a spatio-temporal scale, indicating the transition time of solute particles, which is helpful to monitor and manage the pollutant leakage accidents. In this study, an effective Lagrangian model for the age of tracer is developed based on the lattice Boltzmann method in D2Q5 lattices. A tracer age problem in an asymmetrical circular reservoir is then employed as a benchmark test to verify this method. Then it is applied to computing the age of tracers under two different reservoir operation schemes in the Danjiangkou Reservoir, the drinking water source for the Middle Route of South-to-North Water Transfer Project.

Do the Emotional Benefits of Optimism Vary Across Older Adulthood? A Life Span Perspective.

PubMed

Wrosch, Carsten; Jobin, Joelle; Scheier, Michael F

2017-06-01

This study examined whether the emotional benefits of dispositional optimism for managing stressful encounters decrease across older adulthood. Such an effect might emerge because age-related declines in opportunities for overcoming stressors could reduce the effectiveness of optimism. This hypothesis was tested in a 6-year longitudinal study of 171 community-dwelling older adults (age range = 64-90 years). Hierarchical linear models showed that dispositional optimism protected relatively young participants from exhibiting elevations in depressive symptoms over time, but that these benefits became increasingly reduced among their older counterparts. Moreover, the findings showed that an age-related association between optimism and depressive symptoms was observed particularly during periods of enhanced, as compared to reduced, stress. These results suggest that dispositional optimism protects emotional well-being during the early phases of older adulthood, but that its effects are reduced in advanced old age. © 2016 Wiley Periodicals, Inc.

[Management and new current French recommendations for tetanus care].

PubMed

Nicolai, Dominique; Farcet, Anaïs; Molines, Catherine; Delalande, Géraldine; Retornaz, Frédérique

2015-06-01

Tetanus is an acute severe disease induced by an exotoxin, often lethal. All cases occur in untreated or inadequately vaccinated patients and mainly in elderly patients who accumulate many risk factors. The current management of wounds faced difficulties in the assessment of immunization status and wound risks status. Indeed, all injuries can potentially lead to tetanus. Minor risks and chronic wounds are mainly found as tetanus cause. Vaccination remains the key element in reducing the morbidity and mortality associated with tetanus. It is estimated that the vaccine's coverage is fairly good, but decreases with age. To improve tetanus prevention, new vaccine recommendations have been established which recommend vaccine's injections at fixed age, but their impact seems to be limited especially in the elderly. The immunochromatographic tests have demonstrated cost-effectiveness in the Emergency department settings. They are currently not available outside hospital while general practionners also face a significant risk. Effectiveness of these tests should be studied in outpatients population including cost-effectiveness.

Physical therapy management of knee osteoarthritis in the middle-aged athlete.

PubMed

Adams, Thomas; Band-Entrup, Debra; Kuhn, Scott; Legere, Lucas; Mace, Kimberly; Paggi, Adam; Penney, Matthew

2013-03-01

Osteoarthritis (OA) is prevalent in today's population, including the athletic and recreationally active "middle-aged" population. OA is a degenerative condition of the articular/hyaline cartilage of synovial joints and commonly affects the knee joint. In general, athletic participation does not specifically influence a higher incidence of knee OA in this population; however, traumatic injury to the knee joint poses a definitive risk in developing early-onset OA. The purpose of this article is to review evidence-based nonpharmacological interventions for the conservative management of knee OA. Manual therapy, therapeutic exercise, patient education, and weight management are strongly supported in the literature for conservative treatment of knee OA. Modalities [thermal, electrical stimulation (ES), and low-level laser therapy (LLLT)] and orthotic intervention are moderately supported in the literature as indicated management strategies for knee OA. While many strongly supported conservative interventions have been published, additional research is needed to determine the most effective approach in treating knee OA.

The innovative characteristics and obstruction of technology adoption for management of integrated plants (PTT) of corn in Gowa Regency Indonesia

NASA Astrophysics Data System (ADS)

Jamil, M. H.; Musa, Y.; Tenriawaru, A. N.; Rahayu, N. E.

2018-05-01

The research aimed to analyze the effects of the farmer’s characteristic, innovation characteristics, and the obstruction faced in the technology adoption for the management of integrated plants corn in Gowa Regency. The method used was explanative in character. Respondents comprised 80 corn farmers chosen randomly. Data were collected using the interviews method which were then quantified using likers scale. The data was analyzed by logistic binary regression. The research results indicated that the farmer’s characteristics which consisted of the age, education, experience, and the land area had no significant effect on the technology adoption of maize integrated crops management (PTT). The obstruction of the adoption, which consisted of the limited capital, availability of inputs, and intensity of counseling had a significant effect on the adoption of maize integrated crops management. While the farmer’s knowledge had no significant effect on the adoption of maize integrated crops management. The variable of the limited capital had a positive coefficient, the more available the farmer’s capital the higher was the chance of farmers to adopt technology integrated crops management. The higher of the extension intensity, the higher of farmer’s chance to adopt the technology of the maize integrated corps management.

Educational strategies to train health care professionals across the education continuum on the process of frailty prevention and frailty management: a systematic review.

PubMed

Windhaber, Thomas; Koula, Maria Lamprini; Ntzani, Evangelia; Velivasi, Alexandra; Rizos, Evangelos; Doumas, Michail Theofilos; Pappas, Evangelos Elias; Onder, Graziano; Vetrano, Davide Liborio; Roudriguez Laso, Angel; Roudriguez Manjas, Leocadio; Illario, Maddalena; Roller-Wirnsberger, Regina Elisabeth

2018-02-23

In addition to the normal process of ageing, frailty, defined as a geriatric syndrome, is becoming more prevalent. Around 10% of people over 65 years and 25-50% of those aged over 85 years are frail. Frail elderly are more vulnerable to external stressors and have an increased risk of adverse health outcomes. To tackle these challenges, European Union (EU) member states need to develop a health work force capable of the right skills mix. A goal-centred education and training of professionals is crucial for effective and efficient health care delivery for Europe's greying population. The aim of this study was to systematically collect, review and critically appraise studies carried out to investigate the efficacy and effectiveness of comprehensive educational programmes for health professionals related to frailty prevention and/or frailty management. A systematic review was carried out searching the databases PubMed, CINAHL, Cochrane CENTRAL, Medline, Up to date and Embase. Additionally, a manual search of the reference lists and searches via Google Scholar and greylit.org was done. No relevant publications addressing the evidence and sustainability of educational/training programmes for frailty prevention and/or frailty management were identified. The result of an empty review is surprising because several educational programmes in different countries are currently run. A significant knowledge gap exists in the scientific literature regarding education and training of health care workers regarding prevention and management of frailty. Further research is needed to identify effective educational strategies for health professionals to prevent and manage frailty.

Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group.

PubMed

Holton, Sara; Rowe, Heather; Kirkman, Maggie; Jordan, Lynne; McNamee, Kathleen; Bayly, Christine; McBain, John; Sinnott, Vikki; Fisher, Jane

2016-02-15

As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. To identify public opinion about sexual and reproductive health in Australia. To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health.

Incontinence Treatment: Newer Treatment Options

MedlinePlus

... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ...

Anthropogenic Influences on Conservation Values of White Rhinoceros

PubMed Central

Ferreira, Sam M.; Botha, Judith M.; Emmett, Megan C.

2012-01-01

White rhinoceros (rhinos) is a keystone conservation species and also provides revenue for protection agencies. Restoring or mimicking the outcomes of impeded ecological processes allows reconciliation of biodiversity and financial objectives. We evaluate the consequences of white rhino management removal, and in recent times, poaching, on population persistence, regional conservation outcomes and opportunities for revenue generation. In Kruger National Park, white rhinos increased from 1998 to 2008. Since then the population may vary non-directionally. In 2010, we estimated 10,621 (95% CI: 8,767–12,682) white rhinos using three different population estimation methods. The desired management effect of a varying population was detectable after 2008. Age and sex structures in sink areas (focal rhino capture areas) were different from elsewhere. This comes from relatively more sub-adults being removed by managers than what the standing age distribution defined. Poachers in turn focused on more adults in 2011. Although the effect of poaching was not detectable at the population level given the confidence intervals of estimates, managers accommodated expected poaching annually and adapted management removals. The present poaching trend predicts that 432 white rhinos may be poached in Kruger during 2012. The white rhino management model mimicking outcomes of impeded ecological processes predicts 397 rhino management removals are required. At present poachers may be doing “management removals,” but conservationists have no opportunity left to contribute to regional rhino conservation strategies or generate revenue through white rhino sales. In addition, continued trends in poaching predict detectable white rhino declines in Kruger National Park by 2016. Our results suggest that conservationists need innovative approaches that reduce financial incentives to curb the threats that poaching poses to several conservation values of natural resources such as white rhinos. PMID:23029354

Management and Prevention of Breast Cancer After Radiation to the Chest for Childhood, Adolescent, and Young Adulthood Malignancy.

PubMed

Koo, Eva; Henderson, Michael A; Dwyer, Mary; Skandarajah, Anita R

2015-12-01

Women treated with chest irradiation for childhood, adolescent, and young adulthood (CAYA) malignancies, in particular Hodgkin's lymphoma, have an increased risk of developing second cancers of the breast (SCB). However, there are few uniform guidelines regarding surveillance and prevention for this high-risk group. A systematic search using PUBMED and OVID MEDLINE was performed. Publications listed under the terms "breast neoplasm", "neoplasm, radiation-induced", "therapeutic radiation-induced breast cancer", "screening", "surveillance", "prevention", and "prophylaxis" between January 1992 and January 2015 were assessed. A total of 138 publications were reviewed. Factors associated with increased SCB risk include young age at irradiation, prolong duration since irradiation (peak relative risk 13.87 at 15-19 years postradiation), and increased radiation dose and field. Early menopause reduces SCB risk. Annual screening mammography and breast MRI is recommended from age 25 or 8 years posttreatment for women treated with ≥20 Gy chest radiation before age 30 years. Compared with sporadic primary breast cancers (PBC), SCB more often are bilateral (6-34 %), managed with mastectomy (56-100 %), hormone receptor-negative (27-49 %), and high-grade (35 %). Women with SCB have a similar breast cancer event-free survival and breast cancer-specific survival compared to women with PBC. However, their overall survival is worse due to comorbid conditions. There is paucity of information regarding secondary prevention of SCB. Survivors of CAYA malignancy are at risk of many late effects, including iatrogenic breast cancer from chest irradiation. They are best managed in a multidisciplinary late-effects setting where tailored risk management can be provided.

Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness.

PubMed

Whiteman, Karen L; Lohman, Matthew C; Gill, Lydia E; Bruce, Martha L; Bartels, Stephen J

2017-08-01

To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using an adaptive systems engineering framework and user-centered design. First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing. We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application. Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Comparative effect of Piper betle, Chlorella vulgaris and tocotrienol-rich fraction on antioxidant enzymes activity in cellular ageing of human diploid fibroblasts

PubMed Central

2013-01-01

Background Human diploid fibroblasts (HDFs) undergo a limited number of cellular divisions in culture and progressively reach a state of irreversible growth arrest, a process termed cellular ageing. Even though beneficial effects of Piper betle, Chlorella vulgaris and tocotrienol-rich fraction (TRF) have been reported, ongoing studies in relation to ageing is of interest to determine possible protective effects that may reverse the effect of ageing. The aim of this study was to evaluate the effect of P. betle, C. vulgaris and TRF in preventing cellular ageing of HDFs by determining the activity of antioxidant enzymes viz.; catalase, superoxide dismutase (SOD) and glutathione peroxidase. Methods Different passages of HDFs were treated with P. betle, C. vulgaris and TRF for 24 h prior to enzymes activity determination. Senescence-associated beta-galactosidase (SA β-gal) expression was assayed to validate cellular ageing. Results In cellular ageing of HDFs, catalase and glutathione peroxidase activities were reduced, but SOD activity was heightened during pre-senescence. P. betle exhibited the strongest antioxidant activity by reducing SA β-gal expression, catalase activities in all age groups, and SOD activity. TRF exhibited a strong antioxidant activity by reducing SA β-gal expression, and SOD activity in senescent HDFs. C. vulgaris extract managed to reduce SOD activity in senescent HDFs. Conclusion P. betle, C. vulgaris, and TRF have the potential as anti-ageing entities which compensated the role of antioxidant enzymes in cellular ageing of HDFs. PMID:23948056

Comparative effect of Piper betle, Chlorella vulgaris and tocotrienol-rich fraction on antioxidant enzymes activity in cellular ageing of human diploid fibroblasts.

PubMed

Makpol, Suzana; Yeoh, Thong Wei; Ruslam, Farah Adilah Che; Arifin, Khaizurin Tajul; Yusof, Yasmin Anum Mohd

2013-08-16

Human diploid fibroblasts (HDFs) undergo a limited number of cellular divisions in culture and progressively reach a state of irreversible growth arrest, a process termed cellular ageing. Even though beneficial effects of Piper betle, Chlorella vulgaris and tocotrienol-rich fraction (TRF) have been reported, ongoing studies in relation to ageing is of interest to determine possible protective effects that may reverse the effect of ageing. The aim of this study was to evaluate the effect of P. betle, C. vulgaris and TRF in preventing cellular ageing of HDFs by determining the activity of antioxidant enzymes viz.; catalase, superoxide dismutase (SOD) and glutathione peroxidase. Different passages of HDFs were treated with P. betle, C. vulgaris and TRF for 24 h prior to enzymes activity determination. Senescence-associated beta-galactosidase (SA β-gal) expression was assayed to validate cellular ageing. In cellular ageing of HDFs, catalase and glutathione peroxidase activities were reduced, but SOD activity was heightened during pre-senescence. P. betle exhibited the strongest antioxidant activity by reducing SA β-gal expression, catalase activities in all age groups, and SOD activity. TRF exhibited a strong antioxidant activity by reducing SA β-gal expression, and SOD activity in senescent HDFs. C. vulgaris extract managed to reduce SOD activity in senescent HDFs. P. betle, C. vulgaris, and TRF have the potential as anti-ageing entities which compensated the role of antioxidant enzymes in cellular ageing of HDFs.

Age, growth rates, and paleoclimate studies of deep sea corals

USGS Publications Warehouse

Prouty, Nancy G; Roark, E. Brendan; Andrews, Allen; Robinson, Laura; Hill, Tessa; Sherwood, Owen; Williams, Branwen; Guilderson, Thomas P.; Fallon, Stewart

2015-01-01

Deep-water corals are some of the slowest growing, longest-lived skeletal accreting marine organisms. These habitat-forming species support diverse faunal assemblages that include commercially and ecologically important organisms. Therefore, effective management and conservation strategies for deep-sea corals can be informed by precise and accurate age, growth rate, and lifespan characteristics for proper assessment of vulnerability and recovery from perturbations. This is especially true for the small number of commercially valuable, and potentially endangered, species that are part of the black and precious coral fisheries (Tsounis et al. 2010). In addition to evaluating time scales of recovery from disturbance or exploitation, accurate age and growth estimates are essential for understanding the life history and ecology of these habitat-forming corals. Given that longevity is a key factor for population maintenance and fishery sustainability, partly due to limited and complex genetic flow among coral populations separated by great distances, accurate age structure for these deep-sea coral communities is essential for proper, long-term resource management.

Nurses' experiences of practice and political reform in long-term aged care in Australia: implications for the retention of nursing personnel.

PubMed

Venturato, Lorraine; Kellett, Ursula; Windsor, Carol

2007-01-01

The aim of the study was to explore registered nurses' experiences in long-term aged care in light of the political reform of aged care services in Australia. In Australia, the aged care industry has undergone a lengthy period of political and structural reform. Despite reviews into various aspects of these reforms, there has been little consideration of the effect these are having on the practice experiences and retention of nursing staff in long-term care. In this critical hermeneutic study, 14 nurses from long-term care facilities in Australia were interviewed about their experiences during the reform period. The data revealed a sense of tension and conflict between nurses' traditional values, roles and responsibilities and those supported by the reforms. Nurses struggled to re-negotiate both their practice roles and values as the reforms were implemented and the system evolved. Nursing management support was an important aspect in mediating the effect of reforms on nursing staff. This research highlights both the tensions experienced by nurses in long-term aged care in Australia and the need to re-negotiate nursing roles, responsibilities and values within an evolving care system. This research supports a role for sensitive and proactive nursing management during periods of industry reform as a retention strategy for qualified nursing personnel.

The Effect of "Cover, Copy, and Compare" on Spelling Accuracy of High School Students with Learning Disabilities

ERIC Educational Resources Information Center

Zielinski, Katie; McLaughlin, T. F.; Derby, K. Mark

2012-01-01

The purpose of this study was to evaluate the effectiveness of cover, copy, and compare (CCC) on spelling accuracy for three high school aged students with learning disabilities. CCC is a student-managed procedure that teaches discrete skills through self-tutoring and error correction. The effectiveness of CCC was evaluated using a multiple…

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.

Managing aging in nuclear power plants: Insights from NRC maintenance team inspection reports

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

Fresco, A.; Subudhi, M.; Gunther, W.

1993-12-01

A plant`s maintenance program is the principal vehicle through which age-related degradation is managed. From 1988 to 1991, the NRC evaluated the maintenance program of every nuclear power plant in the United States. Forty-four out of a total of 67 of the reports issued on these in-depth team inspections were reviewed for insights into the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear plant systems, structures, and components. Relevant information was extracted from these inspection reports and sorted into several categories, including Specific Aging Insights, Preventive Maintenance,more » Predictive Maintenance and Condition Monitoring, Post Maintenance Testing, Failure Trending, Root Cause Analysis and Usage of Probabilistic Risk Assessment in the Maintenance Process. Specific examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging have been identified. The information also was sorted according to systems and components, including: Auxiliary Feedwater, Main Feedwater, High Pressure Injection for both BWRs and PWRs, Service Water, Instrument Air, and Emergency Diesel Generator Air Start Systems, and Emergency Diesel Generators Air Start Systems, emergency diesel generators, electrical components such as switchgear, breakers, relays, and motor control centers, motor operated valves and check valves. This information was compared to insights gained from the Nuclear Plant Aging Research (NPAR) Program. Attributes of plant maintenance programs where the NRC inspectors felt that improvement was needed to properly address the aging issue also are discussed.« less

Effects of PMTO in Foster Families with Children with Behavior Problems: A Randomized Controlled Trial.

PubMed

Maaskant, Anne M; van Rooij, Floor B; Overbeek, Geertjan J; Oort, Frans J; Arntz, Maureen; Hermanns, Jo M A

2017-01-01

The present randomized controlled trial examined the effectiveness of Parent Management Training Oregon for foster parents with foster children (aged 4-12) with severe externalizing behavior problems in long-term foster care arrangements. Foster children's behavior problems are challenging for foster parents and increase the risk of placement breakdown. There is little evidence for the effectiveness of established interventions to improve child and parent functioning in foster families. The goal of Parent Management Training Oregon, a relatively long and intensive (6-9 months, with weekly sessions) parent management training, is to reduce children's problem behavior through improvement of parenting practices. We specifically investigated whether Parent Management Training Oregon is effective to reduce foster parenting stress. A significant effect of Parent Management Training Oregon, compared to Care as Usual was expected on reduced parenting stress improved parenting practices, and on reduced child behavior problems. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 foster families (46 Parent Management Training Oregon, 40 Care as Usual) using a pre-posttest design. Multilevel analyses based on the intention to treat principle (retention rate 73 %) showed that Parent Management Training Oregon, compared to Care as Usual, reduced general levels of parenting stress as well as child related stress and parent-related stress (small to medium effect sizes). The clinical significance of this effect was, however, limited. Compared to a decrease in the Care as Usual group, Parent Management Training Oregon helped foster mothers to maintain parental warmth (small effect size). There were no other effects of Parent Management Training Oregon on self-reported parenting behaviors. Child behavior problems were reduced in both conditions, indicating no additive effects of Parent Management Training Oregon to Care as Usual on child functioning. The potential implication of reduced foster parenting stress for placement stability is discussed.

Kamp K’aana, a 2-week residential weight management summer camp, shows long-term improvement in body mass index z scores

USDA-ARS?s Scientific Manuscript database

Long-term effects of Kamp K'aana, a 2-week residential weight management camp, on body mass index (BMI) measures were evaluated on 71 of 108 (66%) obese youth 10 to 14 years of age. Measures were obtained at 11-month study follow-up (n=38) or extracted from medical record (n=33). Compared with basel...

Fuel loading and fire intensity-effects on longleaf pine seedling survival

Treesearch

Steven B. Jack; J. Kevin Hiers; Robert J. Mitchell; Jennifer L. Gagnon

2010-01-01

Modeling silvicultural practices after natural disturbance, with a particular focus on the use of fire and small canopy openings, may be particularly appropriate in longleaf pine (Pinus palustris Mill.) woodlands managed for multiple age classes and over long time scales. However, information about the effects of litter accumulation and fire...

Success in Weight Management Among Patients with Type 2 Diabetes: Do Perceived Autonomy Support, Autonomous Motivation, and Self-Care Competence Play a Role?

PubMed

Koponen, Anne M; Simonsen, Nina; Suominen, Sakari B

2018-01-01

Based on self-determination theory (SDT), this study investigated whether the three central SDT variables-perceived autonomy support (from a physician), autonomous motivation and self-care competence-were associated with success in weight management (SWM) among primary care patients with type 2 diabetes when the effect of other important life-context factors was controlled for. Patients participated in a mail survey in 2011. Those who had tried to change their health behavior during the past two years in order to lose weight, either with or without success (n = 1433, mean age 63 years, 50% men), were included in this study. The successors were more autonomously motivated and energetic than the non-successors. Moreover, male gender, younger age, taking oral medication only, and receiving less social support in diabetes care predicted better success. Autonomous motivation predicted SWM; self-care competence also played a role by partly mediating the effect of autonomous motivation on SWM. These results support the idea of SDT that internalizing the value of weight management and its health benefits is necessary for long-term maintenance of health behavior change. Perceived autonomy support was not directly associated with SWM. However, physicians can promote patients' weight management by supporting their autonomous motivation and self-care competence.

Clinical-outcome-based demand management in health services.

PubMed

Brogan, C; Lawrence, D; Mayhew, L

2008-01-01

THE PROBLEM OF MANAGING DEMAND: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure will be at the expense of clinical outcomes and unmet need, which will perpetuate financial crises.

Age alters uptake pattern of organic and inorganic nitrogen by rubber trees.

PubMed

Liu, Min; Xu, Fanzhen; Xu, Xingliang; Wanek, Wolfgang; Yang, Xiaodong

2018-04-05

Several studies have explored plant nutrient acquisition during ecosystem succession, but it remains unclear how age affects nitrogen (N) acquisition by the same tree species. Clarifying the age effect will be beneficial to fertilization management through improving N-use efficiency and reducing the risk of environmental pollution due to NO3- leaching. To clarify the effect of age on N uptake, rubber (Hevea brasiliensis (Willd. ex A. Juss.) Muell. Arg.) plantations of five ages (7, 16, 24, 32 and 49 years) were selected in Xishuangbanna of southern China for brief 15N exposures of intact roots using field hydroponic experiments. 15N-labeled NH4+, NO3- or glycine were applied in this study. All targeted rubber trees uptake rates followed an order of NH4+ > glycine > NO3-. As age increased, NH4+ uptake increased first and then decreased sharply, partly consistent with the pattern of soil NH4+ concentrations. Uptake of glycine decreased first and then increased gradually, while no significant change of NO3- uptake rates existed with increasing age. Overall, rubber trees with ages from 7 to 49 years all showed a preference for NH4+ uptake. Young rubber trees (7 and 16 years) had higher NH4+ and lower glycine preferences than older trees (24, 32 and 49 years). Mycorrhizal colonization rates of rubber trees were higher in intermediately aged plantations (16, 24 and 32 years) than in plantations aged 7 and 49 years. A positive relationship was observed between arbuscular mycorrhizal colonization rates and NO3- preference. The results from this study demonstrate that rubber trees do not change their preference for NH4+ but strongly decreased their reliance on it with age. These findings indicate that the shift of N uptake patterns with age should be taken into account for rubber fertilization management to improve N-use efficiency and reduce the risk of environmental pollution during rubber production.

Managing chronic inflammation in the aging diabetic patient with CKD by diet or sevelamer carbonate: a modern paradigm shift.

PubMed

Vlassara, H; Cai, W; Chen, X; Serrano, E J; Shobha, M S; Uribarri, J; Woodward, M; Striker, G E

2012-12-01

The maintenance of normal metabolism and body defenses depends on the balance between cellular antioxidant and anti-inflammatory factors. This balance can be disrupted by agents/mechanisms in the extracellular milieu that induce excess reactive oxygen species (ROS) and inflammation. Cytopathic advanced glycation endproducts, present in ever increasing amounts in the modern diet, are one of the major environmental factors that cause excess ROS and/or inflammation at all ages and induce complications in aging, such as chronic kidney disease (CKD) and type 2 diabetes. Increased ROS and/or inflammation are present in both aging and CKD, and are associated with reduced cellular defenses against ROS and/or inflammation. Affected individuals have reduced defenses against further stress and are predisposed to organ failure, now a well-known phenomenon in aging. Thus, new methods are urgently needed to safely reduce ROS and/or inflammation in the aging type 2 diabetes patient with CKD. Studies of both normal aging and diabetic patients with kidney disease underline the fact that increased ROS and/or inflammation can be managed in these conditions by economical, safe, and effective interventions that reduce the uptake of advanced glycation endproducts by either modifying preparation of food or an oral drug. This communication reviews these data and adds new information on the efficacy of a drug, sevelamer carbonate, required to reduce ROS and/or inflammation in the aging type 2 diabetes patient complicated by CKD. If larger and longer studies confirm the hypothesis that one or both of these interventions reduce progression of CKD, it could represent a new paradigm in the management of complications in the type 2 diabetes patient with CKD.

Preparing the workforce for healthy aging programs: the Skills for Healthy Aging Resources and Programs (SHARP) model.

PubMed

Frank, Janet C; Altpeter, Mary; Damron-Rodriguez, JoAnn; Driggers, Joann; Lachenmayr, Susan; Manning, Colleen; Martinez, Dana M; Price, Rachel M; Robinson, Patricia

2014-10-01

Current public health and aging service agency personnel have little training in gerontology, and virtually no training in evidence-based health promotion and disease management programs for older adults. These programs are rapidly becoming the future of our community-based long-term care support system. The purpose of this project was to develop and test a model community college career technical education program, Skills for Healthy Aging Resources and Programs (SHARP), for undergraduate college students, current personnel in aging service and community organizations, and others interested in retraining. A multidisciplinary cross-sector team from disciplines of public health, sociology, gerontology and nursing developed four competency-based courses that focus on healthy aging, behavior change strategies, program management, an internship, and an option for leader training in the Chronic Disease Self-Management Program. To enhance implementation and fidelity, intensive faculty development training was provided to all instructors and community agency partners. Baseline and postprogram evaluation of competencies for faculty and students was conducted. Process evaluation for both groups focused on satisfaction with the curricula and suggestions for program improvement. SHARP has been piloted five times at two community colleges. Trainees (n = 113) were primarily community college students (n = 108) and current aging service personnel (n = 5). Statistically significant improvements in all competencies were found for both faculty and students. Process evaluation outcomes identified the needed logical and component adaptations to enhance the feasibility of program implementation, dissemination, and student satisfaction. The SHARP program provides a well-tested, evidence-based effective model for addressing workforce preparation in support of healthy aging service program expansion and delivery. © 2014 Society for Public Health Education.

The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: Contested discourses of ageing

PubMed Central

Myers, Jason; Smith, Glenn; Higgs, Paul; Burns, Aine; Hopkins, Katherine; Jones, Louise

2014-01-01

Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a ‘natural’ and a ‘normal’ paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap. PMID:24695386

The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: contested discourses of ageing.

PubMed

Low, Joe; Myers, Jason; Smith, Glenn; Higgs, Paul; Burns, Aine; Hopkins, Katherine; Jones, Louise

2014-11-01

Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a 'natural' and a 'normal' paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap. © The Author(s) 2014.

Seroepidemiology of Brucella abortus infection in bovids in Sri Lanka.

PubMed

Silva, I; Dangolla, A; Kulachelvy, K

2000-07-03

From 1992 to 1995, 0.15% (n=3916) of the bovids (cattle and buffalo) in Sri Lanka were sampled, using a multi-stage sampling procedure. Serum antibodies for Brucella abortus were detected using the indirect enzyme-linked immunosorbent assay (ELISA). The age, the agroecological zone and the management system practiced in the farms of the sampled bovids were studied as risk factors for seropositivity. The overall seroprevalence of brucellosis in cattle was 4.7% (n=3076) and 4.2% in buffaloes (n=840). Bovids that were over 3 years of age, from the dry zone (annual rainfall 20-35 in.), and reared under an extensive management system had higher odds of being seropositive. Bovids from the dry zone were at approximately six times higher odds of being seropositive even after controlling for the possible effects of age and management system. Approximately 75% of the seropositive males were from the dry zone. Most bovids (84%) from the dry zone in this study were reared under an extensive management system (free grazing) which allows unrestricted contact between animals. These factors may have contributed to the spread of brucellosis in bovids in the dry zone. This infection might be an important cause of abortion in bovids in Sri Lanka. However, there is also evidence of other causes for abortion, repeat breeding and retained placenta.

Missouri Ozark Forest Ecosystem Project: the experiment

Treesearch

Steven L. Sheriff

2002-01-01

Missouri Ozark Forest Ecosystem Project (MOFEP) is a unique experiment to learn about the impacts of management practices on a forest system. Three forest management practices (uneven-aged management, even-aged management, and no-harvest management) as practiced by the Missouri Department of Conservation were randomly assigned to nine forest management sites using a...

Probabilistic thinking and death anxiety: a terror management based study.

PubMed

Hayslip, Bert; Schuler, Eric R; Page, Kyle S; Carver, Kellye S

2014-01-01

Terror Management Theory has been utilized to understand how death can change behavioral outcomes and social dynamics. One area that is not well researched is why individuals willingly engage in risky behavior that could accelerate their mortality. One method of distancing a potential life threatening outcome when engaging in risky behaviors is through stacking probability in favor of the event not occurring, termed probabilistic thinking. The present study examines the creation and psychometric properties of the Probabilistic Thinking scale in a sample of young, middle aged, and older adults (n = 472). The scale demonstrated adequate internal consistency reliability for each of the four subscales, excellent overall internal consistency, and good construct validity regarding relationships with measures of death anxiety. Reliable age and gender effects in probabilistic thinking were also observed. The relationship of probabilistic thinking as part of a cultural buffer against death anxiety is discussed, as well as its implications for Terror Management research.

Age related issues in reperfusion of myocardial infarction.

PubMed

Carro, Amelia; Bastiaenen, Rachel; Kaski, Juan Carlos

2011-04-01

Advances in pharmacological treatment and effective early myocardial revascularization have led to improved clinical outcomes in patients with acute myocardial infarction (AMI). However, it has been suggested that compared to younger subjects, elderly AMI patients are less likely to receive evidence-based treatment. Several reasons have been postulated to explain this trend, including uncertainty regarding the benefits of the commonly used interventions in the older age group as well as increased risk associated with comorbidities. The diagnosis, management, and post-hospitalization care of elderly patients presenting with an acute coronary syndrome (ACS) pose many difficulties at present due, at least in part, to the fact that trial data are scanty as elderly patients have been poorly represented in most clinical trials. Thus it appears that these high-risk individuals are often managed with more conservative strategies, compared to younger patients. This article reviews current evidence regarding management of AMI in the elderly.

Effects of Market Prices and Silvicultural Practices on Lumber Value of Standing Trees In Uneven-Ages Plots

Treesearch

David W. Patterson

1998-01-01

Uneven-aged management plots were established using three variables (site index, basal area, and maximum diameter). This study looked at the significance of the variables on the lumber volume per acre, lumber value per thousand board feet (Mbf), and stand value per acre as well as the influence on these analysis by market prices (May 1997, May 1998, and October 1998)....

77 FR 16270 - Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-20

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0070] Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION: Draft..., ``Updated Aging Management Criteria for PWR Reactor Vessel Internal Components.'' This draft LR-ISG revises...

77 FR 23513 - Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0070] Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION: Draft...-ISG), LR-ISG-2011-04, ``Updated Aging Management Criteria for PWR Reactor Vessel Internal Components...

Negotiating 'positive' aging in the presence of age-related vision loss (ARVL): The shaping and perpetuation of disability.

PubMed

McGrath, Colleen; Laliberte Rudman, Debbie; Polgar, Jan; Spafford, Marlee M; Trentham, Barry

2016-12-01

While previous research has explored the meaning of positive aging discourses from the perspective of older adults, the perspective of older adults aging with a disability has not been studied. In fact the intersection of aging and disability has been largely underexplored in both social gerontology and disability studies. This critical ethnography engaged ten older adults aging with vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews. The overarching objective was to understand those attributes that older adults with age-related vision loss perceive as being the markers of a 'good old age.' The authors critically examined how these markers, and their disabling effects, are situated in ageist and disablist social assumptions regarding what it means to 'age well'. The participants' descriptions of the markers of a 'good old age' were organized into five main themes: 1) maintaining independence while negotiating help; 2) responding positively to vision loss; 3) remaining active while managing risk; 4) managing expectations to be compliant, complicit, and cooperative and; 5) striving to maintain efficiency. The study findings have provided helpful insights into how the ideas and assumptions that operate in relation to disability and impairment in late life are re-produced among older adults with age-related vision loss and how older adults take on an identity that is consistent with socially embedded norms regarding what it means to 'age well'. Copyright © 2016 Elsevier Inc. All rights reserved.

The Association of Increased Total Glycosylated Hemoglobin Levels with Delayed Age at Menarche in Young Women with Type 1 Diabetes

PubMed Central

Danielson, Kirstie K.; Palta, Mari; Allen, Catherine; D’Alessio, Donn J.

2005-01-01

Context: Delayed menarche is associated with subsequent reproductive and skeletal complications. Previous research has found delayed growth and pubertal maturation with type 1 diabetes and with poor glycemic control. The effect of diabetes management on menarche is important to clarify because tighter control might prevent these complications. Objective: To investigate age at menarche in young women with type 1 diabetes, and examine the effect of diabetes management (e.g. total glycosylated hemoglobin (GHb) level, number of blood glucose checks, insulin therapy intensity, insulin dose) on age at menarche in those diagnosed before menarche. Design: The Wisconsin Diabetes Registry Project is a follow-up study of a type 1 diabetes population-based incident cohort initially enrolled 1987 – 1992. Setting: Twenty-eight counties in south-central Wisconsin. Patients or Other Participants: Recruited through referrals, self-report, and hospital/clinic ascertainment. Individuals with newly diagnosed type 1 diabetes, <30 years old, were invited to participate. Of 288 young women enrolled, 188 reported menarche by 2002; 105 were diagnosed before menarche. Interventions: Not applicable. Main Outcome Measure: Age at menarche. Results: Mean age at menarche was 12.78 years, compared to 12.54 years in the United States (p = 0.01). Ages at menarche and diagnosis were not associated. For those diagnosed before menarche, age at menarche was delayed 1.3 months with each one percent increase in mean total GHb level in the three years prior to menarche. Conclusions: Age at menarche was moderately delayed in young women with type 1 diabetes. Delayed menarche could potentially be minimized with improved GHb levels. PMID:16204372

[Troyakov. Experience in using hytolysin in the integrated management of urinary tract infections and methapylactics of nephrolithiasis].

PubMed

Saenko, V S; Kapsargin, F P; Pesegov, S V; M, V

2017-07-01

Urinary tract infection (UTI) are a risk factor for diseases leading to impairment of renal function and kidney stone disease (KSD). Growing resistance of uropathogens to antibacterial agents is a challenging issue in most countries of the world. Urolithiasis is the second most prevalent urologic condition following urinary tract infections and has a pronounced tendency to recur. Rational stone metaphylaxis leads to a significant reduction in the incidence of recurrent stones. In recent decades, there has been a markedly increasing interest in plant-based therapies in managing urologic diseases. To evaluate the effectiveness of phytotherapeutic medication Phytolysin in the integrated management of UTI and metaphylaxis of urolithiasis. Comprehensive evaluation of the effectiveness of Phytolysin was conducted at the Department of Urology, I.M. Sechenov First MSMU and Department of Urology, Andrology and Sexology, Voino-Yasenetsky Krasnoyarsk SMU in 40 women with episodes of exacerbation of chronic cystitis and 30 patients of both sexes during the postoperative metaphylaxis of the KSD. The age of the patients ranged from 20 to 68 years (mean age 40+/-2,8 years). Adding Phytolysin to the integrated management results in the improvement in general clinical signs and laboratory parameters of blood and urine, leads to a decrease in the level of leukocyturia, bacteriuria and an increase in diuresis and urinary alkalinization, reduces the number relapses of UTI and stone formation. Phytolysin is an effective and safe medication.

34 CFR 271.20 - What conditions must an applicant meet to obtain funding?

Code of Federal Regulations, 2012 CFR

2012-07-01

... a plan of operation for the proposed project that includes: (1) An effective plan of management that..., gender, age or handicapping condition. (l) The project must have an adequate budget to support the...

34 CFR 271.20 - What conditions must an applicant meet to obtain funding?

Code of Federal Regulations, 2014 CFR

2014-07-01

... a plan of operation for the proposed project that includes: (1) An effective plan of management that..., gender, age or handicapping condition. (l) The project must have an adequate budget to support the...

34 CFR 271.20 - What conditions must an applicant meet to obtain funding?

Code of Federal Regulations, 2013 CFR

2013-07-01

... a plan of operation for the proposed project that includes: (1) An effective plan of management that..., gender, age or handicapping condition. (l) The project must have an adequate budget to support the...

Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: study protocol for a randomised controlled trial.

PubMed

Wiseman, Jodie; Simons, Megan; Kimble, Roy; Ware, Robert; McPhail, Steven; Tyack, Zephanie

2017-02-16

Abnormal scar development following burn injury can cause substantial physical and psychological distress to children and their families. Common burn scar prevention and management techniques include silicone therapy, pressure garment therapy, or a combination of both. Currently, no definitive, high-quality evidence is available for the effectiveness of topical silicone gel or pressure garment therapy for the prevention and management of burn scars in the paediatric population. Thus, this study aims to determine the effectiveness of these treatments in children. A randomised controlled trial will be conducted at a large tertiary metropolitan children's hospital in Australia. Participants will be randomised to one of three groups: Strataderm® topical silicone gel only, pressure garment therapy only, or combined Strataderm® topical silicone gel and pressure garment therapy. Participants will include 135 children (45 per group) up to 16 years of age who are referred for scar management for a new burn. Children up to 18 years of age will also be recruited following surgery for burn scar reconstruction. Primary outcomes are scar itch intensity and scar thickness. Secondary outcomes include scar characteristics (e.g. colour, pigmentation, pliability, pain), the patient's, caregiver's and therapist's overall opinion of the scar, health service costs, adherence, health-related quality of life, treatment satisfaction and adverse effects. Measures will be completed on up to two sites per person at baseline and 1 week post scar management commencement, 3 months and 6 months post burn, or post burn scar reconstruction. Data will be analysed using descriptive statistics and univariate and multivariate regression analyses. Results of this study will determine the effectiveness of three noninvasive scar interventions in children at risk of, and with, scarring post burn or post reconstruction. Australian New Zealand Clinical Trials Registry, ACTRN12616001100482 . Registered on 5 August 2016.

Groundwater Age in Multi-Level Water Quality Monitor Wells on California Central Valley Dairies

NASA Astrophysics Data System (ADS)

Esser, B. K.; Visser, A.; Hillegonds, D. J.; Singleton, M. J.; Moran, J. E.; Harter, T.

2011-12-01

Dairy farming in California's Central Valley is a significant source of nitrate to underlying aquifers. One approach to mitigation is to implement farm-scale management plans that reduce nutrient loading to groundwater while sustaining crop yield. While the effect of different management practices on crop yield is easily measured, their effect on groundwater quality has only infrequently been evaluated. Documenting and predicting the impact of management on water quality requires a quantitative assessment of transport (including timescale and mixing) through the vadose and saturated zones. In this study, we measured tritium, helium isotopic composition, and noble gas concentrations in groundwater drawn from monitor wells on several dairies in the Lower San Joaquin Valley and Tulare Lake Basin of California's Central Valley in order to predict the timescales on which changes in management may produce observable changes in groundwater quality. These dairies differ in age (from <10 to >100 years old), thickness of the vadose zone (from <10 to 60 m), hydrogeologic setting, and primary source of irrigation water (surface or groundwater). All of the dairies use manure wastewater for irrigation and fertilization. Three of the dairies have implemented management changes designed to reduce nutrient loading and/or water usage. Monitor wells in the southern Tulare Lake Basin dairies were installed by UC-Davis as multi-level nested wells allowing depth profiling of tritium and noble gases at these sites. Tritium/helium-3 groundwater ages, calculated using a simple piston-flow model, range from <2 to >50 years. Initial tritium (the sum of measured tritium and tritiogenic helium-3) is close to or slightly above precipitation in the calculated recharge year for young samples; and significantly above the precipitation curve for older samples. This pattern is consistent with the use of 20-30 year old groundwater recharged before 1980 for irrigation, and illustrates how irrigation with groundwater can complicate the use of tritium alone for age dating. The presence of radiogenic helium-4 in several samples with measurable tritium provides evidence of mixing between pre-modern and younger groundwater. Groundwater age-depth relationships are complicated, consistent with transient flow patterns in shallow agricultural groundwaters affected by irrigation pumping and recharge. For the multi-level installations in the southern dairies, both depth profiles and re-sampling after significant changes in groundwater elevation emphasize the need to sample groundwater within 3 meters of the water table to obtain "first-encounter" groundwater with a tritium/helium-3 age of less than 5 years, and to use age tracers to identify wells and groundwater conditions suitable for monitoring and assessment of best management practice impacts on underlying groundwater quality. This work was carried out with funding from Sustainable Conservation and the California State Water Resources Control Board in collaboration with UC-Davis, and was performed under the auspices of the U.S. DOE by LLNL under Contract DE-AC52-07NA27344.

Relative toxicity and residual activity of insecticides used in blueberry pest management: mortality of natural enemies.

PubMed

Roubos, Craig R; Rodriguez-Saona, Cesar; Holdcraft, Robert; Mason, Keith S; Isaacs, Rufus

2014-02-01

A series of bioassays were conducted to determine the relative toxicities and residual activities of insecticides labeled for use in blueberry (Vaccinium corymbosum L.) on natural enemies, to identify products with low toxicity or short duration effects on biological control agents. In total, 14 insecticides were evaluated using treated petri dishes and four commercially available natural enemies (Aphidius colemani Viereck, Orius insidiosus [Say], Chrysoperla rufilabris [Burmeister], and Hippodamia convergens [Guérin-Menéville]). Dishes were aged under greenhouse conditions for 0, 3, 7, or 14 d before introducing insects to test residual activity. Acute effects (combined mortality and knockdown) varied by insecticide, residue age, and natural enemy species. Broad-spectrum insecticides caused high mortality to all biocontrol agents, whereas products approved for use in organic agriculture had little effect. The reduced-risk insecticide acetamiprid consistently caused significant acute effects, even after aging for 14 d. Methoxyfenozide, novaluron, and chlorantraniliprole, which also are classified as reduced-risk insecticides, had low toxicity, and along with the organic products could be compatible with biological control. This study provides information to guide blueberry growers in their selection of insecticides. Further research will be needed to determine whether adoption of a pest management program based on the use of more selective insecticides will result in higher levels of biological control in blueberry.

Effectiveness of hypnosis as an adjunct to behavioral weight management.

PubMed

Bolocofsky, D N; Spinler, D; Coulthard-Morris, L

1985-01-01

This study examined the effect of adding hypnosis to a behavioral weight-management program on short- and long-term weight change. One hundred nine subjects, who ranged in age from 17 to 67, completed a behavioral treatment either with or without the addition of hypnosis. At the end of the 9-week program, both interventions resulted in significant weight reduction. However, at the 8-month and 2-year follow-ups, the hypnosis clients showed significant additional weight loss, while those in the behavioral treatment exhibited little further change. More of the subjects who used hypnosis also achieved and maintained their personal weight goals. The utility of employing hypnosis as an adjunct to a behavioral weight-management program is discussed.

White-tailed deer age ratios as herd management and predator impact measures in Pennsylvania

USGS Publications Warehouse

Rosenberry, Christopher S.; Norton, Andrew S.; Diefenbach, Duane R.; Fleegle, Jeannine T.; Wallingford, Bret D.

2011-01-01

A review of the Pennsylvania Game Commission's (PGC) deer management program and public concern about predator impacts on deer (Odocoileus virginianus) populations compelled the PGC to investigate the role of age ratios in developing management recommendations. Age ratios, such as proportion of juveniles in the antlerless harvest, may provide an index to population productivity and predator impacts. We estimated proportion of juveniles in the antlerless harvest from hunter-killed deer, population trends using the Pennsylvania (USA) sex–age–kill model, and reproduction from road-killed females. Using these estimates and a simulation model, we concluded that no single age-ratio value would serve as a reliable measure of population status. Wildlife Management Unit-specific trends in proportion of juveniles in the antlerless harvest and population trends provided the most relevant management information. We also provide an example decision chart to guide management actions in response to declining age ratios in the harvest. Although predator management activities and juvenile survival studies are often desired by the public, our decision-chart example indicated a number of deer management options exist before investing resources in predator management activities and juvenile survival studies.

Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration

PubMed Central

Hall, Andrew; Gelder, Carole; Friedl, Simone; Brennan, Eileen; Swallow, Veronica

2017-01-01

Background Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint—5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is “dry” and “boring,” could be “scary,” and was either hard to understand or not relevant to individuals’ circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a “normal” life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a “normal” life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. PMID:28676470

Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration.

PubMed

Nightingale, Ruth; Hall, Andrew; Gelder, Carole; Friedl, Simone; Brennan, Eileen; Swallow, Veronica

2017-07-04

Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint-5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is "dry" and "boring," could be "scary," and was either hard to understand or not relevant to individuals' circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a "normal" life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a "normal" life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. ©Ruth Nightingale, Andrew Hall, Carole Gelder, Simone Friedl, Eileen Brennan, Veronica Swallow. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.07.2017.

Understanding Cultural Issues in Diabetes Self-Management Behaviors of Korean Immigrants

PubMed Central

Cha, Eun Seok; Yang, Kyeongra; Lee, Jia; Min, Jiwon; Kim, Kevin H.; Dunbar, Sandra B.; Jennings, Bonnie Mowinski

2013-01-01

Purpose The purpose of this study was to explore potential factors affecting self-management behaviors in Korean immigrants with type 2 diabetes mellitus (KIT2Ds). Methods A qualitative descriptive design guided this study. Semi-structured interviews lasting 45-60 minutes were conducted with 20 KIT2Ds in the participant’s preferred language; in all cases this was Korean. Each interview was audio-taped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by three bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English speaking audience while staying true to the data and preserving the nuanced Korean meanings. Results The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the U. S. and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (a) issues on treatment regimen related to both medications and diet, (b) resources that helped or hindered their ability to manage diabetes, and (c) the physician/patient relationship. Conclusions There were important cultural nuances that need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors. PMID:23019236

Applying RE-AIM to the evaluation of FUEL Your Life : a worksite translation of DPP.

PubMed

Brace, Andrea M; Padilla, Heather M; DeJoy, David M; Wilson, Mark G; Vandenberg, Robert J; Davis, Marsha

2015-01-01

Weight management programs are becoming increasingly common in workplace settings; however, few target middle-aged men. The purpose of this article is to describe the process evaluation of a worksite translation of the Diabetes Prevention Program in a predominantly middle-aged male population. The translated program, FUEL Your Life, was largely self-directed, with support from peer health coaches and occupational health nurses. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to examine the factors that influenced program implementation using data from an environmental assessment, participant surveys, peer health coach surveys, and occupational health nurse interviews. An overwhelming majority of the employees who enrolled in the study were overweight or obese (92%). Overall, the program was effective for weight maintenance; those with higher levels of participation and engagement had better weight loss outcomes. The peer health coach and family elements of the intervention were underused. The program was successful in reaching the intended population; however, the program had limited success in engaging this population. Not surprisingly, weight loss was a function of participant engagement and participation. Increasing participant engagement and participation is important to the success of weight management interventions translated to the worksite setting. Garnering buy-in and support from management can serve to increase the perceived importance of weight management in worksites. With management support, weight management protocols could be integrated as a component of the mandatory safety and health assessments already in place, fostering promotion of healthy weight in the workforce. © 2014 Society for Public Health Education.

Nonarteritic anterior ischemic optic neuropathy: cause, effect, and management.

PubMed

Berry, Shauna; Lin, Weijie V; Sadaka, Ama; Lee, Andrew G

2017-01-01

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common form of ischemic optic neuropathy and the second most common optic neuropathy. Patients are generally over the age of 50 years with vasculopathic risk factors (eg, diabetes mellitus, hypertension, and obstructive sleep apnea). The exact mechanism of NAION is not fully understood. In addition, several treatment options have been proposed. This article summarizes the current literature on the diagnosis, treatment, and management of NAION.

Safety and efficacy of blood glucose management practices at a diabetes camp.

PubMed

Gunasekera, Hasantha; Ambler, Geoffrey

2006-10-01

Camps are an important part of diabetic management in children yet data on the safety and efficacy of camps are limited. We assessed the safety and efficacy of blood glucose management guidelines at summer camps for diabetic children. Consistent management guidelines were implemented during 10 consecutive diabetes camps held in the same facility between 1998 and 2002. Using the entire sample of campers aged 9-13 years, we analysed insulin dosage alterations, the frequency of hypoglycaemia (<4 mmol/L), hyperglycaemia (>15 mmol/L) and ketosis and evaluated our overnight management guidelines. The effects of sex, year, age, insulin regimen and duration of diagnosis on hypoglycaemia frequency were determined. Mean insulin doses decreased 19.2% (95% confidence interval 16.9-21.6%) by the last day of camp (day 6) relative to the day prior to camp. Mean blood glucose levels were 11.4 mmol/L before breakfast and the main evening meal, 11.3 mmol/L before bed, 10.8 mmol/L at midnight and 9.4 mmol/L at 3 am. Of the 10 839 readings analysed, 984 (9.1%) were below 4 mmol/L (0.5 per camper/day) with no clinical grade 3 (seizure or coma) hypoglycaemia. Hypoglycaemia frequency was independent of sex, year, age, insulin regimen and duration of diagnosis (all P > 0.05). There were 2570 (23.7%) readings above 15 mmol/L (1.4 per camper/day) but only 42 (0.4%) were associated with significant ketosis. Children at diabetes camps experience considerable blood glucose variability; however, the careful application of monitoring and management guidelines can avoid serious adverse events.

Focus groups for developing a peer mentoring program to improve self-management in pediatric inflammatory bowel disease.

PubMed

Mackner, Laura M; Ruff, Jessica M; Vannatta, Kathryn

2014-10-01

Inflammatory bowel disease (IBD) presents challenges for self-management in many areas. A peer mentoring program may offer advantages over other forms of self-management interventions because youth may be more receptive to learning self-management skills from a peer than from a parent or professional. The purpose of the present study was to identify themes from focus groups to inform development of a peer mentoring program for improving self-management in pediatric IBD. Focus groups were conducted for youth ages 12 to 17, stratified by age (3 groups; n = 14), young adults ages 18 to 20 (1 group; n = 5), and parents of the youth (3 groups; n = 17). Broad questions covered program goals, general program characteristics, mentor/mentee characteristics, and family involvement, and transcriptions were analyzed via directed content analysis, with the a priori codes specified as the broad questions above. Participants identified the primary goals of a program as support, role model, information/education, and fun. They described a program that would include a year-long, 1-on-1 mentor relationship with a peer who has had IBD for at least a year, educational group activities, fun activities that are not focused on IBD, expectations for in-person contact 1 to 2 times per month, and mentor-to-mentor and parent support. Many of the suggestions from the focus groups correspond with research findings associated with successful mentoring programs. Using participants' suggestions and empirically based best practices for mentoring may result in an effective peer mentoring program for improving self-management in youth with IBD.

Effects of timber harvests on invertebrate biomass and avian nest success

Treesearch

Jeffrey P. Duguay; Petra Bohall Wood; Gary W. Miller

2000-01-01

Concerns over declining songbird populations have led to investigations of effects of various timber management practices on breeding songbirds. We assessed the influence of 2 types of practices, two-age and clearcutting, on invertebrate biomass and avian daily nest survival in the Monongahela National Forest of West Virginia during summers of 1995 and 1996. We also...

Effectiveness of forest management strategies to mitigate effects of global change in south-central Siberia

Treesearch

Eric J. Gustafson; Anatoly Z. Shvidenko; Robert M. Scheller

2011-01-01

We investigated questions about the ability of broad silvicultural strategies to achieve multiple objectives (reduce disturbance losses, maintain the abundance of preferred species, mitigate fragmentation and loss of age-class diversity, and sequester aboveground carbon) under future climate conditions in Siberia. We conducted a factorial experiment using the LANDIS-II...

Delivering Effective Blended Learning: Managing the Dichotomy of Humility and Hubris in Executive Education

ERIC Educational Resources Information Center

Lockhart, James; McKee, Dorothy; Donnelly, Debbie

2017-01-01

The dichotomy of humility and hubris among participants in Executive Education courses presents faculty with a source of heterogeneity not disclosed through the common descriptive statistics of sex, age, education and employment. This article discusses the impact of this dichotomy on the design and delivery of effective executive education. In…

Spatial ecology of timber rattlesnakes on the hardwood ecosystem experiment: pre-treatment results

Treesearch

Brian J. MacGowan; Zachary J. Walker

2013-01-01

The timber rattlesnake (Crotalus horridus) is a species of conservation concern throughout much of its geographic range and may serve as a sentinel species in investigations of the effects of timber harvesting on forest reptiles. Our objective was to determine the effect of even-aged timber management regimes on timber rattlesnake home range and...

Adapting to the effects of climate change [Chapter 14

Treesearch

Jessica E. Halofsky

2018-01-01

Adapting to climate change, or adjusting to current or future climate and its effects (Noble et al. 2014), is critical to minimizing the risks associated with climate change impacts. Adaptation actions can vary from passive (e.g., a "wait and see" approach), to relatively simple (e.g., increasing harvest rotation age), to complex (e.g., managing forest...

Conservative fluid management prevents age-associated ventilator induced mortality.

PubMed

Herbert, Joseph A; Valentine, Michael S; Saravanan, Nivi; Schneck, Matthew B; Pidaparti, Ramana; Fowler, Alpha A; Reynolds, Angela M; Heise, Rebecca L

2016-08-01

Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hospital mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. 2month old and 20month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4h with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. At 4h, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1h in advanced age HVT subjects. In 4h ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in older subjects. Our study demonstrates that conservative fluid alone can attenuate the age associated increase in ventilator associated mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Age Management and Sustainable Careers for the Improvement of the Quality of Ageing at Work.

PubMed

Marcaletti, Francesco

2014-01-01

Prolonging working careers by increasing the statutory age for retirement has become compulsory in most Western societies in order to tackle the shrinking of the labour force, preserve economic productivity, foster knowledge transfer and reduce the risks of financial imbalances in social security systems. This imperative currently results in working careers that already exceed 40 years and come to an end after the age of 65 (e.g. in Italy). Over the next few decades, both career length and retirement age are expected to rise. Thus, creating more inclusive workplaces by increasing their quality is the precondition of a win-win situation for both employers and employees, regardless of age. A request for support in the development of sustainable careers from both private and public labour organisations has led to innovating the mainstream methodologies and research tools in the field of age management. Based on the key elements of the mainstream "work ability concept" - i.e. health, competencies, motivation and work organisation - the Quality of Ageing at Work questionnaire (QAW-q), developed by a team from the WWELL Research Centre, broadens its perspective by surveying elements bridging intra-organisational dimensions and which affect employees' conditions and external socio-institutional constraints: i.e. work-life balance, economic stability, professional identity and relationships in the workplace. The QAW-q is designed to analyse the influence of the different meanings of age (chronological age, seniority within the company and in the labour market) and correlate them with the different dimensions at individual and organisational levels; all these dimensions are weighted by the effect exerted by the passage of time. The results of the QAW-q survey, taken by employees of both private and public companies, serve as a basis for the implementation of measures addressing all the relevant dimensions of the human resource management cycle.

Conservative Fluid Management Prevents Age-Associated Ventilator Induced Mortality

PubMed Central

Herbert, Joseph A.; Valentine, Michael S.; Saravanan, Nivi; Schneck, Matthew B.; Pidaparti, Ramana; Fowler, Alpha A.; Reynolds, Angela M.; Heise, Rebecca L.

2017-01-01

Background Approximately 800 thousand patients require mechanical ventilation in the United States annually with an in-hospital mortality rate of over 30%. The majority of patients requiring mechanical ventilation are over the age of 65 and advanced age is known to increase the severity of ventilator-induced lung injury (VILI) and in-hosptial mortality rates. However, the mechanisms which predispose aging ventilator patients to increased mortality rates are not fully understood. Ventilation with conservative fluid management decreases mortality rates in acute respiratory distress patients, but to date there has been no investigation of the effect of conservative fluid management on VILI and ventilator associated mortality rates. We hypothesized that age-associated increases in susceptibility and incidence of pulmonary edema strongly promote age-related increases in ventilator associated mortality. Methods 2 month old and 20 month old male C57BL6 mice were mechanically ventilated with either high tidal volume (HVT) or low tidal volume (LVT) for up to 4 hours with either liberal or conservative fluid support. During ventilation, lung compliance, total lung capacity, and hysteresis curves were quantified. Following ventilation, bronchoalveolar lavage fluid was analyzed for total protein content and inflammatory cell infiltration. Wet to dry ratios were used to directly measure edema in excised lungs. Lung histology was performed to quantify alveolar barrier damage/destruction. Age matched non-ventilated mice were used as controls. Results At 4hrs, both advanced age and HVT ventilation significantly increased markers of inflammation and injury, degraded pulmonary mechanics, and decreased survival rates. Conservative fluid support significantly diminished pulmonary edema and improved pulmonary mechanics by 1hr in advanced age HVT subjects. In 4hr ventilations, conservative fluid support significantly diminished pulmonary edema, improved lung mechanics, and resulted in significantly lower mortality rates in older subjects. Conclusion Our study demonstrates that conservative fluid alone can attenuate the age associated increase in ventilator associated mortality. PMID:27188767

Lizard activity and abundance greater in burned habitat of a xeric montane forest

USGS Publications Warehouse

Fouts, Kevin L.; Moore, Clinton; Johnson, Kristine D.; Maerz, John C.

2017-01-01

Restoring the natural or historical state of ecosystems is a common objective among resource managers, but determining whether desired system responses to management actions are occurring is often protracted and challenging. For wildlife, the integration of mechanistic habitat modeling with population monitoring may provide expedited measures of management effectiveness and improve understanding of how management actions succeed or fail to recover populations. Southern Appalachia is a region of high biodiversity that has undergone dramatic change as a result of human activities such as historic logging, exotic invasions, and alteration of disturbance regimes—including reduction in application of fire. Contemporary efforts to restore fire-maintained ecosystems within southern Appalachian forests require tools to assess the effects of fire management practices on individual animal fitness and relate them to corresponding influences on species abundance. Using automated sensing equipment, we investigated the effects of burned forests on reptile habitat suitability within the western portion of Great Smoky Mountains National Park, Tennessee. Specifically, we used microclimate measurements to model northern fence lizard Sceloporus undulatus hyacinthinus diurnal activity budgets in unburned and variable burn age (3–27-y) forest stands. We estimated northern fence lizard occurrence and abundance along transects through burned and unburned forests. Burned forest stands had microclimates that resulted in longer modeled daily activity periods under most conditions during summer. S. undulatus abundance was 4.75 times greater on burned stands compared to paired unburned stands, although the relationship between burn age and abundance was not well determined. Results suggest the more open habitat structure of burned areas within these xeric pine–oak forests may benefit S. undulatus.

Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group

PubMed Central

Rowe, Heather

2016-01-01

Background As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. Objective To identify public opinion about sexual and reproductive health in Australia. Methods To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. Results There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Conclusions Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health. PMID:26878865

Effectiveness of Simulation-Based Education on Childhood Fever Management by Taiwanese Parents.

PubMed

Chang, Li-Chuan; Lee, Ping-Ing; Guo, Nai-Wen; Huang, Mei-Chih

2016-12-01

Childhood fever is a common symptom managed by parents at home. Most parents do not know the definition of fever, its effect, or its management. To establish simulation-based education for parents and evaluate its effectiveness for fever management at home are essential for nursing care. This study assesses the long-term effects of simulation-based education on information, motivation, behavioral skills, and behaviors related to parental fever management in Taiwan. Cluster random sampling was used to recruit parents having children aged from 3 months to 5 years who were attending kindergartens in Kaohsiung, Taiwan. A total of 160 parents were randomly assigned into experimental (EP) and control (CP) groups equally. Parents in the EP group received simulation-based education with fever education brochures, while the CP group received only the brochure. Data on parental fever information, motivation, behavioral skills, and management behaviors were collected before the 1 st day, on the 1 st day (except management behaviors), at the 6-month, and at the 12-month marks post-training with a self-developed instrument based on the information-motivation-behavioral skills model. The results of a generalized estimating equation analysis indicated that the information, motivation, behavioral skills, and management behaviors of all participants had improved at the post-test assessment, with the EP group showing significantly better improvement than the CP group. This study supports that simulation-based education effectively enhances fever management of parents for a long period of time. Simulation-based education, compared to using the brochure, was a better strategy for improving parental information, motivation, behavioral skills, and behaviors regarding fever management. We suggest that providing community-based education on fever with scenario simulation is needed to increase parental competence for child care. Copyright © 2016. Published by Elsevier B.V.

Applying organization science to assess the management performance of Marine Protected Areas: An exploratory study.

PubMed

Scianna, Claudia; Niccolini, Federico; Bianchi, Carlo Nike; Guidetti, Paolo

2018-06-18

Marine Protected Areas (MPAs) are important tools to achieve marine conservation and resources management goals. The management effectiveness of MPAs (the degree to which MPAs achieve their goals) is highly variable and can be affected by many MPA attributes, for example their design, enforcement and age. Another key factor possibly affecting MPA management effectiveness is the management performance, here conceived according to Horigue et al. definition (2014) as the "level of effort exerted to enhance and sustain management of MPAs". Organization Science (OS), the discipline that studies organizations, can offer a useful framework to assess and interpret MPA management performance. Using an exploratory multiple case study approach, we applied OS principles to 11 Mediterranean MPAs in order to: i) characterize several MPA organizational features; ii) assess MPA management performance (evaluated as the effort deployed in, for example, planning the future, formalizing measurable goals, and implementing specific strategies). Results show that a number of organizational features and networking attributes are highly variable among the MPAs we have studied. For instance, goals are seldom measurable and the strategy to achieve goals is not systematically pursued. Two relevant outcomes emerge from this exploratory study: i) the management performance of the MPAs considered needs considerable improvements; ii) the methods and the approach proposed could help MPAs' managers and policy makers to understand how to improve their management performance and, consequently, their effectiveness. Copyright © 2018. Published by Elsevier Ltd.

Age at asthma onset and asthma self-management education among adults in the United States.

PubMed

Mirabelli, Maria C; Beavers, Suzanne F; Shepler, Samantha H; Chatterjee, Arjun B

2015-01-01

Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.

Management effectiveness evaluation in protected areas of southern Ecuador.

PubMed

López-Rodríguez, Fausto; Rosado, Daniel

2017-04-01

Protected areas are home to biodiversity, habitats and ecosystem as well as a critical component of human well-being and a generator of leisure-related revenues. However, management is sometimes unsatisfactory and requires new ways of evaluation. Management effectiveness of 36 protected areas in southern Ecuador have been assessed. The protected areas belong to three categories: Heritage of Natural Areas of the Ecuadorian State (PANE), created and funded by the State, Areas of Forest and Protective Vegetation (ABVP), created but no funded by the State, and private reserves, declared and funded by private entities. Management effectiveness was evaluated by answers of managers of the protected areas to questionnaires adapted to the socio-economic and environmental characteristics of the region. Questions were classified into six elements of evaluation: context, planning, inputs, processes, outputs and outcomes as recommended by IUCN. Results were classified into four levels: unsatisfactory, slightly satisfactory, satisfactory and very satisfactory. The PANE areas and private reserves showed higher management effectiveness levels (satisfactory and very satisfactory) than ABVP areas, where slightly satisfactory and unsatisfactory levels prevailed. Resources availability was found as the main reason behind this difference. The extension, age and province of location were found irrelevant. Outputs, inputs and processes require main efforts to improve management effectiveness. Improving planning and input in the PANE areas and inputs and outcomes on ABVP areas is necessary to obtain a similar result in all areas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Experimental stocking of sport fish in the regulated Tallapoosa River to determine critical periods for recruitment

USGS Publications Warehouse

Lloyd, M. Clint; Lai, Quan; Sammons, Steve; Irwin, Elise R.

2017-01-01

The stocking of fish in riverine systems to re-establish stocks for conservation and management appears limited to a few species and often occurs in reaches impacted by impoundments. Stocking of sport fish species such as centrarchids and ictalurids is often restricted to lentic environments, although stocking in lotic environments is feasible with variable success. R. L. Harris Dam on the Tallapoosa River, Alabama is the newest and uppermost dam facility on the river (operating since 1983); flows from the dam have been managed adaptively for multiple stakeholder objectives since 2005. One of the stakeholders’ primary objectives is to provide quality sport fisheries in the Tallapoosa River in the managed area below the dam. Historically, ictalurids and cyprinids dominated the river above Lake Martin. However, investigations after Harris Dam closed have detected a shift in community structure to domination by centrarchids. Flow management (termed the Green Plan) has been occurring since March 2005; however, sport fish populations as measured by recruitment of age-1 sport fishes below the dam has not responded adequately to flow management. The objectives of this research were to: (1) determine if stocking Channel Catfish Ictalurus punctatus and Redbreast Sunfish Lepomis auritus influences year-class strength; (2) estimate vital rates (i.e. growth, mortality, and recruitment) for Channel Catfish populations for use in an age-based population model; and (3) identify age-specific survivorship and fecundity rates contributing to Channel Catfish population stability. No marked Redbreast Sunfish were recaptured due to poor marking efficacy and therefore no further analysis was conducted with this species. Stocked Channel Catfish, similarly, were not recaptured, leaving reasons for non-recapture unknown. Matrix models exploring vital rates illustrated survival to age-1 for Channel Catfish to be less than 0.03% and that survival through ages 2 – 4 had equal contribution to overall population growth, indicating recruitment limitation may impact population size and stability. Results from this study indicate stock enhancement of sport fish populations below Harris Dam may not be an effective management technique at this time.

Follow-up of women with cervical cytological abnormalities showing atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion: a nationwide cohort study.

PubMed

Sundström, Karin; Lu, Donghao; Elfström, K Miriam; Wang, Jiangrong; Andrae, Bengt; Dillner, Joakim; Sparén, Pär

2017-01-01

Atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in abnormal cervical cytology among young women in cervical cancer screening is an increasing health burden, and comparative effectiveness studies of different management options for such diagnoses are needed. The objective of the study was to compare the incidence of invasive cervical cancer, following different management options pursued after an atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion index smear. In this nationwide cohort study, we included all women aged 22-50 years and resident in Sweden 1989-2011 and with at least 1 cervical smear registered during the study period (n = 2,466,671). Follow-up of a first atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion cytological diagnosis within 25 months was classified as repeat cytology, colposcopy/biopsy, or without further assessment. Incidence rate ratios and 95% confidence intervals of subsequent cervical cancer within 6.5 years following atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion were estimated using Poisson regression by age group and management strategy. Women managed with repeat cytology within 6 months after atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion cytology had a similar risk of cervical cancer compared with colposcopy/biopsy (incidence rate ratio, 1.1, 95% confidence interval, 0.5-2.5, and incidence rate ratio, 2.0, 95% confidence interval, 0.6-6.5, respectively) among women aged 22-27 years. For women aged 28 years and older, women managed with repeat cytology had a higher risk for cervical cancer than women managed with colposcopy/biopsy. Our findings suggest that women with a first cytological diagnosis of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion up to age 27 years may indeed be safely followed up with repeat cytology within 6 months. A large amount of colposcopies that are currently performed in this group, therefore, could safely be discontinued. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Suitability of asthma education materials for school-age children: Implications for health literacy.

PubMed

Tzeng, Yu-Fen; Gau, Bih-Shya

2018-03-01

To investigate the suitability of asthma education materials for school-age children with asthma and elucidate how these children used their health-literacy abilities to identify whether the materials can be accepted, comprehended and applied. Effective asthma self-management education is influenced by the suitability of materials and an individual's health literacy. A mixed-method research design was developed using quantitative and qualitative surveys. The suitability of the materials was assessed on the basis of the Chinese version of the Suitability Assessment of Materials by five experts. In addition, five school-age children (age: 8-12 years) were recruited and interviewed. In total, 25 pieces of asthma education material for children were collected. On the basis of their type, the materials were categorised as nine brochures, 11 leaflets and five videos. Of the 25 materials, 17 were rated as superior materials, whereas eight were rated as adequate materials. The suitability scores of the video-based materials were significantly higher than those of the brochures and leaflets (p = .006). One print material was considered to have a reading level suitable for fifth-grade or younger children, whereas the remaining materials were considered suitable for sixth-grade or older children. The following six health-literacy domains were identified: recognising asthma through body knowledge, posing reflective questions, identifying self-care difficulties, receiving adult guidance, learning with enjoyment and addressing learning requirements. The video-based materials had integrated content and were appealing to children. Cartoon animations, interactive computer games, and skill demonstrations may enhance learning stimulation and motivation and increase learning effects in children. The present results may help healthcare providers to understand children's capacities to manage their disease, effectively address children's requirements and function as a key resource for children to strengthen their literacy in asthma management. © 2017 John Wiley & Sons Ltd.

Peripheral Nerve Blocks for the Treatment of Headache in Older Adults: A Retrospective Study.

PubMed

Hascalovici, Jacob R; Robbins, Matthew S

2017-01-01

The objective of this study is to provide demographical and clinical descriptions of patients age 65 years old and older who were treated with peripheral nerve blocks (PNBs) at our institution and evaluate the safety and efficacy of this treatment. Headache disorders are common, disabling chronic neurological diseases that often persist with advancing age. Geriatric headache management poses unique therapeutic challenges because of considerations of comorbidity, drug interactions, and adverse effects. Peripheral nerve blocks are commonly used for acute and short-term prophylactic treatment for headache disorders and may be a safer alternative to standard pharmacotherapy in this demographic. We performed a single center, retrospective chart review of patients at least 65 years of age who received peripheral nerve blocks for headache management over a 6 year period. Sixty-four patients were mostly female (78%) with an average age of 71 years (range 65-94). Representative headache diagnoses were chronic migraine 50%, episodic migraine 12.5%, trigeminal autonomic cephalalgia 9.4%, and occipital neuralgia 7.8%. Average number of headache days/month was 23. Common comorbidities were hypertension 48%, hyperlipidemia 42%, arthritis 27%, depression 47%, and anxiety 33%. Eighty-nine percent were prescribed at least 1 medication fulfilling the Beers criteria. The average number of peripheral nerve blocks per patient was 4. Peripheral nerve blocks were felt to be effective in 73% for all headaches, 81% for chronic migraine, 75% for episodic migraine, 67% for chronic tension type headache, 67% for new daily persistent headache, and 60% for occipital neuralgia. There were no adverse events related to PNBs reported. PNBs might be a safe and effective alternative headache management strategy for older adults. Medical and psychiatric comorbidities, medication overuse, and Beers list medication rates were extraordinarily high, giving credence to the use of peripherally administered therapies in the geriatric population that may be better tolerated and safer. © 2016 American Headache Society.

Ageing Mechanisms and Control. Specialists’ Meeting on Life Management Techniques for Ageing Air Vehicles (Les mecanismes vieillissants et le controle) (Reunions des specialistes des techniques de gestion du cycle de vie pour vehicules aeriens vieillissants)

DTIC Science & Technology

2003-02-01

Beam Weld Repair and Qualification of Titanium Fan Blades for Military Gas Turbine Engines”, NATO-RTO-AVT Workshop on Cost Effective Applications of...announced in the Meeting Announcement Research of Extension of the Life Cycle of Helicopter Rotor Blade in Hungary 39 by M. Balaskó, G. Endröczi, J...and Power Systems MP-069(I), February 2003 Low Cost Composite Structures / Cost Effective Application of Titanium Alloys in Military Platforms MP-069

Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia

PubMed Central

Vasava, Yogesh R.; Bhuyan, Chaturbhuja; Rajagopala, Manjusha; Gupta, S. K.; Dudhamal, T. S.

2010-01-01

Vatastheela is a disease of Mutravahasrotasa, one among the 12 types of Mutraghata disorders elaborated by Sushruta in his seminal work, the Sushruta Samhita. Vatastheela, as described in Ayurveda, closely resembles benign prostatic hyperplasia (BPH) of modern medicine in its signs and symptoms. It is a senile disorder and chiefly affects individuals above the age of 40 years. The symptoms are those of bladder outflow obstruction, with increased frequency of micturition, dribbling, hesitancy, and the features of chronic urinary retention. Surgical management has been accepted as the standard management but is associated with many disadvantages as well as complications, which may not be acceptable at this age. Conservative management with modern medicines is also not free from side effects. So, in this age-group, there is a need for much safer alternative method of management. In this regard, many works have been carried out and shown that the Ayurvedic approach, using natural medicines, is a far better approach. We carried out a comparative study of Mahayavanala Roma Kshara (MRK) and Dhanyaka Gokshura Ghrita (DGG), which are the compounds prescribed for Mutraghata in Ayurvedic literature. The patients were randomly selected from the OPD and IPD of IPGT and RA hospital, Jamnagar, Gujarat, and divided into two groups. In first group, one (500 mg) capsule of MRK was given twice a day with lukewarm water for 45 days; in second group, 10 gm of DGG was given orally twice a day with lukewarm water for 45 days. DGG showed significantly greater relief in the subjective parameters as per International Prostate Symptoms Score (IPSS) than MRK. However, reduction in the size of the prostate and in the volume of the post-void residual urine was found much better in the MRK group. PMID:22131735

Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia.

PubMed

Vasava, Yogesh R; Bhuyan, Chaturbhuja; Rajagopala, Manjusha; Gupta, S K; Dudhamal, T S

2010-07-01

Vatastheela is a disease of Mutravahasrotasa, one among the 12 types of Mutraghata disorders elaborated by Sushruta in his seminal work, the Sushruta Samhita. Vatastheela, as described in Ayurveda, closely resembles benign prostatic hyperplasia (BPH) of modern medicine in its signs and symptoms. It is a senile disorder and chiefly affects individuals above the age of 40 years. The symptoms are those of bladder outflow obstruction, with increased frequency of micturition, dribbling, hesitancy, and the features of chronic urinary retention. Surgical management has been accepted as the standard management but is associated with many disadvantages as well as complications, which may not be acceptable at this age. Conservative management with modern medicines is also not free from side effects. So, in this age-group, there is a need for much safer alternative method of management. In this regard, many works have been carried out and shown that the Ayurvedic approach, using natural medicines, is a far better approach. We carried out a comparative study of Mahayavanala Roma Kshara (MRK) and Dhanyaka Gokshura Ghrita (DGG), which are the compounds prescribed for Mutraghata in Ayurvedic literature. The patients were randomly selected from the OPD and IPD of IPGT and RA hospital, Jamnagar, Gujarat, and divided into two groups. In first group, one (500 mg) capsule of MRK was given twice a day with lukewarm water for 45 days; in second group, 10 gm of DGG was given orally twice a day with lukewarm water for 45 days. DGG showed significantly greater relief in the subjective parameters as per International Prostate Symptoms Score (IPSS) than MRK. However, reduction in the size of the prostate and in the volume of the post-void residual urine was found much better in the MRK group.

Cutaneous infectious diseases: Kids are not just little people.

PubMed

Admani, Shehla; Jinna, Sphoorthi; Friedlander, Sheila Fallon; Sloan, Brett

2015-01-01

The changes in immune response that occur with age play a significant role in disease presentation and patient management. Evolution of the innate and adaptive immune systems throughout life, influenced partly by hormonal changes associated with puberty, plays a role in the differences between pediatric and adult response to disease. We review a series of manifestations of dermatologic infectious diseases spanning bacterial, viral, and fungal origins that can be seen in both pediatric and adult age groups and highlight similarities and differences in presentation and disease course. Therapeutic options are also discussed for these infectious diseases, with particular attention to variations in management between these population subgroups, given differences in pharmacokinetics and side effect profiles. Published by Elsevier Inc.

Predictors of media multitasking in Chinese adolescents.

PubMed

Yang, Xiaohui; Zhu, Liqi

2016-12-01

We examined predictors of media multitasking in Chinese adolescents from 3 contexts: characteristics of the media user, types of media use and family media contexts. Three hundred and twenty adolescents, 11-18 years of age, completed questionnaires to measure media use, impulsivity, sensation seeking, time management disposition and family media environment. The results showed that media multitasking was positively correlated with age and total media use time. Participants with high levels of impulsivity and sensation seeking reported more multitasking behaviour. Multitasking was negatively correlated with time management. Children from media-oriented families often engage in more multitasking. What's more, social networking sites use and music use can mediate the effect of individual and family factors on media multitasking. © 2015 International Union of Psychological Science.

The role of marine reserves in achieving sustainable fisheries

PubMed Central

Roberts, Callum M.; Hawkins, Julie P.; Gell, Fiona R.

2005-01-01

Many fishery management tools currently in use have conservation value. They are designed to maintain stocks of commercially important species above target levels. However, their limitations are evident from continuing declines in fish stocks throughout the world. We make the case that to reverse fishery declines, safeguard marine life and sustain ecosystem processes, extensive marine reserves that are off limits to fishing must become part of the management strategy. Marine reserves should be incorporated into modern fishery management because they can achieve many things that conventional tools cannot. Only complete and permanent protection from fishing can protect the most sensitive habitats and vulnerable species. Only reserves will allow the development of natural, extended age structures of target species, maintain their genetic variability and prevent deleterious evolutionary change from the effects of fishing. Species with natural age structures will sustain higher rates of reproduction and will be more resilient to environmental variability. Higher stock levels maintained by reserves will provide insurance against management failure, including risk-prone quota setting, provided the broader conservation role of reserves is firmly established and legislatively protected. Fishery management measures outside protected areas are necessary to complement the protection offered by marine reserves, but cannot substitute for it. PMID:15713592

Trends in ischemic heart disease mortality in Korea, 1985-2009: an age-period-cohort analysis.

PubMed

Lee, Hye Ah; Park, Hyesook

2012-09-01

Economic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future. We analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time. All three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women. The future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.

Multimodal evaluation and management of children with concussion: using our heads and available evidence.

PubMed

Gioia, Gerard A

2015-01-01

Significant attention has been focused on concussions in children, but a dearth of research evidence exists supporting clinical evaluation and management. The primary objective of this review paper is to describe a multimodal, developmentally adapted, standardized concussion assessment and active rehabilitation approach for children as young as 5 years old. This study reviews the CDC-funded research programme, including the development of tools for post-concussion symptom assessment involving the child and parent, measurement of specific neurocognitive functions and assessment of dynamic cognitive exertional effects. A clinical approach to active, individualized, moderated concussion rehabilitation management is presented, including a 10-step guide to symptom management, with a specific focus on the school challenges faced by the recovering student. To better inform concussion practice across the developmental age spectrum, a significant need exists for further research evidence to refine clinical assessment methods and develop effective treatment approaches.

Tourette syndrome in children and adolescents: special considerations.

PubMed

Eapen, Valsamma; Crncec, Rudi

2009-12-01

Tourette syndrome (TS) affects people of all ages, with onset in early childhood and continuing through the different stages of the life cycle into adolescence and adults. This review focuses on barriers to diagnosis and challenges in the management of young patients with TS. Barriers to identification occur at multiple levels, including detection in the community setting (including schools), parents' help-seeking behavior, and cultural influences on such behavior, as well as diagnosis by the medical provider. Challenges to management include unfamiliarity of primary care providers, inconsistencies in the diagnosis and management plan, and failure to recognize comorbid conditions, as well as inadequate knowledge and lack of resources to effectively deal with comorbidities. In addition to the complexities posed by pharmacological interactions, there are unique psychosocial challenges experienced by young people with TS and their families. Effective communication and collaboration between families, health care providers, and school personnel, as well as supportive communities, are essential components of comprehensive management.

Expectant management of veterans with early-stage prostate cancer.

PubMed

Filson, Christopher P; Shelton, Jeremy B; Tan, Hung-Jui; Kwan, Lorna; Skolarus, Ted A; Saigal, Christopher S; Litwin, Mark S

2016-02-15

For certain men with low-risk prostate cancer, aggressive treatment results in marginal survival benefits while exposing them to urinary and sexual side effects. Nevertheless, expectant management has been underused. In the current study, the authors evaluated the association between various factors and expectant management use among veterans diagnosed with prostate cancer. The authors identified men diagnosed with prostate cancer in 2008. The outcome of interest was use of expectant management, based on documentation captured through an in-depth chart review. Multivariable regression models were fit to examine associations between use of expectant management and patient demographics, cancer severity, and facility characteristics. The authors assessed variation across 21 tertiary care regions and 52 facilities by generating predicted probabilities for receipt of expectant management. Expectant management was more common among patients aged ≥75 years (40% vs 27% for those aged < 55 years; odds ratio, 2.57) and those with low-risk tumors (49% vs 20% for patients with high-risk tumors; odds ratio, 5.35). There was no association noted between patient comorbidity and receipt of expectant management (P = .90). There were also no associations found between facility factors and use of expectant management (all P>.05). Among ideal candidates for expectant management, receipt of expectant management varied considerably across individual facilities (0%-85%; P<.001). Patient age and tumor risk were found to be more strongly associated with use of expectant management than patient comorbidity. Although use of expectant management appears broadly appropriate, there was variation in expectant management noted between hospitals that was apparently not attributable to facility factors. Research determining the basis of this variation, with a focus on providers, will be critical to help optimize prostate cancer treatment for veterans. © 2015 American Cancer Society.

Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial.

PubMed

McSweeney, Kate; Jeffreys, Aimee; Griffith, Joanne; Plakiotis, Chris; Kharsas, Renee; O'Connor, Daniel W

2012-11-01

This cluster randomized controlled trial sought to determine whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia. Three hundred and eighty nine aged care residents were screened for dementia and major depression. Forty four were ultimately included in the intervention sample, selected from 20 aged care facilities located in Melbourne, Australia. Facilities were randomly allocated to an intervention condition involving the provision of multidisciplinary specialist consultation regarding the best-practice management of depression in dementia, or to a care as usual condition. Consultations involved individually tailored medical and psychosocial recommendations provided to care staff and general practitioners. All residents participated in a comprehensive pre-intervention diagnostic assessment, including the administration of the Cornell Scale for Depression in Dementia. This assessment was repeated approximately 15 weeks post-intervention by a rater blind to study condition. Multidisciplinary specialist mental health consultation was significantly more effective than care as usual in treating the clinical depression of aged care residents with dementia (p < 0.05, partial η(2)  = 0.16). At follow-up, the mean Cornell Scale for Depression in Dementia score for the intervention group was 9.47, compared with 14.23 for the control group. In addition, 77% of the intervention group no longer met criteria for major depression. The results of this study suggest that the psychosocial and medical management of depressed aged care residents can be improved by increasing access to specialist mental health consultation. Copyright © 2012 John Wiley & Sons, Ltd.

The effects of household management practices on the global warming potential of urban lawns.

PubMed

Gu, Chuanhui; Crane, John; Hornberger, George; Carrico, Amanda

2015-03-15

Nitrous oxide (N2O) emissions are an important component of the greenhouse gas (GHG) budget for urban turfgrasses. A biogeochemical model DNDC successfully captured the magnitudes and patterns of N2O emissions observed at an urban turfgrass system at the Richland Creek Watershed in Nashville, TN. The model was then used to study the long-term (i.e. 75 years) impacts of lawn management practice (LMP) on soil organic carbon sequestration rate (dSOC), soil N2O emissions, and net Global Warming Potentials (net GWPs). The model simulated N2O emissions and net GWP from the three management intensity levels over 75 years ranged from 0.75 to 3.57 kg N ha(-1)yr(-1) and 697 to 2443 kg CO2-eq ha(-1)yr(-1), respectively, which suggested that turfgrasses act as a net carbon emitter. Reduction of fertilization is most effective to mitigate the global warming potentials of turfgrasses. Compared to the baseline scenario, halving fertilization rate and clipping recycle as an alternative to synthetic fertilizer can reduce net GWPs by 17% and 12%, respectively. In addition, reducing irrigation and mowing are also effective in lowering net GWPs. The minimum-maintenance LMP without irrigation and fertilization can reduce annual N2O emissions and net GWPs by approximately 53% and 70%, respectively, with the price of gradual depletion of soil organic carbon, when compared to the intensive-maintenance LMP. A lawn age-dependent best management practice is recommended: a high dose fertilizer input at the initial stage of lawn establishment to enhance SOC sequestration, followed by decreasing fertilization rate when the lawn ages to minimize N2O emissions. A minimum-maintained LMP with clipping recycling, and minimum irrigation and mowing, is recommended to mitigate global warming effects from urban turfgrass systems. Among all practices, clipping recycle may be a relatively malleable behavior and, therefore, a good target for interventions seeking to reduce the environmental impacts of lawn management through public education. Our results suggest that a long-term or a chronosequence study of turfgrasses with varying ages is warranted to capture the complete dynamics of contribution of turfgrasses to global warming. Copyright © 2015 Elsevier Ltd. All rights reserved.

Parental Experiences of Raising a Child With Medium Chain Acyl-CoA Dehydrogenase Deficiency.

PubMed

Piercy, Hilary; Machaczek, Katarzyna; Ali, Parveen; Yap, Sufin

2017-01-01

Newborn screening enabling early diagnosis of medium chain acyl-CoA dehydrogenase deficiency (MCADD) has dramatically improved health outcomes in children with MCADD. Achieving those outcomes depends on effective management by parents. Understanding parental management strategies and associated anxieties and concerns is needed to inform provision of appropriate care and support. Semistructured interviews were conducted with a purposive sample of parents of children aged 2 to 12 years. Thematic analysis identified two main themes. Managing dietary intake examined how parents managed day-to-day dietary intake to ensure adequate intake and protection of safe fasting intervals. Managing and preventing illness events explored parental experiences of managing illness events and their approach to preventing these events. Management strategies were characterized by caution and vigilance and influenced by a lack of confidence in others to manage the condition. The study identifies the need for increased awareness of the condition, particularly in relation to emergency treatment.

Effect of management practices and animal age on incidence of mastitis in Nili Ravi buffaloes.

PubMed

Ali, Tariq; Rahman, Abdur; Qureshi, Muhammand Subhan; Hussain, Muhammad Tariq; Khan, Muhammad Shauib; Uddin, Siraj; Iqbal, Muhammad; Han, Bo

2014-10-01

Buffalo is an economically important dairy animal in South Asia but mostly ignored in research priorities. In this retrospective study, the effect of management practices and age of animal on the incidence of mastitis in Nili Ravi buffaloes was investigated. A total of 1,560 quarters of buffaloes (n = 390) were screened by visual examination of the udder and milk (clinical mastitis) and California mastitis test (subclinical mastitis). Household data was collected on a predesigned questionnaire and analyzed. The prevalence of subclinical mastitis, clinical mastitis, and blind quarters was 41.8, 13.6, and 9.7 %, respectively. The highest prevalence was noted in the hind quarters and left side as compared to that in the forequarters and right side. This data significantly (p < 0.05) supported the idea that larger herd size has more chances of mastitis, with the highest prevalence (40, 32, and 27 %) in the large, medium, and small herds, respectively. Stage of lactation was significantly (p < 0.01) involved in mastitis, and the highest incidence (43.3 %) was noted in early lactation. Milk production of lactating buffaloes that ranged 6-10 l/day showed a higher rate of mastitis occurrence (p < 0.05). The cleanliness condition of a farm also contributed significantly. Animal age significantly affected the incidence of mastitis. Results revealed that age of the animal has a positive correlation (R (2) = 0.772) with mastitis. This study concluded that some factors alone or in combination with other factors influence significantly the occurrence of mastitis, and to minimize the infection, these factors should be considered. The outcome of the study will be valuable for policy-making for positive management practices and implementation of preventive measures.

Cardiovascular disease and type 1 diabetes: prevalence, prediction and management in an ageing population

PubMed Central

Lee, Siang Ing; Patel, Mitesh; Jones, Christopher M.; Narendran, Parth

2015-01-01

Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1D). However, evidence of its risks and management is often extrapolated from studies in type 2 diabetic (T2D) patients or the general population. This approach is unsatisfactory given that the underlying pathology, demographics and natural history of the disease differ between T1D and T2D. Furthermore, with a rising life expectancy, a greater number of T1D patients are exposed to the cardiovascular (CV) risk factors associated with an ageing population. The aim of this review is to examine the existing literature around CVD in T1D. We pay particular attention to CVD prevalence, how well we manage risk, potential biomarkers, and whether the studies included the older aged patients (defined as aged over 65). We also discuss approaches to the management of CV risk in the older aged. The available data suggest a significant CVD burden in patients with T1D and poor management of CV risk factors. This is underpinned by a poor evidence base for therapeutic management of CV risk specifically for patients with T1D, and in the most relevant population – the older aged patients. We would suggest that important areas remain to be addressed, particularly exploring the risks and benefits of therapeutic approaches to CVD management in the older aged. PMID:26568811

Barriers to Optimal Pain Management in Aged Care Facilities: An Australian Qualitative Study.

PubMed

Veal, Felicity; Williams, Mackenzie; Bereznicki, Luke; Cummings, Elizabeth; Thompson, Angus; Peterson, Gregory; Winzenberg, Tania

2018-04-01

Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. The purpose of this study was to characterize pain management in ACFs and identify the barriers to optimal pain management. This exploratory descriptive qualitative study used semistructured interviews in five Southern Tasmania, Australian ACFs. Interviewees included 23 staff members (18 nurses and 5 facility managers) and were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed; however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents' quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents' resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents' pain effectively; however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents' progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident's management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents. Copyright © 2017. Published by Elsevier Inc.

Self-management in chronic conditions: partners in health scale instrument validation.

PubMed

Peñarrieta-de Córdova, Isabel; Barrios, Flores Florabel; Gutierrez-Gomes, Tranquilina; Piñonez-Martinez, Ma del Socorro; Quintero-Valle, Luz Maria; Castañeda-Hidalgo, Hortensia

2014-03-01

This article describes a study that aimed to validate the Self-care in Chronic Conditions Partners in Health Scale instrument in the Mexican population. The instrument has been validated in Australia for use as a screening tool by primary healthcare professionals to assess the self-care skills and abilities of people with a chronic illness. Validation was conducted using baseline data for 552 people with diabetes, hypertension and cancer aged 18 or older who were users of healthcare centres in Tampico, Tamaulipas, Mexico. Results show high reliability and validity of the instrument and three themes were identified: knowledge, adherence, and dealing with and managing side effects. The findings suggest the scale is useful as a generic self-rated clinical tool for assessing self-management in a range of chronic conditions, and provides an outcome measure for comparing populations and change in patient self-management knowledge and behaviour. The authors recommend validating the scale in other Latin-American settings with more research into the effect of gender on self- management.

78 FR 33120 - Final Interim Staff Guidance LR-ISG-2011-04; Updated Aging Management Criteria for Reactor Vessel...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-03

..., ``Generic Aging Lessons Learned Report'' (GALL Report), for the aging management of Pressurized Water... communicate insights and lessons learned and to address emergent issues not covered in license renewal... ensure that PWR license renewal applicants will adequately address age-related degradation and aging...

The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Special considerations in epilepsy: comorbidities, women of childbearing age, and elderly patients.

PubMed

Mauri Llerda, J A; Suller Marti, A; de la Peña Mayor, P; Martínez Ferri, M; Poza Aldea, J J; Gomez Alonso, J; Mercadé Cerdá, J M

2015-10-01

The characteristics of some population groups (patients with comorbidities, women of childbearing age, the elderly) may limit epilepsy management. Antiepileptic treatment in these patients may require adjustments. We searched articles in Pubmed, clinical practice guidelines for epilepsy, and recommendations by the most relevant medical societies regarding epilepsy in special situations (patients with comorbidities, women of childbearing age, the elderly). Evidence and recommendations are classified according to the prognostic criteria of Oxford Centre of Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic interventions. Epilepsy treatment in special cases of comorbidities must be selected properly to improve efficacy with the fewest side effects. Adjusting antiepileptic medication and/or hormone therapy is necessary for proper seizure management in catamenial epilepsy. Exposure to antiepileptic drugs (AED) during pregnancy increases the risk of birth defects and may affect fetal growth and/or cognitive development. Postpartum breastfeeding is recommended, with monitoring for adverse effects if sedative AEDs are used. Finally, the elderly are prone to epilepsy, and diagnostic and treatment characteristics in this group differ from those of other age groups. Although therapeutic limitations may be more frequent in older patients due to comorbidities, they usually respond better to lower doses of AEDs than do other age groups. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Aged care managers' perceptions of staff preparedness for caring for older survivors of genocide and mass trauma in Australia: How prepared are aged care workers?

PubMed

Teshuva, Karen; Wells, Yvonne

2017-03-01

To investigate aged care managers' perceptions of staff preparedness for working with older people who experienced genocide or mass trauma earlier in their lives (referred to in this paper as 'older survivors'). A survey of 60 aged care service managers was conducted (50% response rate). Trauma knowledge and skills scales with Cronbach's alpha scores of 0.74 and 0.90 respectively, were used. Scores across groups were compared using Student's t-tests. Three-quarters of the respondents reported that their agency had provided aged care services for older survivors. The majority of these managers perceived their staff to be moderately informed about trauma-related issues and half rated staff trauma-related skills positively. These ratings were positively associated with trauma-related staff training, service type and service location. Results suggest that, overall, managers perceive a need to improve aged care staff's preparedness for providing care for older survivors. © 2016 AJA Inc.

Population viability analysis of Lower Missouri River shovelnose sturgeon with initial application to the pallid sturgeon

USGS Publications Warehouse

Bajer, P.G.; Wildhaber, M.L.

2007-01-01

Demographic models for the shovelnose (Scaphirhynchus platorynchus) and pallid (S. albus) sturgeons in the Lower Missouri River were developed to conduct sensitivity analyses for both populations. Potential effects of increased fishing mortality on the shovelnose sturgeon were also evaluated. Populations of shovelnose and pallid sturgeon were most sensitive to age-0 mortality rates as well as mortality rates of juveniles and young adults. Overall, fecundity was a less sensitive parameter. However, increased fecundity effectively balanced higher mortality among sensitive age classes in both populations. Management that increases population-level fecundity and improves survival of age-0, juveniles, and young adults should most effectively benefit both populations. Evaluation of reproductive values indicated that populations of pallid sturgeon dominated by ages ≥35 could rapidly lose their potential for growth, particularly if recruitment remains low. Under the initial parameter values portraying current conditions the population of shovelnose sturgeon was predicted to decline by 1.65% annually, causing the commercial yield to also decline. Modeling indicated that the commercial yield could increase substantially if exploitation of females in ages ≤12 was highly restricted.

Determinants of activation for self-management in patients with COPD.

PubMed

Korpershoek, Yjg; Bos-Touwen, I D; de Man-van Ginkel, J M; Lammers, J-Wj; Schuurmans, M J; Trappenburg, Jca

2016-01-01

COPD self-management is a complex behavior influenced by many factors. Despite scientific evidence that better disease outcomes can be achieved by enhancing self-management, many COPD patients do not respond to self-management interventions. To move toward more effective self-management interventions, knowledge of characteristics associated with activation for self-management is needed. The purpose of this study was to identify key patient and disease characteristics of activation for self-management. An explorative cross-sectional study was conducted in primary and secondary care in patients with COPD. Data were collected through questionnaires and chart reviews. The main outcome was activation for self-management, measured with the 13-item Patient Activation Measure (PAM). Independent variables were sociodemographic variables, self-reported health status, depression, anxiety, illness perception, social support, disease severity, and comorbidities. A total of 290 participants (age: 67.2±10.3; forced expiratory volume in 1 second predicted: 63.6±19.2) were eligible for analysis. While poor activation for self-management (PAM-1) was observed in 23% of the participants, only 15% was activated for self-management (PAM-4). Multiple linear regression analysis revealed six explanatory determinants of activation for self-management (P<0.2): anxiety (β: -0.35; -0.6 to -0.1), illness perception (β: -0.2; -0.3 to -0.1), body mass index (BMI) (β: -0.4; -0.7 to -0.2), age (β: -0.1; -0.3 to -0.01), Global Initiative for Chronic Obstructive Lung Disease stage (2 vs 1 β: -3.2; -5.8 to -0.5; 3 vs 1 β: -3.4; -7.1 to 0.3), and comorbidities (β: 0.8; -0.2 to 1.8), explaining 17% of the variance. This study showed that only a minority of COPD patients is activated for self-management. Although only a limited part of the variance could be explained, anxiety, illness perception, BMI, age, disease severity, and comorbidities were identified as key determinants of activation for self-management. This knowledge enables health care professionals to identify patients at risk of inadequate self-management, which is essential to move toward targeting and tailoring of self-management interventions. Future studies are needed to understand the complex causal mechanisms toward change in self-management.

A Longitudinal Study of Consumer Socialization.

ERIC Educational Resources Information Center

Moschis, George P.; Moore, Roy L.

A study examined the effects of factors (including television, family, peers, age, and socioeconomic status) on consumer socialization, the process by which individuals develop consumption-related cognitions and behaviors. The specific criterion variables studied included consumer affairs knowledge, puffery filtering, consumer finance management,…

Body-Mind-Spirit Practice for Healthy Aging

ERIC Educational Resources Information Center

Lee, Eun-Kyoung Othelia; Yoon, Hyunsook; Lee, Jungui; Yoon, Jiyoung; Chang, Eunjin

2012-01-01

This community-based, health promotion intervention for seniors provided a comprehensive review of the effect of body-mind-spirit (BMS) interventions on health behaviors. The 12-week curriculum offered sessions on exercise, nutrition, sexuality, leisure, stress management, cognitive behavioral therapy, forgiveness, and happiness. Gerontological…

Pressure vessel fracture, fatigue, and life management: PVP-Volume 233

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

Bhandari, S.; Milella, P.P.; Pennell, W.E.

1992-01-01

This volume contains papers relating to the structural integrity assessment of pressure vessels and piping, with special emphasis on the effects of aging. The papers are organized in the following five areas: (1) pressure vessel life management; (2) fracture characterization using local and dual-parameter approaches; (3) stratification and thermal fatigue; (4) creep, fatigue, and fracture; and (5) integrated approach to integrity assessment of pressure components. Separate abstracts were prepared for 39 papers in this conference.

Male Rat Germ Cells Display Age-Dependent and Cell-Specific Susceptibility in Response to Oxidative Stress Challenges1

PubMed Central

Selvaratnam, Johanna; Paul, Catriona; Robaire, Bernard

2015-01-01

For decades male germ cells were considered unaffected by aging, due to the fact that males continue to generate sperm into old age; however, evidence indicates that germ cells from aged males are of lower quality than those of young males. The current study examines the effects of aging on pachytene spermatocytes and round spermatids, and is the first study to culture these cells in isolation for an extended period. Our objective is to determine the cell-specific responses germ cells have to aging and oxidative insult. Culturing isolated germ cells from young and aged Brown Norway rats revealed that germ cells from aged males displayed an earlier decline in viability, elevated levels of reactive oxygen species (ROS), and increased spermatocyte DNA damage, compared to young males. Furthermore, oxidative insult by prooxidant 3-morpholinosydnonimine provides insight into how spermatocytes and spermatids manage excess ROS. Genome-wide microarray analyses revealed that several transcripts for antioxidants, Sod1, Cat, and Prdxs, were up-regulated in response to ROS in germ cells from young males while being expressed at lower levels in the aged. In contrast, the expression of DNA damage repair genes Rad50 and Atm were increased in the germ cells from aged animals. Our data indicate that as germ cells undergo spermatogenesis, they adapt and respond to oxidative stress differently, depending on their phase of development, and the process of aging results in redox dysfunction. Thus, even at early stages of spermatogenesis, germ cells from aged males are unable to mount an appropriate response to manage oxidative stress. PMID:26224006

Online training in sports concussion for youth sports coaches.

PubMed

Glang, Ann; Koester, Michael C; Beaver, Sherry Vondy; Clay, Janet E; McLaughlin, Karen A

2010-03-01

The purpose of this study was to evaluate ACTive: Athletic Concussion Training using Interactive Video Education, an interactive e-learning program designed to train community coaches of youth ages 10-18 in effective sports concussion prevention and management practices. Seventy-five youth sports coaches from across the country completed the study over the Internet. Results of a randomized control trial demonstrated significant differences between treatment and control participants on measures of (a) knowledge about sports concussion, management, and prevention; (b) attitudes about the importance of preventing sports concussion; and (c) intention and self-efficacy in sports concussion management and prevention. The results suggest that ACTive is an effective method of training youth sports coaches who are in an important position to reduce risks associated with sports concussion.

Outreach pharmacy service in old age homes: a Hong Kong experience.

PubMed

Lau, Wai-Man; Chan, Kit; Yung, Tsz-Ho; Lee, Anna See-Wing

2003-06-01

To explore drug-related problems in old age homes in Hong Kong through outreach pharmacy service. A standard form was used by outreach pharmacists to identify drug-related problems at old age homes. Homes were selected through random sampling, voluntary participation or adverse selection. Initial observation and assessment were performed in the first and second weeks. Appropriate advice and recommendations were given upon assessment and supplemented by a written report. Educational talks were provided to staff of the homes in addition to other drug information materials. At week 7 to 9, evaluations were carried out. Eighty-five homes were assessed and identified to have problems in the drug management system. These problems could generally be classified into physical storage (8.8%), quality of storage (19.2%), drug administration system (13.3%), documentation (16.4%), and drug knowledge of staff of homes (42.2%). Quality of drug storage was the most common problem found, followed by documentation and drug knowledge (73%, 50% and 44% of points assessed with problems, respectively). Apart from lack of drug knowledge and unawareness of potential risks by staff, minimal professional standards unmet may be fundamentally related to lack of professional input and inadequacy in legislation. Most homes demonstrated significant improvements upon simple interventions, from a majority of homes with more than 10 problems to a majority with less than 5 problems. Diverse problems in drug management are common in old age homes, which warrants attention and professional inputs. Simple interventions and education by pharmacists are shown to be effective in improving the quality of drug management and hence care to residents. While future financing of old age home service can be reviewed within the social context to provide incentives for improvement, review of regulatory policy with enforcement may be more fundamental and effective in upholding the service standard.

A Pine Is a Pine and a Spruce Is a Spruce--The Effect of Tree Species and Stand Age on Epiphytic Lichen Communities.

PubMed

Bäcklund, Sofia; Jönsson, Mari; Strengbom, Joachim; Frisch, Andreas; Thor, Göran

2016-01-01

With an increasing demand for forest-based products, there is a growing interest in introducing fast-growing non-native tree species in forest management. Such introductions often have unknown consequences for native forest biodiversity. In this study, we examine epiphytic lichen species richness and species composition on the trunks of non-native Pinus contorta and compare these to the native Pinus sylvestris and Picea abies in managed boreal forests in northern Sweden across a chronosequence of age classes. Overall, we recorded a total of 66,209 lichen occurrences belonging to 57 species in the 96 studied forest stands. We found no difference in species richness of lichens between stands of P. contorta and P. sylvestris, but stands of P. abies had higher total species richness. However, species richness of lichens in stands of P. abies decreased with increasing stand age, while no such age effect was detected for P. contorta and P. sylvestris. Lichen species composition progressively diverged with increasing stand age, and in 30-year-old stands all three tree species showed species-specific assemblages. Epiphytic lichen assemblages in stands of 30-year-old P. contorta were influenced by greater basal area, canopy closure, and average diameter at breast height, P. abies stands by higher branch density and canopy closure, and stands of P. sylvestris by greater bark crevice depth. Differences in lichen species richness and composition were mainly explained by canopy closure and habitat availability, and the greater canopy closure in mature P. abies stands promoted the colonization and growth of calicioid lichen species. Our results indicate that the non-native P. contorta have similar species richness as the native P. sylvestris. The main difference in lichen species richness and composition is between P. abies and Pinus spp. in managed forests of boreal Sweden.

A Pine Is a Pine and a Spruce Is a Spruce – The Effect of Tree Species and Stand Age on Epiphytic Lichen Communities

PubMed Central

Bäcklund, Sofia; Jönsson, Mari; Strengbom, Joachim; Frisch, Andreas; Thor, Göran

2016-01-01

With an increasing demand for forest-based products, there is a growing interest in introducing fast-growing non-native tree species in forest management. Such introductions often have unknown consequences for native forest biodiversity. In this study, we examine epiphytic lichen species richness and species composition on the trunks of non-native Pinus contorta and compare these to the native Pinus sylvestris and Picea abies in managed boreal forests in northern Sweden across a chronosequence of age classes. Overall, we recorded a total of 66,209 lichen occurrences belonging to 57 species in the 96 studied forest stands. We found no difference in species richness of lichens between stands of P. contorta and P. sylvestris, but stands of P. abies had higher total species richness. However, species richness of lichens in stands of P. abies decreased with increasing stand age, while no such age effect was detected for P. contorta and P. sylvestris. Lichen species composition progressively diverged with increasing stand age, and in 30-year-old stands all three tree species showed species-specific assemblages. Epiphytic lichen assemblages in stands of 30-year-old P. contorta were influenced by greater basal area, canopy closure, and average diameter at breast height, P. abies stands by higher branch density and canopy closure, and stands of P. sylvestris by greater bark crevice depth. Differences in lichen species richness and composition were mainly explained by canopy closure and habitat availability, and the greater canopy closure in mature P. abies stands promoted the colonization and growth of calicioid lichen species. Our results indicate that the non-native P. contorta have similar species richness as the native P. sylvestris. The main difference in lichen species richness and composition is between P. abies and Pinus spp. in managed forests of boreal Sweden. PMID:26799558

Current nutritional recommendations and novel dietary strategies to manage sarcopenia

PubMed Central

Calvani, Riccardo; Miccheli, Alfredo; Landi, Francesco; Bossola, Maurizio; Cesari, Matteo; Leeuwenburgh, Christiaan; Sieber, Cornel C.; Bernabei, Roberto; Marzetti, Emanuele

2015-01-01

Sarcopenia, the loss of skeletal muscle mass and function that occurs with aging, is associated with increased risk for several adverse health outcomes, including frailty, disability, falls, loss of independent living, and mortality. At present, no pharmacological treatment exists that is able to definitely halt the progression of sarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related muscle wasting. In this scenario, the combination of nutritional interventions and physical exercise appears to be the most effective strategy presently available for the management of sarcopenia. The purposes of this review are to summarize the current knowledge on the role of nutrition as a countermeasure for sarcopenia, illustrate the mechanisms of action of relevant dietary agents on the aging muscle, and introduce novel nutritional strategies that may help preserve muscle mass and function into old age. Issues related to the identification of the optimal timing of nutritional interventions in the context of primary and secondary prevention are also discussed. Finally, the prospect of elaborating personalized dietary and physical exercise recommendations through the implementation of integrated, high-throughput analytic approaches is illustrated. PMID:26082911

Impacts Of Long-Term Prescribed Fire On Decomposition And Litter Quality In Uneven-Aged Loblolly Pine Stands

Treesearch

Michele L. Renschin; Hal O. Liechty; Michael G. Shelton

2002-01-01

Abstract - Although fire has long been an important forest management tool in the southern United States, little is known concerning the effects of long-term fire use on nutrient cycling and decomposition. To better understand the effects of fire on these processes, decomposition rates, and foliage litter quality were quantified in a study...

Effect of one low thinning on cove and slope hardwoods in the New Jersey highlands

Treesearch

H. B. Tepper; G. T. Bamford

1959-01-01

The exact value of thinning in managing hardwoods is not yet known. Further study of the many factors that affect thinning results is needed. These factors include methods and intensities of thinning, ages at which thinnings are started or repeated, effects of species composition in mixed stands, and influence of site index on response to thinning.

Effect of initial planting spacing on wood properties of unthinned loblolly pine at age 21

Treesearch

Alexander III Clark; Lewis Jordan; Laurie Schimleck; Richard F. Daniels

2008-01-01

Young, fast growing, intensively managed plantation loblolly pine (Pinus taeda L.) contains a large proportion of juvenile wood that may not have the stiffness required to meet the design requirements for southern pine dimension lumber. An unthinned loblolly pine spacing study was sampled to determine the effect of initial spacing on wood stiffness,...

Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study, Valore Project.

PubMed

Buja, Alessandra; Gini, Rosa; Visca, Modesta; Damiani, Gianfranco; Federico, Bruno; Francesconi, Paolo; Donato, Daniele; Marini, Alessandro; Donatini, Andrea; Brugaletta, Salvatore; Baldo, Vincenzo; Bellentani, Mariadonata

2013-05-24

For chronic conditions, disparities can take effect cumulatively at various times as the disease progresses, even when care is provided. The aim of this study was to quantify the prevalence of diabetes, congestive heart failure (CHF) and coronary heart disease (CHD) in adults by citizenship, and to compare the performance of primary care services in managing these chronic conditions, again by citizenship. This is a population-based retrospective cohort study on 1,948,622 people aged 16 years or more residing in Italy. A multilevel regression model was applied to analyze adherence to care processes using explanatory variables at both patient and district level. The age-adjusted prevalence of diabetes was found higher among immigrants from high migratory pressure countries (HMPC) than among Italians, while the age-adjusted prevalence of CHD and CHF was higher for Italians than for HMPC immigrants or those from highly-developed countries (HDC). Our results indicate lower levels in all quality management indicators for citizens from HMPC than for Italians, for all the chronic conditions considered. Patients from HDC did not differ from Italian in their adherence to disease management schemes. This study revealed a different prevalence of chronic diseases by citizenship, implying a different burden of primary care by citizenship. Our findings show that more effort is needed to guarantee migrant-sensitive primary health care.

Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie.

PubMed

Fauchier, Laurent; Alonso, Christine; Anselme, Frederic; Blangy, Hugues; Bordachar, Pierre; Boveda, Serge; Clementy, Nicolas; Defaye, Pascal; Deharo, Jean-Claude; Friocourt, Patrick; Gras, Daniel; Halimi, Franck; Klug, Didier; Mansourati, Jacques; Obadia, Benjamin; Pasquié, Jean-Luc; Pavin, Dominique; Sadoul, Nicolas; Taieb, Jerome; Piot, Olivier; Hanon, Olivier

2016-10-01

Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5-7years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

PubMed

Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

2010-03-01

Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p < 0.001), with most improvement observed in symptoms and emotions. It was concluded that implementation of a 12-week asthma disease management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

Effect of immunological castration management strategy on lipid oxidation and sensory characteristics of bacon stored under simulated food service conditions.

PubMed

Herrick, R T; Tavárez, M A; Harsh, B N; Mellencamp, M A; Boler, D D; Dilger, A C

2016-07-01

The objectives of this study were to determine the effect of 1) immunological castration (Improvest, a gonadotropin releasing factor analog-diphtheria toxoid conjugate) management strategy (age at slaughter and time of slaughter after second dose) and 2) sex on lipid oxidation and sensory characteristics of bacon stored under simulated food service conditions. For Objective 1, immunological castration management strategies included 24-wk-old immunologically castrated (IC) barrows 4, 6, 8, or 10 wk after the second Improvest dose (ASD); 26-wk-old IC barrows 6 wk ASD; and 28-wk-old IC barrows 8 wk ASD ( = 63). Objective 2 ( = 97) included IC barrows, physically castrated (PC) barrows, and gilts slaughtered at 24, 26, and 28 wks of age. Bellies from 2 slaughter dates were manufactured into bacon under commercial conditions. Bacon slices were laid out on parchment paper, packaged in oxygen-permeable poly-vinyl-lined boxes, and frozen (-33°C) for 1, 4, 8, or 12 wk to simulate food service conditions. At the end of each storage period, bacon was evaluated for lipid oxidation, moisture and lipid content, and sensory characteristics. Data from both objectives were analyzed using the MIXED procedure in SAS with belly as the experimental unit. For both objectives, as storage time increased, lipid oxidation of bacon increased ( < 0.01), regardless of management strategy or sex. Also, there was no sex or management strategy × week of frozen storage interaction for any traits evaluated ( ≥ 0.25). For Objective 1, lipid content of bacon from IC barrows increased as time of slaughter ASD increased ( < 0.05), regardless of age at slaughter. Additionally, there were no differences in sensory attributes of bacon across management strategies. For the evaluation of sex effects in Objective 2, lipid oxidation was greater ( < 0.05) in IC barrows compared with PC barrows but was not different than gilts ( > 0.05). After 12 wk of frozen storage, lipid oxidation values for IC barrows, PC barrows, and gilts were still below 0.5 mg malondialdehyde/kg of meat, the threshold at which trained panelists may deem a food to be rancid. In conclusion, bacon shelf life characteristics were not altered by the immunological castration management strategy and bacon from IC barrows was similar to bacon from gilts. Therefore, bacon from IC barrows would result in shelf life and sensory quality similar to PC barrows and gilts.

Haloperidol, risperidone, olanzapine and aripiprazole in the management of delirium: A comparison of efficacy, safety, and side effects.

PubMed

Boettger, Soenke; Jenewein, Josef; Breitbart, William

2015-08-01

The aim of this study was to compare the efficacy and side-effect profile of the typical antipsychotic haloperidol with that of the atypical antipsychotics risperidone, olanzapine, and aripiprazole in the management of delirium. The Memorial Delirium Assessment Scale (MDAS), the Karnofsky Performance Status (KPS) scale, and a side-effect rating were recorded at baseline (T1), after 2-3 days (T2), and after 4-7 days (T3). Some 21 cases were case-matched by age, preexisting dementia, and baseline MDAS scores, and subsequently analyzed. The baseline characteristics of the medication groups were not different: The mean age of the patients ranged from 64.0 to 69.6 years, dementia was present in between 23.8 and 28.6%, and baseline MDAS scores were 19.9 (haloperidol), 18.6 (risperidone), 19.4 (olanzapine), and 18.0 (aripiprazole). The doses of medication at T3 were 5.5 mg haloperidol, 1.3 mg risperidone, 7.1 mg olanzapine, and 18.3 mg aripiprazole. Over one week, the decline in MDAS scores between medications was equal, and no differences between individual MDAS scores existed at T2 or T3. After one week, the MDAS scores were 6.8 (haloperidol), 7.1 (risperidone), 11.7 (olanzapine), and 8.3 (aripiprazole). At T2, delirium resolution occurred in 42.9-52.4% of cases and at T3 in 61.9-85.7%; no differences in assessments between medications existed. Recorded side effects were extrapyramidal symptoms (EPSs) in haloperidol- and risperidone-managed patients (19 and 4.8%, respectively) and sedation with olanzapine (28.6%). Haloperidol, risperidone, aripiprazole, and olanzapine were equally effective in the management of delirium; however, they differed in terms of their side-effect profile. Extrapyramidal symptoms were most frequently recorded with haloperidol, and sedation occurred most frequently with olanzapine.

Patient Preferences for Pain Management in Advanced Cancer: Results from a Discrete Choice Experiment.

PubMed

Meads, David M; O'Dwyer, John L; Hulme, Claire T; Chintakayala, Phani; Vinall-Collier, Karen; Bennett, Michael I

2017-10-01

Pain from advanced cancer remains prevalent, severe and often under-treated. The aim of this study was to conduct a discrete choice experiment with patients to understand their preferences for pain management services and inform service development. Focus groups were used to develop the attributes and levels of the discrete choice experiment. The attributes were: waiting time, type of healthcare professional, out-of-pocket costs, side-effect control, quality of communication, quality of information and pain control. Patients completed the discrete choice experiment along with clinical and health-related quality of life questions. Conditional and mixed logit models were used to analyse the data. Patients with cancer pain (n = 221) and within palliative care services completed the survey (45% were female, mean age 64.6 years; age range 21-92 years). The most important aspects of pain management were: good pain control, zero out-of-pocket costs and good side-effect control. Poor or moderate pain control and £30 costs drew the highest negative preferences. Respondents preferred control of side effects and provision of better information and communication, over access to certain healthcare professionals. Those with lower health-related quality of life were less willing to wait for treatment and willing to incur higher costs. The presence of a carer influenced preferences. Outcome attributes were more important than process attributes but the latter were still valued. Thus, supporting self-management, for example by providing better information on pain may be a worthwhile endeavour. However, service provision may need to account for individual characteristics given the heterogeneity in preferences.

Stress management and dietary counseling in hypertensive patients: a pilot study of additional effect.

PubMed

Katsarou, Alexia L; Vryonis, Marios M; Protogerou, Athanassios D; Alexopoulos, Evangelos C; Achimastos, Apostolos; Papadogiannis, Dimitrios; Chrousos, George P; Darviri, Christina

2014-01-01

In Western societies, cardiovascular (CV) disease is the primary cause of mortality, and high blood pressure (BP) is the main reversible factor leading to CV disease. Dietary habits and psychosocial stress contribute to the establishment of hypertension, while its role in the control of high BP is currently examined. In this study, we examined the effect and feasibility of a combined intervention of dietary education and stress management on the control of hypertension. A randomized, controlled pilot study was designed to evaluate the effect of combined education on stress management techniques and dietary habits (Mediterranean diet principle) on office BP after eight weeks. Of the 45 randomized subjects, 36 were included in the final analysis (control group = 20 (age: 67 ± 12 years, 31.8%, males) and intervention group = 16 (age: 62 ± 12 years, 47%, males)). CV disease risk factors (except smoking), BP, dietary habits, perceived stress and physical activity (all assessed with validated questionnaires) were similar between the two groups at baseline. After eight weeks, office BP (systolic and diastolic) and perceived stress were significantly reduced, whereas the adherence in Mediterranean diet principle was significantly increased, but only in the intervention group. A combined intervention of stress management techniques and Mediterranean diet education seems to be beneficial for BP reduction. Such interventions could possibly serve as a complementary treatment along with drug therapy or in the early treatment of high normal BP. A call to action for designing epidemiological studies and evaluating the efficacy of such non-pharmacological treatment strategies is therefore warranted.

Evaluation of time management behaviors and its related factors in the senior nurse managers, Kermanshah-Iran.

PubMed

Ziapour, Arash; Khatony, Alireza; Jafari, Faranak; Kianipour, Neda

2015-01-21

Time management is an extensive concept that is associated with promoting the performance of managers. The present study was carried out to investigate the time management behaviors along with its related factors among senior nurse mangers. In this descriptive-analytical study, 180 senior nurse managers were selected using census method. The instrument for data collection was a standard time behavior questionnaire. Data were analyzed by descriptive and analytical statistics. The findings showed that among the dimensions of time management behaviors, setting objectives and prioritization, and mechanics of time management dimensions obtained the highest and lowest frequency, respectively. Comparison of the mean scores of time management behaviors indicated a significant difference in the gender (p<0.05), age (p<0.001), education (p=0.015), job experience (p<0.001), managerial experience (p<0.001) and management rank management (p<0.029). On the whole, senior nurse managers enjoyed a favorable time management skill. Given the importance of time management behaviors, it seems that teaching these behaviors more seriously through regular educational programs can effectively promote the performance of senior nurse managers.

Collaborative care management effectively promotes self-management: patient evaluation of care management for depression in primary care.

PubMed

DeJesus, Ramona S; Howell, Lisa; Williams, Mark; Hathaway, Julie; Vickers, Kristin S

2014-03-01

Chronic disease management in the primary care setting increasingly involves self-management support from a nurse care manager. Prior research had shown patient acceptance and willingness to work with care managers. This survey study evaluated patient-perceived satisfaction with care management and patient opinions on the effectiveness of care management in promoting self-management. Qualitative and quantitative survey responses were collected from 125 patients (79% female; average age 46; 94% Caucasian) enrolled in care management for depression. Qualitative responses were coded with methods of content analysis by 2 independent analysts. Patients were satisfied with depression care management. Patients felt that care management improved their treatment above and beyond other aspects of their depression treatment (mean score, 6.7 [SD, 2]; 10 = Very much), increased their understanding of depression self-management (mean score, 7.2 [SD, 2]; 10 = Very much), and increased the frequency of self-management goal setting (mean score, 6.9 [SD, 3]; 10 = Very much). Predominant qualitative themes emphasized that patients value emotional, motivational, and relational aspects of the care manager relationship. Patients viewed care managers as caring and supportive, helpful in creating accountability for patients and knowledgeable in the area of depression care. Care managers empower patients to take on an active role in depression self-management. Some logistical challenges associated with a telephonic intervention are described. Care manager training should include communication and motivation strategies, specifically self-management education, as these strategies are valued by patients. Barriers to care management, such as scheduling telephone calls, should be addressed in future care management implementation and study.

Effects of short duration stress management training on self-perceived depression, anxiety and stress in male automotive assembly workers: a quasi-experimental study

PubMed Central

Edimansyah, BA; Rusli, BN; Naing, L

2008-01-01

To examine the effects of short duration stress management training (SMT) on self-perceived depression, anxiety and stress in male automotive assembly workers, 118 male automotive workers from Pekan, Pahang (n = 60, mean age = 40.0 years, SD = 6.67) and Kota Bharu, Kelantan (n = 58, mean age = 38.1 years, SD = 5.86) were assigned to experimental and control group, respectively. A SMT program consisting of aerobic exercise, stress management manual, video session, lecture, question and answer session, and pamphlet and poster session were conducted in the experimental group. A validated short-form Malay version of the Depression Anxiety Stress Scales (DASS-21) were self-administered before and after the intervention program in the experimental and control group and their time and group interaction effects were examined using the repeated measure ANOVA test. Results indicated that the mean (SD) scores for DASS-Depression (p = 0.036) and DASS-Anxiety (p = 0.011) were significantly decreased, respectively, after the intervention program in the experimental group as compared to the control group (significant time-group interaction effects). No similar effect was observed for the mean (SD) scores for DASS-Stress (p = 0.104). However, the mean (SD) scores for subscales of DASS-Depression (Dysphoria, p = 0.01), DASS-Anxiety (Subjective Anxiety, p = 0.007, Situational Anxiety, p = 0.048), and DASS-Stress (Nervous Arousal, p = 0.018, Easily Upset, p = 0.047) showed significant time and group interaction effects. These findings suggest that short duration SMT is effective in reducing some aspects of self-perceived depression, anxiety and stress in male automotive workers. PMID:19021918

A Review of the Literature on Social and Emotional Learning for Students Ages 3-8: Characteristics of Effective Social and Emotional Learning Programs (Part 1 of 4). REL 2017-245

ERIC Educational Resources Information Center

O'Conner, Rosemarie; De Feyter, Jessica; Carr, Alyssa; Luo, Jia Lisa; Romm, Helen

2017-01-01

Social and emotional learning (SEL) is the process by which children and adults learn to understand and manage emotions, maintain positive relationships, and make responsible decisions. This is the first in a series of four related reports about what is known about SEL programs for students ages 3-8. The report series addresses four issues raised…

Individual tree height increment model for managed even-aged stands of ponderosa pine throughout the western United States using linear mixed effects models

Treesearch

Fabian Uzoh; William W. Oliver

2006-01-01

A height increment model is developed and evaluated for individual trees of ponderosa pine throughout the species range in western United States. The data set used in this study came from long-term permanent research plots in even-aged, pure stands both planted and of natural origin. The data base consists of six levels-of-growing stock studies supplemented by initial...

Anorexia of Aging: Assessment and Management.

PubMed

Landi, Francesco; Picca, Anna; Calvani, Riccardo; Marzetti, Emanuele

2017-08-01

Older people often experience loss of appetite and/or decreased food intake that, unavoidably, impact energy metabolism and overall health status. The association of age-related nutritional deficits with several adverse outcomes has led to the recognition of a geriatric condition referred to as "anorexia of aging." Anorexia is an independent predictor of morbidity and mortality both in the community and across clinical settings. Multidimensional interventions within personalized care plans currently represent the most effective option to ensure the provision of adequate amounts of food, limit weight loss, and prevent adverse health outcomes in older adults. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of Aging and Exercise on Mitochondrial Quality Control in Skeletal Muscle

PubMed Central

Kim, Yuho; Triolo, Matthew

2017-01-01

Mitochondria are characterized by its pivotal roles in managing energy production, reactive oxygen species, and calcium, whose aging-related structural and functional deteriorations are observed in aging muscle. Although it is still unclear how aging alters mitochondrial quality and quantity in skeletal muscle, dysregulation of mitochondrial biogenesis and dynamic controls has been suggested as key players for that. In this paper, we summarize current understandings on how aging regulates muscle mitochondrial biogenesis, while focusing on transcriptional regulations including PGC-1α, AMPK, p53, mtDNA, and Tfam. Further, we review current findings on the muscle mitochondrial dynamic systems in aging muscle: fusion/fission, autophagy/mitophagy, and protein import. Next, we also discuss how endurance and resistance exercises impact on the mitochondrial quality controls in aging muscle, suggesting possible effective exercise strategies to improve/maintain mitochondrial health. PMID:28656072

Factors limiting mallard brood survival in prairie pothole landscapes

USGS Publications Warehouse

Krapu, Gary L.; Pietz, Pamela J.; Brandt, David A.; Cox, Robert R.

2000-01-01

In order to estimate mallard (Anas platyrhynchos) production from managed and unmanaged lands, waterfowl biologists need measurable predictors of brood survival. We evaluated effects of percent of seasonal basins holding water (WETSEAS), percent of upland landscape in perennial cover (PERNCOVER), rainfall (RAIN), daily minimum ambient temperature (TMIN), hatch date (HATCHDATE), brood age (BA; 0-7 or 8-30 days), age of brood females, and brood size on mallard brood survival in prairie pothole landscapes, and developed a predictive model using factors found to have significant effects. Sixteen of 56 radiomarked broods experienced total loss during 1,250 exposure days. Our final fitted model of brood survival contained only main effects of WETSEAS, HATCHDATE, and RAIN. Total brood loss during the first 30 days of exposure was 11.2 times more likely for broods hatched on areas with 59% WETSEAS. Total brood loss was 5.2 times more likely during rainy conditions than during dry periods, and the hazard of total brood loss increased by 5% for each 1-day delay in hatching between 17 May and 12 August. High survival of mallard broods in landscapes where most seasonal basins contain water underscores the importance of maintaining seasonal wetlands as a major component of wetland complexes managed for mallard production. Because early hatched broods have higher survival, we also suggest that waterfowl managers focus their efforts on enhancing nest success of early laid clutches, especially in wet years.

Effects of sleep management with self-help treatment for the Japanese elderly with chronic insomnia: a quasi-experimental study.

PubMed

Tamura, Norihisa; Tanaka, Hideki

2017-08-01

This study aimed to determine whether sleep management with self-help treatment is more effective in improving insomnia, compared to a waiting-list control. A total of 51 participants with insomnia, aged ≥60 years, were assigned to two groups: the treatment group or waiting-list control group. Intervention included sleep education, group work, moderately intense exercise, and self-help treatment using a sleep diary for 2 weeks. Participants completed the Insomnia Severity Index (ISI-J) and sleep diaries wearing an activity recorder pre- and post-treatment. The treatment group showed a significant improvement in the ISI-J with a fairly large effect size (Cohen's d: within = 0.78, between = 0.70), whereas the waiting-list control group did not. Sleep diary and activity recorder data showed small to moderate effect sizes in the treatment group. Thus, sleep management with self-help treatment was superior to a waiting-list control for insomnia severity in the targeted elderly population.

Compliance, Safety, and Effectiveness of Fixed-Dose Artesunate-Amodiaquine for Presumptive Treatment of Non-Severe Malaria in the Context of Home Management of Malaria in Madagascar

PubMed Central

Ratsimbasoa, Arsène; Ravony, Harintsoa; Vonimpaisomihanta, Jeanne-Aimée; Raherinjafy, Rogelin; Jahevitra, Martial; Rapelanoro, Rabenja; Rakotomanga, Jean De Dieu Marie; Malvy, Denis; Millet, Pascal; Ménard, Didier

2012-01-01

Home management of malaria is recommended for prompt, effective antimalarial treatment in children less than five years of age. Compliance, safety, and effectiveness of the new fixed-dose artesunate-amodiaquine regimen used to treat suspected malaria were assessed in febrile children enrolled in a 24-month cohort study in two settings in Madagascar. Children with fever were asked to visit community health workers. Presumptive antimalarial treatment was given and further visits were scheduled for follow-up. The primary endpoint was the risk of clinical/parasitologic treatment failure. Secondary outcomes included fever/parasite clearance, change in hemoglobin levels, and frequency of adverse events. The global clinical cure rate was 98.4% by day 28 and 97.9% by day 42. Reported compliance was 83.4%. No severe adverse effects were observed. This study provides comprehensive data concerning the clinical cure rate obtained with artesunate-amodiaquine and evidence supporting the scaling up of home management of malaria. PMID:22302849

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age.

PubMed

Shaw, Jonathon; Marshall, Tracey; Morris, Helen; Hayton, Conal; Chaudhuri, Nazia

2017-11-01

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib. These new agents have been shown to reduce decline in lung function and pirfenidone has been shown to reduce mortality. The changing landscape of IPF diagnosis and management present a number of issues that may be encountered including management of side effects related to antifibrotic therapy. This article aims to give an overview of the holistic approach to the management of patients with IPF, including antifibrotic management, symptom management and the invaluable role of the ILD specialist nurse.

Idiopathic pulmonary fibrosis: a holistic approach to disease management in the antifibrotic age

PubMed Central

Shaw, Jonathon; Marshall, Tracey; Morris, Helen; Chaudhuri, Nazia

2017-01-01

Idiopathic pulmonary fibrosis (IPF) is the most common cause of interstitial lung disease (ILD) and carries a worse prognosis than many cancers. Until recently, there were no active treatment options available for patients with IPF, meaning palliation or lung transplantation in selected patients were the only options. The management of IPF has changed dramatically over the last decade with the advent of two antifibrotic agents; pirfenidone and nintedanib. These new agents have been shown to reduce decline in lung function and pirfenidone has been shown to reduce mortality. The changing landscape of IPF diagnosis and management present a number of issues that may be encountered including management of side effects related to antifibrotic therapy. This article aims to give an overview of the holistic approach to the management of patients with IPF, including antifibrotic management, symptom management and the invaluable role of the ILD specialist nurse. PMID:29268540

Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

PubMed

Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

2015-01-01

An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care. This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the effects of key moderators. Current results do not support case management as an effective model, especially concerning reduction of secondary care use or total costs. We consider reasons for lack of effect and highlight key research questions for the future. The review protocol is available as part of the PROSPERO database (registration number: CRD42014010824).

The impact of diabetes self-management education on glucose management and empowerment in ethnic Armenians with type 2 diabetes.

PubMed

Naccashian, Zarmine

2014-01-01

The purpose of this study was to investigate the impact of diabetes self-management education on glycemic control and perceptions of empowerment in Armenian American immigrants diagnosed with type 2 diabetes. A quasi-experimental pre and post design was used to investigate the impact of using education on self-management as measured by A1C levels and empowerment scores. Nine hours of diabetes self-management education classes were offered in the Armenian language to 75 clients at 2 adult health day care centers over 6 weeks. The participants were mostly first-generation Armenian immigrants aged 65 years and older. A1C results, the 8-item Diabetes Empowerment Scale (DES), and the 15-item Armenian Ethnic Orientation Questionnaire-Revised (AEOQ-R) were used to determine the impact of education on self-care management. After institutional review board approval was obtained, 75 participants completed the study. A paired t test indicated that the postintervention mean A1C level was significantly lower than the preintervention mean A1C level. The postintervention mean DES score was significantly greater than the preintervention mean DES score. No mediating effects of age, gender, acculturation, and number of years with the disease were identified for either A1C or DES score. The findings demonstrate the efficacy of the diabetes self-management education classes in improving diabetes self-care management skills. © 2014 The Author(s).

Gastrointestinal parasite egg excretion in young calves in periurban livestock production in Mali.

PubMed

Wymann, Monica Natalie; Traore, Koniba; Bonfoh, Bassirou; Tembely, Saïdou; Tembely, Sékouba; Zinsstag, Jakob

2008-04-01

To acquire the information needed to improve parasite control in periurban cattle production in Mali, repeated sampling of faeces of 694 calves kept around Bamako was done in 2003/2004. The effects of season, age, breed, management type, parasite control and presence of sheep on egg and oocyst counts were determined. A Bayesian model was used with a negative binomial distribution and herd and individual effects, to account for the clustering of calves in herds and the repeated sampling. Interviews were conducted to report the current control strategies. We found eggs of Strongyloides papillosus (Age class 0-1 month: prevalence 39%, 2-3 months: 59%, 5-6 months: 42%), strongyles (14%, 24%, 36%), coccidian oocysts (37%, 68%, 64%) and at low prevalence eggs of Toxocara vitulorum, Moniezia sp., Trichuris sp. and Paramphistomum sp. Season and age effects occurred. Reported utilisation of parasite control was high (92%) but monthly recorded use was significantly lower (61%).

Managing age discrimination: an examination of the techniques used when seeking employment.

PubMed

Berger, Ellie D

2009-06-01

This article examines the age-related management techniques used by older workers in their search for employment. Data are drawn from interviews with individuals aged 45-65 years (N = 30). Findings indicate that participants develop "counteractions" and "concealments" to manage perceived age discrimination. Individuals counteract employers' ageist stereotypes by maintaining their skills and changing their work-related expectations and conceal age by altering their résumés, physical appearance, and language used. This research suggests that there is a need to reexamine the hiring practices of employers and to improve legislation in relation to their accountability.

Satisfaction of village doctors with the township and village health services integration policy in the western minority-inhabited areas of China.

PubMed

Feng, Da; Zhang, Liang; Xiang, Yuan-Xi; Zhang, Dong-Lan; Wang, Ruo-Xi; Tang, Shang-Feng; Fu, Hang; Li, Bo-Yang

2017-02-01

Township and Village Health Services Integration Management (TVHSIM) is an essential form of China's two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China's new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors' satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors' personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels (all P<0.05). Age (P<0.05) and years of practice (P<0.01) were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level (P<0.05) was negatively correlated with Operations Management as well. However, social insurance status (P<0.05) was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors' satisfaction with TVHSIM (P<0.01). In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

The Role of Opioid Analgesics in Geriatric Pain Management.

PubMed

Naples, Jennifer Greene; Gellad, Walid F; Hanlon, Joseph T

2016-11-01

When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly. Finally, to assist clinicians with selecting appropriate therapy, the article concludes with an evidence-based approach to optimize opioid prescribing in older adults with CNCP. Copyright © 2016 Elsevier Inc. All rights reserved.

A control-oriented lithium-ion battery pack model for plug-in hybrid electric vehicle cycle-life studies and system design with consideration of health management

NASA Astrophysics Data System (ADS)

Cordoba-Arenas, Andrea; Onori, Simona; Rizzoni, Giorgio

2015-04-01

A crucial step towards the large-scale introduction of plug-in hybrid electric vehicles (PHEVs) in the market is to reduce the cost of its battery systems. Currently, battery cycle- and calendar-life represents one of the greatest uncertainties in the total life-cycle cost of battery systems. The field of battery aging modeling and prognosis has seen progress with respect to model-based and data-driven approaches to describe the aging of battery cells. However, in real world applications cells are interconnected and aging propagates. The propagation of aging from one cell to others exhibits itself in a reduced battery system life. This paper proposes a control-oriented battery pack model that describes the propagation of aging and its effect on the life span of battery systems. The modeling approach is such that it is able to predict pack aging, thermal, and electrical dynamics under actual PHEV operation, and includes consideration of random variability of the cells, electrical topology and thermal management. The modeling approach is based on the interaction between dynamic system models of the electrical and thermal dynamics, and dynamic models of cell aging. The system-level state-of-health (SOH) is assessed based on knowledge of individual cells SOH, pack electrical topology and voltage equalization approach.

Recent developments in the management of dry age-related macular degeneration

PubMed Central

Buschini, Elisa; Fea, Antonio M; Lavia, Carlo A; Nassisi, Marco; Pignata, Giulia; Zola, Marta; Grignolo, Federico M

2015-01-01

Dry age-related macular degeneration (AMD), also called geographic atrophy, is characterized by the atrophy of outer retinal layers and retinal pigment epithelium (RPE) cells. Dry AMD accounts for 80% of all intermediate and advanced forms of the disease. Although vision loss is mainly due to the neovascular form (75%), dry AMD remains a challenge for ophthalmologists because of the lack of effective therapies. Actual management consists of lifestyle modification, vitamin supplements, and supportive measures in the advanced stages. The Age-Related Eye Disease Study demonstrated a statistically significant protective effect of dietary supplementation of antioxidants (vitamin C, vitamin E, beta-carotene, zinc, and copper) on dry AMD progression rate. It was also stated that the consumption of omega-3 polyunsaturated fatty acids, such as docosahexaenoic acid and eicosapentaenoic acid, has protective effects. Other antioxidants, vitamins, and minerals (such as crocetin, curcumin, and vitamins B9, B12, and B6) are under evaluation, but the results are still uncertain. New strategies aim to 1) reduce or block drusen formation, 2) reduce or eliminate inflammation, 3) lower the accumulation of toxic by-products from the visual cycle, 4) reduce or eliminate retinal oxidative stress, 5) improve choroidal perfusion, 6) replace/repair or regenerate lost RPE cells and photoreceptors with stem cell therapy, and 7) develop a target gene therapy. PMID:25878491

A Comparison between Electrochemical Impedance Spectroscopy and Incremental Capacity-Differential Voltage as Li-ion Diagnostic Techniques to Identify and Quantify the Effects of Degradation Modes within Battery Management Systems

NASA Astrophysics Data System (ADS)

Pastor-Fernández, Carlos; Uddin, Kotub; Chouchelamane, Gael H.; Widanage, W. Dhammika; Marco, James

2017-08-01

Degradation of Lithium-ion batteries is a complex process that is caused by a variety of mechanisms. For simplicity, ageing mechanisms are often grouped into three degradation modes (DMs): conductivity loss (CL), loss of active material (LAM) and loss of lithium inventory (LLI). State of Health (SoH) is typically the parameter used by the Battery Management System (BMS) to quantify battery degradation based on the decrease in capacity and the increase in resistance. However, the definition of SoH within a BMS does not currently include an indication of the underlying DMs causing the degradation. Previous studies have analysed the effects of the DMs using incremental capacity and differential voltage (IC-DV) and electrochemical impedance spectroscopy (EIS). The aim of this study is to compare IC-DV and EIS on the same data set to evaluate if both techniques provide similar insights into the causes of battery degradation. For an experimental case of parallelized cells aged differently, the effects due to LAM and LLI were found to be the most pertinent, outlining that both techniques are correlated. This approach can be further implemented within a BMS to quantify the causes of battery ageing which would support battery lifetime control strategies and future battery designs.

Calorie restriction (CR) and CR mimetics for the prevention and treatment of age-related eye disorders.

PubMed

Kawashima, Motoko; Ozawa, Yoko; Shinmura, Ken; Inaba, Takaaki; Nakamura, Shigeru; Kawakita, Tetsuya; Watanabe, Mitsuhiro; Tsubota, Kazuo

2013-10-01

The morbidity of ocular diseases, including macular degeneration, diabetic retinopathy, and dry eye disease, has been gradually increasing worldwide. Because these diseases develop from age-associated ocular dysfunctions, interventions against the aging process itself may be a promising strategy for their management. Among the several approaches to interrupt aging processes, calorie restriction (CR) has been shown to recover and/or slow age-related functional declines in various organs, including the eye. Here, we review interventions against the aging process as potential therapeutic approaches to age-related ocular diseases. The effects of CR and CR mimetics in animal models of age-related eye diseases are explored. Furthermore, we discuss the possibilities of expanding this research to prospective studies to elucidate the molecular mechanisms by which CR and/or CR mimetics preserve ocular functions. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators Groupe de rythmologie et stimulation cardiaque de la Société française de cardiologie et Société française de gériatrie et gérontologie.

PubMed

Fauchier, Laurent; Alonso, Christine; Anselme, Frédéric; Blangy, Hugues; Bordachar, Pierre; Boveda, Serge; Clementy, Nicolas; Defaye, Pascal; Deharo, Jean-Claude; Friocourt, Patrick; Gras, Daniel; Halimi, Franck; Klug, Didier; Mansourati, Jacques; Obadia, Benjamin; Pasquié, Jean-Luc; Pavin, Dominique; Sadoul, Nicolas; Taieb, Jérôme; Piot, Olivier; Hanon, Olivier

2016-09-01

Despite the increasingly high rate of implantation of pacemakers (PM) and cardioverter-defibrillators (ICD) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety, and effectiveness of the conventional pacing, ICD and cardiac resynchronization therapy (CRT) in elderly patients. Although peri-procedural risk may be slightly higher in the elderly, the procedure of implantation of PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, a general consensus is that dual chamber pacing, along with the programming of an algorithm to minimise ventricular pacing is preferred. In very old patients presenting with intermittent or suspected AV block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is comparable in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantage of the device on arrhythmic death may be attenuated by a higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live >5-7 years after implantation. The elderly patients usually experience a significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non responders remains globally the same, while considering a less aggressive approach in terms of re interventions (revision of LV lead placement, addition of a RV or LV lead, LV endocardial pacing configuration). Overall, age, comorbidities and comprehensive geriatric assessment should be the decisive factor in making a decision on device implantation selection for survival and well-being benefit in elderly patients.

[Effects of gout web based self-management program on knowledge related to disease, medication adherence, and self-management].

PubMed

Oh, Hyun Soo; Park, Won; Kwon, Seong Ryul; Lim, Mie Jin; Suh, Yeon Ok; Seo, Wha Sook; Park, Jong Suk

2013-08-01

This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.

How do disturbances and climate effects on carbon and water fluxes differ between multi-aged and even-aged coniferous forests?

PubMed

Tang, Xuguang; Li, Hengpeng; Ma, Mingguo; Yao, Li; Peichl, Matthias; Arain, Altaf; Xu, Xibao; Goulden, Michael

2017-12-01

Disturbances and climatic changes significantly affect forest ecosystem productivity, water use efficiency (WUE) and carbon (C) flux dynamics. A deep understanding of terrestrial feedbacks to such effects and recovery mechanisms in forests across contrasting climatic regimes is essential to predict future regional/global C and water budgets, which are also closely related to the potential forest management decisions. However, the resilience of multi-aged and even-aged forests to disturbances has been debated for >60years because of technical measurement constraints. Here we evaluated 62site-years of eddy covariance measurements of net ecosystem production (NEP), evapotranspiration (ET), the estimates of gross primary productivity (GPP), ecosystem respiration (R e ) and ecosystem-level WUE, as well as the relationships with environmental controls in three chronosequences of multi- and even-aged coniferous forests covering the Mediterranean, temperate and boreal regions. Age-specific dynamics in multi-year mean annual NEP and WUE revealed that forest age is a key variable that determines the sign and magnitude of recovering forest C source-sink strength from disturbances. However, the trends of annual NEP and WUE across succession stages between two stand structures differed substantially. The successional patterns of NEP exhibited an inverted-U trend with age at the two even-aged chronosequences, whereas NEP of the multi-aged chronosequence increased steadily through time. Meanwhile, site-level WUE of even-aged forests decreased gradually from young to mature, whereas an apparent increase occurred for the same forest age in multi-aged stands. Compared with even-aged forests, multi-aged forests sequestered more CO 2 with forest age and maintained a relatively higher WUE in the later succession periods. With regard to the available flux measurements in this study, these behaviors are independent of tree species, stand ages and climate conditions. We also found that distinctly different environmental factors controlled forest C and water fluxes under three climatic regimes. Typical weather events such as temperature anomalies or drying-wetting cycles severely affected forest functions. Particularly, a summer drought in the boreal forest resulted in an increased NEP owing to a considerable decrease in R e , but at the cost of greater water loss from deeper groundwater resources. These findings will provide important implications for forest management strategies to mitigate global climate change. Copyright © 2017 Elsevier B.V. All rights reserved.

Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980-2005: retrospective cohort study.

PubMed

Wada, Koji; Kondo, Naoki; Gilmour, Stuart; Ichida, Yukinobu; Fujino, Yoshihisa; Satoh, Toshihiko; Shibuya, Kenji

2012-03-06

To assess the temporal trends in occupation specific all causes and cause specific mortality in Japan between 1980 and 2005. Longitudinal analysis of individual death certificates by last occupation before death. Data on population by age and occupation were derived from the population census. Government records, Japan. Men aged 30-59. Age standardised mortality rate for all causes, all cancers, cerebrovascular disease, ischaemic heart disease, unintentional injuries, and suicide. Age standardised mortality rates for all causes and for the four leading causes of death (cancers, ischaemic heart disease, cerebrovascular disease, and unintentional injuries) steadily decreased from 1980 to 2005 among all occupations except for management and professional workers, for whom rates began to rise in the late 1990s (P<0.001). During the study period, the mortality rate was lowest in other occupations such as production/labour, clerical, and sales workers, although overall variability of the age standardised mortality rate across occupations widened. The rate for suicide rapidly increased since the late 1990s, with the greatest increase being among management and professional workers. Occupational patterns in cause specific mortality changed dramatically in Japan during the period of its economic stagnation and resulted in the reversal of occupational patterns in mortality that have been well established in western countries. A significant negative effect on the health of management and professional workers rather than clerks and blue collar workers could be because of increased job demands and more stressful work environments and could have eliminated or even reversed the health inequality across occupations that had existed previously.

Effectiveness of a School- and Community-based Academic Asthma Health Education Program on Use of Effective Asthma Self-care Behaviors in Older School-age Students

PubMed Central

Kintner, Eileen K.; Cook, Gwendolyn; Marti, C. Nathan; Allen, April; Stoddard, Debbie; Harmon, Phyllis; Gomes, Melissa; Meeder, Linda; Van Egeren, Laurie A.

2014-01-01

Purpose The purpose was to evaluate the effectiveness of SHARP, an academic asthma health education and counseling program, on fostering use of effective asthma self-care behaviors. Design and Methods This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design guided the study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at pre-intervention and 1, 12, and 24 months post-intervention. Analysis involved multilevel modeling. Results All students demonstrated improvement in episode management, risk-reduction/prevention, and health promotion behaviors; SHARP students demonstrated increased improvement in episode management and risk-reduction/prevention behaviors. Practice Implications Working with schoolteachers, nurses can improve use of effective asthma self-care behaviors. PMID:25443867

Do Self-Management Interventions Work in Patients With Heart Failure? An Individual Patient Data Meta-Analysis.

PubMed

Jonkman, Nini H; Westland, Heleen; Groenwold, Rolf H H; Ågren, Susanna; Atienza, Felipe; Blue, Lynda; Bruggink-André de la Porte, Pieta W F; DeWalt, Darren A; Hebert, Paul L; Heisler, Michele; Jaarsma, Tiny; Kempen, Gertrudis I J M; Leventhal, Marcia E; Lok, Dirk J A; Mårtensson, Jan; Muñiz, Javier; Otsu, Haruka; Peters-Klimm, Frank; Rich, Michael W; Riegel, Barbara; Strömberg, Anna; Tsuyuki, Ross T; van Veldhuisen, Dirk J; Trappenburg, Jaap C A; Schuurmans, Marieke J; Hoes, Arno W

2016-03-22

Self-management interventions are widely implemented in the care for patients with heart failure (HF). However, trials show inconsistent results, and whether specific patient groups respond differently is unknown. This individual patient data meta-analysis assessed the effectiveness of self-management interventions in patients with HF and whether subgroups of patients respond differently. A systematic literature search identified randomized trials of self-management interventions. Data from 20 studies, representing 5624 patients, were included and analyzed with the use of mixed-effects models and Cox proportional-hazard models, including interaction terms. Self-management interventions reduced the risk of time to the combined end point of HF-related hospitalization or all-cause death (hazard ratio, 0.80; 95% confidence interval [CI], 0.71-0.89), time to HF-related hospitalization (hazard ratio, 0.80; 95% CI, 0.69-0.92), and improved 12-month HF-related quality of life (standardized mean difference, 0.15; 95% CI, 0.00-0.30). Subgroup analysis revealed a protective effect of self-management on the number of HF-related hospital days in patients <65 years of age (mean, 0.70 versus 5.35 days; interaction P=0.03). Patients without depression did not show an effect of self-management on survival (hazard ratio for all-cause mortality, 0.86; 95% CI, 0.69-1.06), whereas in patients with moderate/severe depression, self-management reduced survival (hazard ratio, 1.39; 95% CI, 1.06-1.83, interaction P=0.01). This study shows that self-management interventions had a beneficial effect on time to HF-related hospitalization or all-cause death and HF-related hospitalization alone and elicited a small increase in HF-related quality of life. The findings do not endorse limiting self-management interventions to subgroups of patients with HF, but increased mortality in depressed patients warrants caution in applying self-management strategies in these patients. © 2016 American Heart Association, Inc.

Frequency Domain Reflectometry Modeling and Measurement for Nondestructive Evaluation of Nuclear Power Plant Cables

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

Glass, Samuel W.; Fifield, Leonard S.; Jones, Anthony M.

Cable insulation polymers are among the more susceptible materials to age-related degradation within a nuclear power plant. This is recognized by both regulators and utilities, so all plants have developed cable aging management programs to detect damage before critical component failure in compliance with regulatory guidelines. Although a wide range of tools are available to evaluate cables and cable systems, cable aging management programs vary in how condition monitoring and NDE is conducted as utilities search for the most reliable and cost-effective ways to assess cable system condition. Frequency domain reflectometry (FDR) is emerging as one valuable tool to locatemore » and assess damaged portions of a cable system with minimal cost and only requires access in most cases to one of the cable terminal ends. This work examines a physics-based model of a cable system and relates it to FDR measurements for a better understanding of specific damage influences on defect detectability.« less

The Effect of Age and Task Difficulty

ERIC Educational Resources Information Center

Mallo, Jason; Nordstrom, Cynthia R.; Bartels, Lynn K.; Traxler, Anthony

2007-01-01

Electronic Performance Monitoring (EPM) is a common technique used to record employee performance. EPM may include counting computer keystrokes, monitoring employees' phone calls or internet activity, or documenting time spent on work activities. Despite EPM's prevalence, no studies have examined how this management tool affects older workers--a…

Quality Management Builds Solid eTraining

ERIC Educational Resources Information Center

Echard, Rachel D.; Berge, Zane L.

2008-01-01

History has shown effective training techniques can produce significant business results especially in customer service, product development, and capability in obtaining new skill sets. This linkage of training to business strategy has given many businesses the needed competitive edge in today's global market. In today's technology age,…

An Air Force Guide for Effective Meeting Management

DTIC Science & Technology

2011-05-01

The inspection program to ensure its sustainment has faced increasing workload requirements due to structural issues related to heavy use and aging...26 Data Sources /Format...aircraft availability, the High Velocity Maintenance (HVM) concept is being implemented to replace the current PDM process for heavy maintenance

41 CFR 101-8.723 - Remedial action by recipient.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 8-NONDISCRIMINATION IN PROGRAMS RECEIVING FEDERAL FINANCIAL ASSISTANCE 8.7-Discrimination Prohibited on the Basis of Age § 101-8.723 Remedial action... remedial action that GSA may require to overcome the effects of the discrimination. If another recipient...

41 CFR 101-8.723 - Remedial action by recipient.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 8-NONDISCRIMINATION IN PROGRAMS RECEIVING FEDERAL FINANCIAL ASSISTANCE 8.7-Discrimination Prohibited on the Basis of Age § 101-8.723 Remedial action... remedial action that GSA may require to overcome the effects of the discrimination. If another recipient...

Parameters on plant absortion of double-stranded Ribonucleic acid, dsRNA

USDA-ARS?s Scientific Manuscript database

Efficient absorption of double-stranded Ribonucleic acid, dsRNA, into citrus is critical for effective psyllid management by RNA interference, RNAi. Parameters which might affect absorption into citrus trees and subsequent ingestion by Asian citrus psyllid were evaluated. Age of leaves, variety of c...

Early Onset Ageing and Service Preparation in People with Intellectual Disabilities: Institutional Managers' Perspective

ERIC Educational Resources Information Center

Lin, Jin-Ding; Wu, Chia-Ling; Lin, Pei-Ying; Lin, Lan-Ping; Chu, Cordia M.

2011-01-01

Although longevity among older adults with intellectual disabilities is increasing, there is limited information on their premature aging related health characteristics and how it may change with increasing age. The present paper provides information of the institutional manager's perception on early onset aging and service preparation for this…

77 FR 14567 - Draft General Management Plan/Environmental Impact Statement for the Ice Age Complex at Cross...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

... Impact Statement for the Ice Age Complex at Cross Plains, Cross Plains, Wisconsin AGENCY: National Park... General Management Plan/Environmental Impact Statement for the Ice Age Complex at Cross Plains, Wisconsin... also send comments to Superintendent, Ice Age National Scenic Trail, 700 Rayovac Drive, Suite 100...

Forest management strategy affects saproxylic beetle assemblages: A comparison of even and uneven-aged silviculture using direct and indirect sampling.

PubMed

Joelsson, Klara; Hjältén, Joakim; Gibb, Heloise

2018-01-01

Management of forest for wood production has altered ecosystem structures and processes and led to habitat loss and species extinctions, worldwide. Deadwood is a key resource supporting forest biodiversity, and commonly declines following forest management. However, different forest management methods affect dead wood differently. For example, uneven-aged silviculture maintains an age-stratified forest with ongoing dead wood production, while even-aged silviculture breaks forest continuity, leading to long periods without large trees. We asked how deadwood-dependent beetles respond to different silvicultural practices and if their responses depend on deadwood volume, and beetles preference for decay stages of deadwood. We compared beetle assemblages in five boreal forest types with different management strategies: clearcutting and thinning (both representing even-aged silviculture), selective felling (representing uneven-aged silviculture), reference and old growth forest (both uneven-aged controls without a recent history [~50 years] of management, but the latter with high conservation values). We collected beetles using window traps and by sieving the bark from experimental logs (bolts). Beetle assemblages on clear-cuts differed from all other stand types, regardless of trapping method or decay stage preference. Thinning differed from reference stands, indicating incomplete recovery after clear-cutting, while selective felling differed only from clear-cuts. In contrast to our predictions, early and late successional species responded similarly to different silvicultural practices. However, there were indications of marginal assemblage differences both between thinned stands and selective felling and between thinned and old growth stands (p = 0.10). The stand volume of early decay stage wood influenced assemblage composition of early, but not late successional species. Uneven-aged silviculture maintained species assemblages similar to those of the reference and old growth stands and might therefore be a better management option when considering biodiversity conservation.

Consumption estimates of walleye stocked as fry to suppress fathead minnow populations in west-central Minnesota wetlands

USGS Publications Warehouse

Ward, M.C.; Willis, D.W.; Herwig, B.R.; Chipps, S.R.; Parsons, B.G.; Reed, J.R.; Hanson, M.A.

2008-01-01

Fisheries managers throughout the Prairie Pothole Region of Minnesota often use semi-permanent and permanent wetland basins to extensively culture walleye Sander vitreus fry. Waterfowl managers have expressed concern over this practice because of the potential influence that fish have on food resources used by waterfowl during development and migration. It is well known that native fathead minnows Pimephales promelas can have detrimental effects on macroinvertebrates, zooplankton, water clarity, epiphyton, and macrophytes in wetlands. Because walleye commonly become piscivorous as soon as mouth gape allows, walleye fry may suppress fathead minnow populations and improve wetland conditions for waterfowl. In this study, we quantify consumption estimates, specifically predation on fathead minnows, by age-0 and age-1 walleye reared in natural wetland basins. Six wetlands were stocked in mid-May 2001 and 2002 at a rate of 12,000 walleye fry ha-1. Age-0 walleye were sampled bi-weekly from mid-June through mid-September 2001. Age-0 and age-1 walleye were sampled monthly from mid-May through mid-September 2002. A generalised diet shift from zooplankton to fish to macroinvertebrates was observed in 2001, whereas diets of juvenile walleye contained primarily macroinvertebrates in 2002. Stocked walleye quickly reduced fathead minnow populations in 2001 and suppression was maintained throughout 2002. Although walleye consumed primarily macroinvertebrates once prey fish populations became suppressed, consumption estimates of invertebrates by walleye were substantially less than those documented for fathead minnow populations. Thus, stocking age-0 walleye was an effective biomanipulation tool that substantially reduced fathead minnow densities and influenced lower trophic levels in these aquatic communities. ?? 2007 Blackwell Munksgaard.

Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions.

PubMed

Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

2016-01-01

Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions

PubMed Central

Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

2016-01-01

Many patients with Alzheimer’s disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer’s disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement. PMID:26955265

Effectiveness and outcome of management strategies for dabigatran- or warfarin-related major bleeding events.

PubMed

Majeed, Ammar; Hwang, Hun-Gyu; Eikelboom, John W; Connolly, Stuart; Wallentin, Lars; Feuring, Martin; Brueckmann, Martina; Noack, Herbert; Yusuf, Salim; Schulman, Sam

2016-04-01

Strategies used for the management of dabigatran-related major bleeding events (MBEs), and their effectiveness have not been systematically evaluated. Reports on 1034 individuals experiencing 1121 MBEs (696 on dabigatran, and 425 on warfarin) in 5 phase III randomized controlled trials were assessed independently by two investigators. MBEs were managed either by drug discontinuation only (37%), or drug discontinuation with either transfusion of only red cell concentrates (38%), or plasma (23%). Few MBEs (2%) were treated with coagulation factor concentrates. The effectiveness of the management was assessed as good in significantly larger proportion of MBEs on dabigatran (91%) than on warfarin (84%, odds ratio [OR] 1.68; 95% confidence interval [CI], 1.14-2.49), which was consistent with the lower 30-day mortality (OR (OR 0.66; 95% CI, 0.44-1.00)). The effectiveness of bleeding management in non-traumatic bleeding was better in patients with dabigatran than with warfarin (OR 1.82; 95% CI, 1.18-2.79) but was similar in traumatic bleeding (OR 0.75; 95% CI, 0.25-2.30). The relative effectiveness of management of bleeding and 30-day mortality rates across other key subgroups of patients or sites of bleeding, the use of platelet inhibitors, age-, sex- and renal function subgroups, were comparable in MBEs on dabigatran or warfarin. Despite the unavailability of a specific antidote at the time of these studies, bleeding in patients receiving dabigatran was managed in the overwhelming majority of patients without coagulation factor concentrates, with comparable or superior effectiveness and lower 30-day mortality rates versus those who bleed while receiving warfarin. Copyright © 2016 Elsevier Ltd. All rights reserved.

Business Issues in an Aging America. A Report from The Travelers Insurance Companies Conference, Managing an Aging Workforce (New York, NY, February 1982).

ERIC Educational Resources Information Center

Travelers Insurance Companies, Hartford, CT.

This report consists of excerpts from nine papers presented at a conference on managing an aging workforce. The first excerpt deals with the nature and impact of age-related changes. Discussed next is the need to better identify the changes that come with age and to develop improved methods to assess human capability without respect to age. The…

Incontinence and sexuality in later life.

PubMed

Garrett, Dawne; Tomlin, Karen

2015-07-01

This article explores the interrelated aspects of incontinence and sexuality in older age. It describes the physiological changes that may have an effect on sexual function and the genitourinary system as people age. The enduring importance of sexual intimacy is discussed. Treatments for incontinence and to improve sexual function are explored. The authors conclude that nurses, particularly those involved in continence management, have a role in ensuring sensitive assessment and access to treatment, which can support many older people to maintain fulfilling sexual activity.

Effects of management in gestational diabetes mellitus with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures: a prospective cohort study.

PubMed

Han, Yun; Zheng, Yan-Li; Wu, Ai-Min; Liu, Hong-Bin; Su, Jian-Bin; Lu, Xiao-Yan; Han, Yu-Wen; Ji, Jin-Long; Ji, Ju-Hua; Shi, Yue

2016-12-01

A great quantity of gestational diabetes mellitus with normal prepregnancy body mass index have emerged with the new criteria of gestational diabetes mellitus in China based on the International Diabetes in Pregnancy Consensus group criteria, and understanding placental changes and how they affect outcomes are necessary in order to develop effective management approach. The aim of this study was to prospectively explore the effect of active management starting from the late second trimester in gestational diabetes mellitus women with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures, and to provide scientific evidences for optimizing the management of gestational diabetes mellitus in China. Gestational diabetes mellitus women with normal prepregnancy body mass index in the same period of this prospective cohort study were divided into intervention group (n = 51) and control group (n = 55). The intervention group was managed rigorously, while the control group received conventional prenatal cares. The glucose profile, gestational weight gain and pregnancy outcomes were followed up and placental ultrastructures were observed and recorded by transmission electron microscopy. The blood glucose level and gestational weight gain in intervention group were significantly better controlled than those in control group (P < 0.01). The incidences of fetal distress, cesarean section and large for gestational age were significantly lower in intervention group than in control group (P < 0.05). There was a significant reduction in the incidence of abnormal placental ultrastructure in the intervention group (P < 0.01). After adjustment for confounding factors, the undesirable glycemic control and conventional management were related to abnormal placental ultrastructure (P < 0.05). Meanwhile, the undesirable glycemic control, abnormal placental ultrastructure and conventional management made sense in the incidence of fetal distress (P < 0.05), and the target glycemic control, recommend weight gain and active management were associated with reductions in the prevalence of cesarean delivery and large for gestational age (P < 0.05). The active management of gestational diabetes mellitus women with normal prepregnancy body mass index can improve pregnancy outcomes and placental ultrastructures, and the abnormal placental ultrastructure might be closely associated with the undesirable glycemic control and adverse pregnancy outcomes.

Dementia and depression with ischemic heart disease: a population-based longitudinal study comparing interventional approaches to medical management.

PubMed

Mutch, W Alan C; Fransoo, Randall R; Campbell, Barry I; Chateau, Dan G; Sirski, Monica; Warrian, R Keith

2011-02-28

We compared the proportion of ischemic heart disease (IHD) patients newly diagnosed with dementia and depression across three treatment groups: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management alone (IHD-medical). De-identified, individual-level administrative records of health service use for the population of Manitoba, Canada (approximately 1.1 million) were examined. From April 1, 1993 to March 31, 1998, patients were identified with a diagnosis of IHD (ICD-9-CM codes). Index events of CABG or PCI were identified from April 1, 1998 to March 31, 2003. Outcomes were depression or dementia after the index event. Patients were followed forward to March 31, 2006 or until censored. Proportional hazards regression analysis was undertaken. Independent variables examined were age, sex, diabetes, hypertension and income quintile, medical management alone for IHD, or intervention by PCI or CABG. Age, sex, diabetes, and presence of hypertension were all strongly associated with the diagnosis of depression and dementia. There was no association with income quintile. Dementia was less frequent with PCI compared to medical management; (HR = 0.65; p = 0.017). CABG did not provide the same protective effect compared to medical management (HR = 0.90; p = 0.372). New diagnosis depression was more frequent with interventional approaches: PCI (n = 626; hazard ratio = 1.25; p = 0.028) and CABG (n = 1124, HR = 1.32; p = 0.0001) than non-interventional patients (n = 34,508). Subsequent CABG was nearly 16-fold higher (p<0.0001) and subsequent PCI was 22-fold higher (p<0.0001) for PCI-managed than CABG-managed patients. Patients managed with PCI had the lowest likelihood of dementia-only 65% of the risk for medical management alone. Both interventional approaches were associated with a higher risk of new diagnosed depression compared to medical management. Long-term myocardial revascularization was superior with CABG. These findings suggest that PCI may confer a long-term protective effect from dementia. The mechanism(s) of dementia protection requires elucidation.

Online self-management interventions for chronically ill patients: cognitive impairment and technology issues.

PubMed

Archer, Norm; Keshavjee, Karim; Demers, Catherine; Lee, Ryan

2014-04-01

As the fraction of the population with chronic diseases continues to grow, methods and/or technologies must be found to help the chronically ill to take more responsibility to self-manage their illnesses. Internet based and/or mobile support for disease self-management interventions have often proved effective, but patients with chronic illnesses may have co-occurring cognitive impairment, making it more difficult for them to cope with technologies. Many older patients are also not familiar with technologies or they may have cognitive disabilities or dementia that reduce their ability to self-manage their healthcare. On-line solutions to the needs of chronically ill patients must be investigated and acted upon with care in an integrated manner, since resources invested in these solutions will be lost if patients do not adopt and continue to use them successfully. To review the capabilities of online and mobile support for self-management of chronic illnesses, and the impacts that age and disease-related issues have on these interventions, including cognitive impairment and lack of access or familiarity with Internet or mobile technologies. This study includes a review of the co-occurrence of cognitive impairment with chronic diseases, and discusses how cognitive impairment, dyadic caregiver patient support, patient efficacy with technology, and smart home technologies can impact the effectiveness and sustainability of online support for disease self-management. Disease self-management interventions (SMIs) using online patient centered support can often enable patients to manage their own chronic illnesses. However, our findings show that cognitive impairment often co-occurs in patients with chronic disease. This, along with age-related increases in multiple chronic illnesses and lack of technology efficacy, can be obstacles to Internet and mobile support for chronic disease self-management. Patients with chronic diseases may have greater than expected difficulties in using Internet and mobile technologies for disease self-management, often due to cognitive impairment or unfamiliarity with technology. Approaches to dealing with such barriers include suitable integration of solutions involving patient-caregiver dyads, better design of online applications, careful attention to technology adoption and sustainability, and smart home technologies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis

PubMed Central

Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

2015-01-01

Background An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care ‘at-risk’ of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. Methods and Findings We carried out a systematic review and meta-analysis of the effectiveness of case management for ‘at-risk’ patients in primary care. Six bibliographic databases were searched using terms for ‘case management’, ‘primary care’, and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health – self-assessed health status, mortality; Cost – total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction – patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial ‘strength’ of primary care. Conclusions This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the effects of key moderators. Current results do not support case management as an effective model, especially concerning reduction of secondary care use or total costs. We consider reasons for lack of effect and highlight key research questions for the future. Review Protocol The review protocol is available as part of the PROSPERO database (registration number: CRD42014010824). PMID:26186598

Optimizing management regimes for carbon storage and other benefits in uneven-aged stands dominated by Norway spruce, with a derivation of the economic supply of carbon storage

Treesearch

Joseph Buongiorno; Espen Andreas Halvorsen; Ole Martin Bollandsas; Terje Gobakken; Ole Hofstad

2012-01-01

This study sought optimal sustainable management regimes of uneven-aged Norway spruce-dominated stands with multiple objectives. The criteria were financial returns, CO2 sequestration and diversity of tree size and species. At prevailing timber prices, harvest and transport costs, and interest rates, uneven-aged management for timber alone was...

Assessing Land Management Change Effects on Forest Carbon and Emissions Under Changing Climate

NASA Astrophysics Data System (ADS)

Law, B. E.

2014-12-01

There has been limited focus on fine-scale land management change effects on forest carbon under future environmental conditions (climate, nitrogen deposition, increased atmospheric CO2). Forest management decisions are often made at the landscape to regional levels before analyses have been conducted to determine the potential outcomes and effectiveness of such actions. Scientists need to evaluate plausible land management actions in a timely manner to help shape policy and strategic land management. Issues of interest include species-level adaptation to climate, resilience and vulnerability to mortality within forested landscapes and regions. Efforts are underway to improve land system model simulation of future mortality related to climate, and to develop and evaluate plausible land management options that could help mitigate or avoid future die-offs. Vulnerability to drought-related mortality varies among species and with tree size or age. Predictors of species ability to survive in specific environments are still not resolved. A challenge is limited observations for fine-scale (e.g. 4 km2) modeling, particularly physiological parameters. Uncertainties are primarily associated with future land management and policy decisions. They include the interface with economic factors and with other ecosystem services (biodiversity, water availability, wildlife habitat). The outcomes of future management scenarios should be compared with business-as-usual management under the same environmental conditions to determine the effects of management changes on forest carbon and net emissions to the atmosphere. For example, in the western U.S., land system modeling and life cycle assessment of several management options to reduce impacts of fire reduced long-term forest carbon gain and increased carbon emissions compared with business-as-usual management under future environmental conditions. The enhanced net carbon uptake with climate and reduced fire emissions after thinning did not compensate for the increased wood removals over 90 years, leading to reduced net biome production. Analysis of land management change scenarios at fine scales is needed, and should consider other ecological values in addition to carbon.

Effectiveness of a Mindfulness-Based Intervention in the Management of Musculoskeletal Pain in Nursing Workers.

PubMed

Lopes, Shirlene Aparecida; Vannucchi, Bruna Pesce; Demarzo, Marcelo; Cunha, Ângelo Geraldo José; Nunes, Maria do Patrocínio Tenório

2018-05-17

Chronic pain is a prevalent disorder in nursing workers worldwide. Several studies have proposed measures to mitigate this critical scenario. Mindfulness-based interventions (MBI) have been found to have promising results in the treatment of this disorder. To quantify the effectiveness of an adapted mindfulness program (AMP) in the management of musculoskeletal pain (MSP) in nursing technicians of a Brazilian university hospital. This study was a clinical, prospective, open, repeated measures trial, with data collection between January and July 2015. Brazilian university hospital. Participants/Subjects: Sixty-four female nursing technicians with a mean age of 47.01 years (standard deviation = 9.50) with chronic pain symptoms. Sixty-four female nursing technicians with a mean age of 47.01 years (standard deviation = 9.50) and MSP participated in this prospective study. Before the intervention (T0), scores of anxiety, depression, mindfulness, musculoskeletal complaints, pain catastrophizing, self-compassion, and perception of quality of life were quantified. These scores were reevaluated after 8 weeks (T1) and 12 weeks (T2) of weekly AMP sessions (60 minutes each). The variables were evaluated by analysis of variance for repeated measures, followed by the Bonferroni test. AMP reduced the scores of musculoskeletal symptoms, anxiety, depression, and pain catastrophizing (p < .001). A significant increase was identified in self-compassion scores and perception of quality of life in the physical, psychological, and overall assessment (p ≤ .04). Positive effects of AMP occurred at T1 and remained unchanged at T2. AMP contributed to a reduction in painful symptoms and improved the quality of life of nursing workers, with a lasting effect until the 20th week of follow-up, indicating utility as an effective strategy for the management of MSP in the group studied. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Using systems science for population health management in primary care.

PubMed

Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

2014-10-01

Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of <5 years. Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

Age differences in workplace intervention effects on employees’ nighttime and daytime sleep

PubMed Central

Lee, Soomi; Almeida, David M.; Berkman, Lisa; Olson, Ryan; Moen, Phyllis; Buxton, Orfeu M.

2017-01-01

Objectives To examine the effects of a workplace flexibility/support intervention on employees’ sleep quantity and quality during nights and days and whether the effects differ by employee age. Design Cluster-randomized controlled trial. Setting Information technology industry workplaces. Participants US employees (Mage = 46.9 years) at an information technology firm who provided actigraphy at baseline and a 12-month follow-up (N = 396; n = 195 intervention, n = 201 control). Intervention The Work, Family, and Health Study intervention aimed to increase workplace flexibility and support. The intervention consisted of facilitated discussions to help employees increase control over when and where they work as well as manager-specific training sessions to increase manager support for employees’ work-family issues. Measurements Nighttime sleep duration, wake after sleep onset (WASO), and nap duration were measured with wrist actigraphy. Day-to-day variability in these variables (min2) was also estimated. Results Intervention employees increased nighttime sleep duration at 12 months, by 9 minutes per day, relative to control employees. There were interaction effects between the intervention and age on daytime nap duration and day-to-day variability in WASO. Older employees (56–70 years) in the intervention condition decreased nap duration at 12 months relative to older employees in the control condition. Older employees in the intervention condition also exhibited a greater decrease in day-to-day variability of WASO at 12 months compared with their baseline. Conclusions The workplace flexibility/support intervention was effective in enhancing employees’ sleep health by increasing nighttime sleep duration. Furthermore, the intervention was particularly effective for older employees in decreasing their daytime nap duration and day-to-day variability in WASO. PMID:28105463

Current perspectives on the health risks associated with the consumption of advanced glycation end products: recommendations for dietary management

PubMed Central

Palimeri, Sotiria; Palioura, Eleni; Diamanti-Kandarakis, Evanthia

2015-01-01

Advanced glycation end products (AGEs) constitute a complex group of compounds produced endogenously during the aging process and under conditions of hyperglycemia and oxidative stress. AGEs also have an emerging exogenous origin. Cigarette smoke and diet are the two main exogenous sources of AGEs (glycotoxins). Modern Western diets are rich in AGEs which have been implicated in the pathogenesis of several metabolic and degenerative disorders. Accumulating evidence underlies the beneficial effect of the dietary restriction of AGEs not only in animal studies but also in patients with diabetic complications and metabolic diseases. This article reviews the evidence linking dietary glycotoxins to several disorders from diabetic complications and renal failure to liver dysfunction, female reproduction, eye and cognitive disorders as well as cancer. Furthermore, strategies for AGE reduction are discussed with a focus on dietary modification. PMID:26366100

Roles of Clinician, Patient, and Community Characteristics in the Management of Pediatric Upper Respiratory Tract Infections.

PubMed

Yaeger, Jeffrey P; Temte, Jonathan L; Hanrahan, Lawrence P; Martinez-Donate, P

2015-11-01

Prior studies have evaluated factors predictive of inappropriate antibiotic prescription for upper respiratory tract infections (URIs). Community factors, however, have not been examined. The aim of this study was to evaluate the roles of patient, clinician, and community factors in predicting appropriate management of URIs in children. We used a novel database exchange, linking electronic health record data with community statistics, to identify all patients aged 3 months to 18 years in whom URI was diagnosed in the period from 2007 to 2012. We followed the Healthcare Effectiveness Data and Information Set (HEDIS) quality measurement titled "Appropriate treatment for children with upper respiratory infection" to determine the rate of appropriate management of URIs. We then stratified data across individual and community characteristics and used multiple logistic regression modeling to identify variables that independently predicted antibiotic prescription. Of 20,581 patients, the overall rate for appropriate management for URI was 93.5%. Family medicine clinicians (AOR = 1.5; 95% CI 1.31, 1.71; reference = pediatric clinicians), urgent care clinicians (AOR = 2.23; 95% CI 1.93, 2.57; reference = pediatric clinicians), patients aged 12 to 18 years (AOR = 1.44; 95% CI 1.25, 1.67; reference = age 3 months to 4 years), and patients of white race/ ethnicity (AOR = 1.83; 95% CI 1.41, 2.37; reference = black non-Hispanic) were independently predictive of antibiotic prescription. No community factors were independently predictive of antibiotic prescription. Results correlate with prior studies in which non-pediatric clinicians and white race/ethnicity were predictive of antibiotic prescription, while association with older patient age has not been previously reported. Findings illustrate the promise of linking electronic health records with community data to evaluate health care disparities. © 2015 Annals of Family Medicine, Inc.

Treatment of Cancer in the Older Aged Person.

PubMed Central

Balducci, Lodovico

2010-01-01

Cancer is a disease of aging.1 Currently 50% of all malignancies occur in individuals 65 and over1 and by the year 2030 older individuals will account for 70% of all neoplasms. With the aging of the population the management of cancer in the older person with chemotherapy is beoming increasingly common. This treatment may be safe and effective if some appropriate measures are taken, including, an assessment of the physiologic age of each patient, modification of doses according to the renal function, use of meyelopoietic growth factors prophylactically in presence of moderately toxic chemotherapy, and provision of an adequate caregiver. Cure, prolongation of survival, and symptom palliation are universal goals of medical treatment. Prolongation of active life expectancy should be added to the treatment goal of the older aged person. PMID:21415975

The impact of ED nurse manager leadership style on staff nurse turnover and patient satisfaction in academic health center hospitals.

PubMed

Raup, Glenn H

2008-10-01

Nurse managers with effective leadership skills are an essential component to the solution for ending the nursing shortage. Empirical studies of existing ED nurse manager leadership styles and their impact on key nurse management outcomes such as staff nurse turnover and patient satisfaction have not been performed. The specific aims of this study were to determine what types of leadership styles were used by ED nurse managers in academic health center hospitals and examine their influence on staff nurse turnover and patient satisfaction. ED nurse managers were asked to complete the Multifactor Leadership Questionnaire and a 10-item researcher defined nurse manager role and practice demographics survey. Completed surveys (15 managers and 30 staff nurses) representing 15 out of 98 possible U.S. academic health centers were obtained. Fisher's exact test with 95% confidence intervals were used to analyze the data. The sample percentage of managers who exhibited Transformational leadership styles and demographic findings of nurse manager age, total years experience and length of time in current position matched current reports in the literature. A trend of lower staff nurse turnover with Transformational leadership style compared to non-Trasformational leadership styles was identified. However, the type of leadership style did not appear to have an effect on patient satisfaction. The ED is an ever-changing, highly regulated, critical-care environment. Effective ED nurse manager leadership strategies are vital to maintaining the standards of professional emergency nursing practice to create an environment that can produce management outcomes of decreased staff nurse turnover, thereby enhancing staff nurse retention and potentially impacting patient satisfaction.

A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis.

PubMed

Kastner, Monika; Sawka, Anna M; Hamid, Jemila; Chen, Maggie; Thorpe, Kevin; Chignell, Mark; Ewusie, Joycelyne; Marquez, Christine; Newton, David; Straus, Sharon E

2014-09-25

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians. The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ≥ 50 years, men aged ≥ 65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance. The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P < 0.001), any osteoporosis medications (0.5%; P = 0.006), and calcium or vitamin D (1.2%; P = 0.001). Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted (mean age 64 years, 77% women), the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial. The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.

‘The year of first aid’: effectiveness of a 3-day first aid programme for 7-14-year-old primary school children

PubMed Central

Banfai, Balint; Pek, Emese; Pandur, Attila; Csonka, Henrietta; Betlehem, Jozsef

2017-01-01

Aim of the study Bystanders can play an important role in the event of sudden injury or illness. Our aim was to evaluate the effects of a 3-day first aid course for all primary school age groups (7–14 years old). Methods 582 school children were involved in the study. Training consisted of three sessions with transfer of theoretical knowledge and practical skills about first aid. The following most urgent situations were addressed in our study: adult basic life support (BLS), using an automated external defibrillator (AED), handling an unconscious patient, managing bleeding and calling the ambulance. Data collection was made with a questionnaire developed for the study and observation. Students were tested before, immediately after and 4 months after training. Results were considered significant in case of p<0.05. Results Prior to training there was a low level of knowledge and skills on BLS, management of the unconscious patient, use of an AED and management of bleeding. Knowledge and skills improved significantly in all of these categories (p<0.01) and remained significantly higher than the pre-test level at 4 months after training (p<0.01). Younger children overall performed less well than older children, but significantly improved over the pre-test level both immediately and 4 months after training (p<0.01). Prior first aid training was associated with knowledge of the correct ambulance number (p=0.015) and management of bleeding (p=0.041). Prior to training, age was associated with pre-test knowledge and skills of all topics (p<0.01); after training, it was only associated with AED use (p<0.001). There was a significant correlation between the depth of chest compression and children’s age, weight, height and body mass index (p<0.001). Ventilation depended on the same factors (p<0.001). Conclusion Children aged 7–14 years are able to perform basic life-saving skills. Knowledge retention after 4 months is good for skills, but thinking in algorithms is difficult for these children. PMID:28420689

Characteristics of employees of small, manufacturing businesses by occupation: Informing evidence-based intervention planning

PubMed Central

Hunt, Mary K; Hennrikus, Deborah; Brosseau, Lisa M; Hannan, Peter J; Katz, Marc; Pinsker, Erika A; Lando, Harry A; Egelhoff, Claudia

2015-01-01

Objectives We examined characteristics of employees in six occupational categories in small, manufacturing businesses (20–150 employees). Methods We analyzed survey data from 47 businesses (n=2577 employees; 86% response rate) and examined relationships between job type and socio-demographic, health, and organizational support characteristics. Analyses were adjusted for age and gender, and company as a random effect. Results Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (p<.001). Job stress was higher for production workers and support staff than managers (p<0.0001). Managers perceived social capital (p<0.001), safety climate (p<0.0001) and support for smoking cessation (p<0.001) higher than production managers, production workers, and support staff. Conclusion Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support. PMID:26539766

Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning.

PubMed

Hunt, Mary K; Hennrikus, Deborah; Brosseau, Lisa M; Hannan, Peter J; Katz, Marc; Pinsker, Erika A; Lando, Harry A; Egelhoff, Claudia

2015-11-01

We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees). We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect. Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff. Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.

Enhancing Asthma Self-Management in Rural School-Aged Children: A Randomized Controlled Trial.

PubMed

Horner, Sharon D; Brown, Adama; Brown, Sharon A; Rew, D Lynn

2016-06-01

To test the effects of 2 modes of delivering an asthma educational intervention on health outcomes and asthma self-management in school-aged children who live in rural areas. Longitudinal design with data collected 4 times over 12 months. The target sample was composed of children in grades 2-5 who had a provider diagnosis of asthma. Elementary schools were stratified into high or low socioeconomic status based on student enrollment in the free or reduced-cost lunch program. Schools were then randomly assigned to 1 of 3 treatment arms: in-school asthma class, asthma day camp, or the attention-control group. Sample retention was good (87.7%) and equally distributed by study arm. Improvements in emergency department visits and office visits were related to attending either the asthma class or asthma day camp. Asthma severity significantly decreased in both asthma treatment groups. Other factors such as hospitalizations, parent asthma management, and child asthma management improved for all groups. Both asthma class and asthma day camp yielded significant reductions in asthma severity. There were reductions in the emergency department and office visits for the 2 asthma arms, and hospitalizations declined significantly for all groups. Asthma self-management also improved in all groups, while it was somewhat higher in the asthma arms. This may be due to the attention being drawn to asthma management by study participation and the action of completing questionnaires about asthma management, asthma symptoms, and health outcomes. © 2015 National Rural Health Association.

A Cyberbullying Intervention with Primary-Aged Students

ERIC Educational Resources Information Center

Toshack, Troy; Colmar, Susan

2012-01-01

A small-scale evaluation of a psycho-educational program on cyberbullying with a group of Year 6 girls was implemented over six sessions, and was subsequently evaluated. Its content included knowledge of cyberbullying and its effects, and management and safety strategies for the participants and their peers. Increases in the girls' detailed…

Wastewater Collection System Toolbox | Eliminating Sanitary ...

EPA Pesticide Factsheets

2017-04-10

Communities across the United States are working to find cost-effective, long-term approaches to managing their aging wastewater infrastructure and preventing the problems that lead to sanitary sewer overflows. The Toolbox is an effort by EPA New England to provide examples of programs and educational efforts from New England and beyond.

Nursing in Crisis

ERIC Educational Resources Information Center

Fulcher, Roxanne

2007-01-01

Both the nation's health-care and nursing education systems are in crisis. While the care provided by registered nurses (RNs) is essential to patients' recovery from acute illness and to the effective management of their chronic conditions, the United States is experiencing a nursing shortage that is anticipated to increase as baby boomers age and…

44 CFR 7.924 - Affirmative action by recipient.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Affirmative action by... Standards for Determining Age Discrimination § 7.924 Affirmative action by recipient. Even in the absence of a finding of discrimination, a recipient may take affirmative action to overcome the effects of...

41 CFR 101-8.708 - Affirmative action by recipient.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Affirmative action by... affirmative action to overcome the effects resulting in limited participation in the recipient's program or... FEDERAL FINANCIAL ASSISTANCE 8.7-Discrimination Prohibited on the Basis of Age § 101-8.708 Affirmative...

41 CFR 101-8.708 - Affirmative action by recipient.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Affirmative action by... affirmative action to overcome the effects resulting in limited participation in the recipient's program or... FEDERAL FINANCIAL ASSISTANCE 8.7-Discrimination Prohibited on the Basis of Age § 101-8.708 Affirmative...

44 CFR 7.924 - Affirmative action by recipient.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Affirmative action by... Standards for Determining Age Discrimination § 7.924 Affirmative action by recipient. Even in the absence of a finding of discrimination, a recipient may take affirmative action to overcome the effects of...

Effects of Temperature, Salinity and Seed Age on Induction of Zostera japonica Germination in North America, USA

EPA Science Inventory

Seagrasses can colonize unstructured mudflats either through clonal growth or seed germination and survival. Zostera japonica is an introduced seagrass in North America that has rapidly colonized mudflats along the Pacific Coast, leading to active management of the species. Gro...

Going Digital: The Transformation of Scholarly Communication and Academic Libraries

ERIC Educational Resources Information Center

Dunlap, Isaac Hunter

2008-01-01

Not since the age of Gutenberg has an information upheaval so thoroughly disrupted the processes of scholarly knowledge creation, management and preservation as the digital revolution currently under way. Academic libraries have traditionally been structured to effectively facilitate the access, use and storage of mostly static, print-based…

Montessori Practices: Options for a Digital Age

ERIC Educational Resources Information Center

Powell, Mark

2016-01-01

Mark Powell's plea for an open-minded view on the full scope of technology that is compatible with Montessori education enriches Maria Montessori's clear modernism of welcoming science into her educational vision. Growing up digital can be intelligently managed so that "technology may offer an effective, adaptable, and easily available means…

Disaster Management in Flash Floods in Leh (Ladakh): A Case Study

PubMed Central

Gupta, Preeti; Khanna, Anurag; Majumdar, S

2012-01-01

Background: On August 6, 2010, in the dark of the midnight, there were flash floods due to cloud burst in Leh in Ladakh region of North India. It rained 14 inches in 2 hours, causing loss of human life and destruction. The civil hospital of Leh was badly damaged and rendered dysfunctional. Search and rescue operations were launched by the Indian Army immediately after the disaster. The injured and the dead were shifted to Army Hospital, Leh, and mass casualty management was started by the army doctors while relief work was mounted by the army and civil administration. Objective: The present study was done to document disaster management strategies and approaches and to assesses the impact of flash floods on human lives, health hazards, and future implications of a natural disaster. Materials and Methods: The approach used was both quantitative as well as qualitative. It included data collection from the primary sources of the district collectorate, interviews with the district civil administration, health officials, and army officials who organized rescue operations, restoration of communication and transport, mass casualty management, and informal discussions with local residents. Results: 234 persons died and over 800 were reported missing. Almost half of the people who died were local residents (49.6%) and foreigners (10.2%). Age-wise analysis of the deaths shows that the majority of deaths were reported in the age group of 25–50 years, accounting for 44.4% of deaths, followed by the 11–25-year age group with 22.2% deaths. The gender analysis showed that 61.5% were males and 38.5% were females. A further analysis showed that more females died in the age groups <10 years and ≥50 years. Conclusions: Disaster preparedness is critical, particularly in natural disasters. The Army's immediate search, rescue, and relief operations and mass casualty management effectively and efficiently mitigated the impact of flash floods, and restored normal life. PMID:23112446

Early pregnancy failure management among family physicians.

PubMed

Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

2013-03-01

Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

Are the most dedicated nurses more vulnerable to job insecurity? Age-specific analyses on family-related outcomes.

PubMed

Ruokolainen, Mervi; Mauno, Saija; Cheng, Ting

2014-11-01

To examine the moderating roles of job dedication and age in the job insecurity-family-related well-being relationship. As job insecurity is a rather permanent stressor among nurses nowadays, more research is needed on the buffering factors alleviating its negative effects on well-being. A total of 1719 Finnish nurses representing numerous health care organisations participated in this cross-sectional study. Moderated hierarchical regression analysis was used to examine the associations. Nurses' younger age and low job dedication operated as protective factors against the negative effect of high job insecurity on parental satisfaction. The effect of job dedication on family-related well-being was also age-specific: high job dedication protected younger nurses from the negative effect of job insecurity on work-family conflict and parental stress, whereas among older nurses those who reported low job dedication showed better well-being in the presence of high job insecurity. The most job-dedicated nurses were more vulnerable to job insecurity in relation to parental satisfaction. In addition, high job dedication combined with high age implied more work-family conflict and parental stress in the presence of high job insecurity. Managers should seek to boost younger nurses' job dedication and to prevent older nurses' over-commitment. © 2013 John Wiley & Sons Ltd.

Development and evaluation of iManage: A self-management app co-designed by adolescents with sickle cell disease.

PubMed

Crosby, Lori E; Ware, Russell E; Goldstein, Alana; Walton, Ashley; Joffe, Naomi E; Vogel, Craig; Britto, Maria T

2017-01-01

Adolescents and young adults (AYAs) with sickle cell disease (SCD) are a vulnerable population with high risk of morbidity that could be decreased with effective self-management. Previous research suggests that mobile applications (apps) may facilitate AYA engagement in health-promoting behaviors. The objectives of this study were: (i) describe Internet access and use in AYA with SCD; (ii) identify barriers for self-management in this population; (iii) collaborate with AYA to co-design a mobile app that would minimize barriers; and (iv) evaluate the feasibility and acceptability of the app. In phase 1, 46 AYAs with SCD 16-24 years of age completed a survey of Internet access and use. During phase 2, 19 AYAs with SCD (average age 20 ± 2.5 years) and eight healthcare providers participated in interviews to identify barriers and co-design sessions to develop the app. In phase 3, five AYAs with SCD completed app feasibility and usability testing. AYAs with SCD had daily Internet access (69%) using their computers (84%) or mobile phones (70%). Participants went online for health information (71%) and preferred Web sites with interactive/social features (83%). Barriers to self-management included failing to believe that their health would suffer, lack of tailored self-management support, lack of a mechanism to visualize self-management progress, and limited opportunities for peer interaction around self-management. The prototype app (iManage) was rated as highly feasible and beneficial. A mobile app prototype co-designed by AYAs with SCD may be a useful tool for engaging them in self-management strategies designed to improve health. © 2016 Wiley Periodicals, Inc.

The effect of health promotion on diagnosis and management of diabetes

PubMed Central

Lee, Jinkook; Smith, James P.

2013-01-01

Background Undiagnosed disease is one of the critical public health problems in the world. In 2002 South Korean introduced the nation’s first comprehensive public health promotion policy, Health Plan 2010. The first phase of Health Plan 2010 started in 2002, promoting early detection of diseases and preventative care and continued until 2005. Methods Using the 2001 and 2005 Korean National Health and Nutrition Examination Surveys that were fielded before and after the health promotion program, we investigate changes in health care utilization and its impacts on the prevalence of diagnosed and undiagnosed diabetes as well as the good management of the disease. Results A significant rise in diabetes diagnoses has occurred during this time period, especially for those with low education and older age. We find that, during this time period, the prevalence of undiagnosed diabetes was significantly reduced especially among older and less educated Koreans, the principal targets of the program. We also find that this health promotion had significant positive effects on good management of diabetes. Conclusions The increase of preventative health care through medical check-up among less-educated, older people suggests that the implementation of free medical check-ups for age 40 and older may have a positive impact on those who had not previously used preventative care. The positive experience in South Korea indicates that similarly designed public health campaigns in other countries have enormous potential in improving the detection and management of chronic disease. PMID:21282142

The effects of patient-professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study.

PubMed

Fu, Yu; Yu, Ge; McNichol, Elaine; Marczewski, Kathryn; José Closs, S

2016-07-01

Self-management may be a lifelong task for patients with chronic back pain. Research suggests that chronic pain self-management programmes have beneficial effects on patients' health outcome. Contemporary pain management theories and models also suggest that a good patient-professional partnership enhances patients' ability to self-manage their condition. (1) To investigate whether there is a reciprocal relationship between self-management of chronic back pain and health-related quality of life (HRQoL); (2) to examine the impact of a good patient-professional partnership on HRQoL, either directly, or indirectly via change in the ability to self-manage pain. This quasi-experimental study was designed to take place during routine service appointments and conducted in a community-based pain management service in the United Kingdom. A patient-professional partnership was established in which patients were actively involved in setting up goals and developing individualised care plans. Through this, health professionals undertook patients' health needs assessment, collaborated with patients to identify specific problems, provided written materials and delivered individualised exercise based on patients' life situation. Patients were recruited following initial consultation and followed up three months later. A total of 147 patients (65% female) with a mean age of 48 years (standard deviation (SD): 14 years) were enrolled in the study. Of these, 103 subjects completed the study. Patients were included if they were aged 18 and over, suffered from chronic back pain, had opted in to the clinic and had sufficient ability to read and understand English. Patients were excluded if they opted out this service after the initial assessment, suffered from malignant pain or required acute medical interventions for their pain relief. Self-reported measures of HRQoL, patient-professional partnerships and self-management ability were collected at baseline and three months later. Pathways proposed were depicted using structural equation modelling. There was no association between patients' self-management ability and HRQoL at baseline. However, a positive direct effect was detected at three months (-0.38, p<0.01). A patient-professional partnership was not found to be beneficial for patients' HRQoL through a direct pathway, but via an indirect pathway where self-management was a mediator (-19.09, p<0.01). This study suggests that the increase in patients' self-management ability may lead to improvement in HRQoL after pain management support provided in a partnership with health professionals. A good patient-professional partnership appears to be beneficial as an augmentation to self-management practice for patients with chronic back pain. Copyright © 2016 Elsevier Ltd. All rights reserved.

Self-management improvement program combined with community involvement in Thai hypertensive population: an action research.

PubMed

Srichairattanakull, Jeamjai; Kaewpan, Wonpen; Powattana, Arpaporn; Pichayapinyo, Panan

2014-04-01

To investigate the effectiveness of a program that utilizes community involvement to improve the self-management strategies among people living with hypertension. Forty-four subjects, aged 35 to 59-year-old, with hypertension in Nakhon Pathom Province, Thailand, were randomly allocated to either an experimental group (n = 22) or a control group (n = 20). The experimental group attended a program to improve self-management methods based on social cognitive theory (SCT). The program lasted 12 weeks, consisted of 1 1/2 hours meeting once a week, including group meetings and home visit monitoring. Mann-Whitney U test and Friedman test were employed to analyze the program's effectiveness. After the program, the mean rank of the perceived self-efficacy for the self-management strategies was statistically different between the two groups (p = 0.023). In the experimental group, after the twelve week, the mean rank of perceived self-efficacy and outcome expectancy increased and diastolic blood pressure decreased after the eight week. The program applied social cognitive theory (SCT) to promote self-management techniques, increased the health promoting behavior among hypertensive people.

Trajectories of Family Management Practices and Early Adolescent Behavioral Outcomes

PubMed Central

Wang, Ming-Te; Dishion, Thomas J.; Stormshak, Elizabeth A.; Willett, John B.

2013-01-01

Stage– environment fit theory was used to examine the reciprocal lagged relations between family management practices and early adolescent problem behavior during the middle school years. In addition, the potential moderating roles of family structure and of gender were explored. Hierarchical linear modeling was used to describe patterns of growth in family management practices and adolescents’ behavioral outcomes and to detect predictors of interindividual differences in initial status and rate of change. The sample comprised approximately 1,000 adolescents between ages 11 years and 15 years. The results indicated that adolescents’ antisocial behaviors and substance use increased and their positive behavioral engagement decreased over time. As adolescent age increased, parental knowledge of their adolescent’s activities decreased, as did parental rule making and support. The level and rate of change in family management and adolescent behavioral outcomes varied by family structure and by gender. Reciprocal longitudinal associations between parenting practices and adolescent problem behavior were found. Specifically, parenting practices predicted subsequent adolescent behavior, and adolescent behavior predicted subsequent parenting practices. In addition, parental warmth moderated the effects of parental knowledge and rule making on adolescent antisocial behavior and substance use over time. PMID:21688899

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.

Risk factors associated with Cryptosporidium parvum infection in dairy cattle in southeastern New York State.

PubMed

Mohammed, H O; Wade, S E; Schaaf, S

1999-06-01

An observational analytical epidemiologic study was carried out to identify factors associated with the risk of infection with Cryptosporidium parvum in dairy herds in southeastern New York state. A random sample of 2943 cattle on 109 farms was selected from the target population. Fecal samples were collected from animals in three different age groups and examined for the presence of C. parvum using a quantitative centrifugation concentration flotation method. Data on intrinsic, preweaning, postweaning, maternity, and general management factors were collected and evaluated for their association with the risk of infection with C. parvum. Indices for each of these categories of management were developed from factors significantly associated with the risk of infection with C. parvum. Significant factors were identified using the logistic regression statistical technique. A final analysis, including the indices, age, and season, was performed to identify factors significantly associated with the risk of infection with C. parvum while simultaneously controlling for the effect of other factors. The farm effect was evaluated using a mixed effect model. Preweaning factors found to be significantly associated with a decreased risk of infection were: use of ventilation in calf rearing areas, daily addition of bedding, feeding of milk replacer, daily disposal and cleaning of bedding, and use of antibiotics. Postweaning factors such as moving of the animals after weaning, cleaning of soiled bedding, and use of antibiotics and ionophores as preventive measures were significantly associated with the decreased risk of an infection with C. parvum. Consideration of maternity management factors showed that winter housing of cows individually within 2 months of calving, use of fresh colostrum to feed calves, and having a concrete floor in the calving area were significantly associated with decreased risk of C. parvum infection. The total number of dairy cattle, total number of other species of agricultural animals on the farm, and the distance of the barn water source from the septic system were found to be significantly associated with increased risk of C. parvum infection. In the final analysis, the risk of infection with C. parvum was significantly decreased with an increased value of the maternity management index score. The general management significantly affected the risk of infection with C. parvum where the risk increased with the increase of the value of the index. The risk of infection significantly decreased with increase in the age of the animal.

Assessing Treatment Effects of Inhaled Corticosteroids on Medical Expenses and Exacerbations among COPD Patients: Longitudinal Analysis of Managed Care Claims

PubMed Central

Akazawa, Manabu; Stearns, Sally C; Biddle, Andrea K

2008-01-01

Objective To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD). Data Sources Claims between 1997 and 2005 from a large managed care database. Study Design Individual-level, fixed-effects regression models estimated the effects of initiating ICS on medical expenses and likelihood of severe exacerbation. Bootstrapping provided estimates of the incremental cost per severe exacerbation avoided. Data Extraction Methods COPD patients aged 40 or older with ≥15 months of continuous eligibility were identified. Monthly observations for 1 year before and up to 2 years following initiation of bronchodilators were constructed. Principal Findings ICS treatment reduced monthly risk of severe exacerbation by 25 percent. Total costs with ICS increased for 16 months, but declined thereafter. ICS use was cost saving 46 percent of the time, with an incremental cost-effectiveness ratio of $2,973 per exacerbation avoided; for patients ≥50 years old, ICS was cost saving 57 percent of time. Conclusions ICS treatment reduces exacerbations, with an increase in total costs initially for the full sample. Compared with younger patients with COPD, patients aged 50 or older have reduced costs and improved outcomes. The estimated cost per severe exacerbation avoided, however, may be high for either group because of uncertainty as reflected by the large standard errors of the parameter estimates. PMID:18671750

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation

PubMed Central

Jit, Mark; Stagg, Helen R; Aldridge, Robert W; White, Peter J

2011-01-01

Objective To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Design Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. Setting London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London’s enhanced tuberculosis surveillance system. Main outcome measures Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. Results The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10 000/QALY gained (about €7300-€11 000 or $10 000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18 000-£26 000/QALY gained; case management support team, £4100-£6800/QALY gained). Conclusions Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance. PMID:22067473

Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation.

PubMed

Jit, Mark; Stagg, Helen R; Aldridge, Robert W; White, Peter J; Abubakar, Ibrahim

2011-09-14

To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system. Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10,000/QALY gained (about €7300-€11,000 or $10,000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18,000-£26,000/QALY gained; case management support team, £4100-£6800/QALY gained). Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.

Sickness absence trends after loss control management

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

Tabaluyan, T.; Kuswadji, S.

1996-12-31

To assess the influence of loss control management programs applied in an oil and gas company to sickness absence trends. After the implementation of loss control management programs in 1990, sickness absence records in 1991, 1992 and 1993 were studied. International Safety Rating System (ISRS) management elements were audited each year. Absence parameter used were sickness frequency, mean sickness days examined by employee group age, length of service, work schedule and work location. Although frequency of sickness absences remain unchanged, there was a marked decrease of mean days per absence for certain worker groups. The effects were true among agemore » group 40-49 years, service group 15-19 years, service group 20-24 years and office workers. Shorter sickness absences among certain group of employees was noted following implementation of loss control management programs.« less

Does aging make employees more resilient to job stress? Age as a moderator in the job stressor-well-being relationship in three Finnish occupational samples.

PubMed

Mauno, Saija; Ruokolainen, Mervi; Kinnunen, Ulla

2013-01-01

This study examined whether an employee's age moderates the relationships between job stressors (i.e. job insecurity, workload, work-family conflict) and self-rated well-being (i.e. work-family enrichment, life satisfaction, job satisfaction, vigor at work). Analysis of covariance and moderated hierarchical regression analysis were used to examine the cross-sectional Finnish data collected among service sector employees (N = 1037), nurses (N = 1719), and academic employees (N = 945). In a situation of high job insecurity, the younger nurses reported higher work-family enrichment, job satisfaction, and vigor compared to their older colleagues. A similar result was also found among the service sector workers in relation to vigor at work. Thus, young age buffered against negative outcomes related to job insecurity. Moreover, older age buffered against the negative effect of high workload on job satisfaction among the service sector and against high work-family conflict on life satisfaction among the academic employees. More attention should be paid to the ability of younger employees to manage problems related to work-family imbalance and high workload, and to older employees' ability to cope with job insecurity. The findings of this study recommend different stress management interventions for older and younger employees.

Space age management for social problems

NASA Technical Reports Server (NTRS)

Levine, A. L.

1973-01-01

Attempts to apply space age management to social problems were plagued with difficulties. Recent experience in the State of Delaware and in New York City, however, indicate new possibilities. Project management as practiced in NASA was applied with promising results in programs dealing with housing and social services. Such applications are feasible, according to recent research, because project management utilizes social and behavioral approaches, as well as advanced management tools, such as PERT, to achieve results.

A prospective survey of chiropractic student experiences with pediatric care and variability of case mix while on clinical placement in Rarotonga.

PubMed

Todd, Angela J; Carroll, Matthew T; Russell, David G; Mitchell, Eleanor K L

2017-03-01

To compare chiropractic students' perceptions of preparedness for practice before and after a clinical placement in Rarotonga and to report demographics from these experiences. The students completed deidentified pre- and postplacement surveys assessing pediatric practice preparedness. Students tallied the patient numbers, age, and chiropractic techniques used per visit for each day of clinic placement. On completion of the program, participating students (27/34, or 79% of the student cohort) did a postplacement survey on their perception of practice preparedness. Data were analyzed with the Spearman rho correlation, the Mann-Whitney U test, and regression analysis. There was an increase in perceived preparedness for pediatric practice, ranging from 24.1% of the student cohort at the start of the study to 82.1% following clinical placement in Rarotonga. The change in student preparedness to practice with children was positively correlated with the total number of children managed (r s = .05, p = .01) and the number of children managed who were under 10 years of age (r s = .60, p = .001). Multiple regression analysis demonstrated a medium positive effect for postprogram preparedness (F [4, 20] = 3.567, p = .024). Clinical outreach to Rarotonga provided a broad case mix of patients and a change in student perceptions of preparedness to practice with children, which was positively affected by the total number of children managed and the number of children managed who were under 10 years of age.

One-year postpartum outcomes following a weight management intervention in pregnant women with obesity

PubMed Central

Vesco, Kimberly K.; Leo, Michael C.; Karanja, Njeri; Gillman, Matthew W.; McEvoy, Cindy T.; King, Janet C.; Eckhardt, Cara L.; Smith, K. Sabina; Perrin, Nancy; Stevens, Victor J.

2016-01-01

Objective This analysis focuses on 1-year maternal and infant follow-up of a randomized trial that tested a weight management intervention conducted during pregnancy. Methods We randomly assigned 114 women with obesity (mean BMI 36.7 kg/m2) at a mean of 15 weeks’ gestation to a weight management intervention or usual care control condition. The intervention ended at delivery and resulted in less gestational weight gain and a lower proportion of large-for-gestational age newborns among intervention compared to control participants. The primary outcome at 12 months postpartum was maternal weight. Secondary outcomes included infant weight-for-age and weight-for-length z-scores. Results At 1 year, mothers in the intervention group weighed 96.3±18.6 kg, and in the control group, 99.7±19.2 kg. There was no significant difference between groups in change in weight from randomization to 1-year postpartum (b=-0.47, 95% CI [-4.03, 3.08]. There was a significant main effect of group for infant weight-for-age z-score (b=-0.40, 95% CI [-0.75,-0.05]) but not infant weight-for-length z-scores (b=-0.20, 95% CI [-0.59,0.20]. Conclusions A gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1-year postpartum. Future studies may be warranted to determine if extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes. PMID:27670399

WITHDRAWN: Hypnosis for children undergoing dental treatment.

PubMed

Al-Harasi, Sharifa; Ashley, Paul F; Moles, David R; Parekh, Susan; Walters, Val

2017-06-20

Managing children is a challenge that many dentists face. Many non-pharmacological techniques have been developed to manage anxiety and behavioural problems in children, such us: 'tell, show & do', positive reinforcement, modelling and hypnosis. The use of hypnosis is generally an overlooked area, hence the need for this review. This systematic review attempted to answer the question: What is the effectiveness of hypnosis (with or without sedation) for behaviour management of children who are receiving dental care in order to allow successful completion of treatment?Null hypothesis: Hypnosis has no effect on the outcome of dental treatment of children. We searched the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE (OVID), EMBASE (OVID), and PsycINFO. Electronic and manual searches were performed using controlled vocabulary and free text terms with no language restrictions. Date of last search: 11th June 2010. All children and adolescents aged up to 16 years of age. Children having any dental treatment, such as: simple restorative treatment with or without local anaesthetic, simple extractions or management of dental trauma. Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The methodological quality of randomised controlled trials (RCTs) was assessed using the criteria described in the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2. Only three RCTs (with 69 participants) fulfilled the inclusion criteria. Statistical analysis and meta-analysis were not possible due to insufficient number of studies. Although there are a considerable number of anecdotal accounts indicating the benefits of using hypnosis in paediatric dentistry, on the basis of the three studies meeting the inclusion criteria for this review there is not yet enough evidence to suggest its beneficial effects.

Factors that influence public awareness of domestic waste characteristics and management in rural areas.

PubMed

Han, Zhiyong; Duan, Qingqing; Fei, Yongqiang; Zeng, Dan; Shi, Guozhong; Li, Haimei; Hu, Meilun

2018-05-01

Public awareness of domestic waste characteristics and management (PADWCM) is a prerequisite for a domestic waste management (DWM) plan. In this study, we considered China as a typical example of developing countries to investigate the public perception of environmental pollution (PEP), its PADWCM, and its socioeconomic factors, using questionnaires and statistical methods. The results indicated that the public PEP was mainly due to obvious environmental contamination in local villages, and the PADWCM is still inadequate in rural areas. However, 83.9% of the respondents agreed that DWM is highly necessary. The PADWCM, including the hazard, recyclability, and characteristic pollution caused by domestic waste, was learned mainly from people's direct PEP, experiences, and repurchasing by recyclers. Education period had highly significant positive correlations and regressions with PEP and PADWCM, respectively. Additionally, education directly affected public awareness in different income and age groups. Demonstration projects had a significant positive effect on the awareness of characteristic pollution caused by domestic waste, which was readily perceived. Propaganda had a significant positive influence on the awareness of treatment necessity. Age and gender had no obvious effects on public PEP and PADWCM. Some aspects of PADWCM requiring a deep understanding became stronger as income increased; however, the PADWCM located close to poor people became weaker. Some aspects of PEP could significantly influence the awareness of characteristic pollution caused by domestic waste and awareness of treatment necessity. Therefore, improving environmental education, performing demonstration projects and effective environmental propaganda, increasing people's income, and attracting young people to participate in DWM will be important for enhancing environmental awareness and DWM in rural areas. Integr Environ Assess Manag 2018;14:395-406. © 2018 SETAC. © 2018 SETAC.

Using best practice to create a pathway to improve management of irritable bowel syndrome: aiming for timely diagnosis, effective treatment and equitable care.

PubMed

Williams, Marianne; Barclay, Yvonne; Benneyworth, Rosie; Gore, Steve; Hamilton, Zoe; Matull, Rudi; Phillips, Iain; Seamark, Leah; Staveley, Kate; Thole, Steve; Greig, Emma

2016-10-01

Irritable bowel syndrome (IBS) costs the National Health Service almost £12 million per annum. Despite national guidelines advising primary care management, these have failed to stem secondary care referrals of patients with likely IBS for unnecessary and costly assessment and investigation without necessarily achieving resolution of their symptoms. In 2011, an integrated team from primary and secondary care developed a business case using baseline data to create a Somerset-wide IBS pathway using Clinical Commissioning Group funding. This provided face-to-face general practitioners (GP) education, developed a diagnostic pathway and funded faecal calprotectin (FC) testing to exclude inflammatory pathology for patients aged 16-45 years with likely IBS and no alarm symptoms. For those with FC≤50 μg/g, we provided a management algorithm and community-based dietetic treatment. Audit results measured usage and outcomes from FC testing, changes in patterns and costs of new patients reviewed in gastroenterology outpatients and dietetic IBS treatment outcomes. The proportion of new patient slots used reduced from 14.3% to 8.7% over 10 months while overall costs reduced by 25% for patients with no alarm symptoms and likely IBS aged 16-45 years. FC results confirmed research findings with no inflammatory pathology, if FC≤50 μg/g over 2 years. 63% of patients had satisfactory control of their IBS after specialist dietetic input with 74% reporting improved quality of life. The combination of GP education, providing diagnosis and management pathways, using FC to exclude inflammatory pathology and providing an effective treatment for patients with likely IBS appeared successful in our pilot. This proved cost-effective, reduced secondary care involvement and improved patient care.

Impact of telemedicine in managing type 1 diabetes among school-age children and adolescents: an integrative review.

PubMed

Guljas, Rebecca; Ahmed, Azza; Chang, Karen; Whitlock, Analei

2014-01-01

Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents. Copyright © 2014 Elsevier Inc. All rights reserved.

The role of epigenetics in cardiovascular health and ageing: A focus on physical activity and nutrition.

PubMed

Wallace, Robert G; Twomey, Laura C; Custaud, Marc-Antoine; Turner, Jonathan D; Moyna, Niall; Cummins, Philip M; Murphy, Ronan P

2017-11-16

The cardiovascular system is responsible for transport of blood and nutrients to tissues, and is pivotal to the physiological health and longevity. Epigenetic modification is a natural, age-associated process resulting in highly contextualised gene expression with clear implications for cell differentiation and disease onset. Biological/epigenetic age is independent of chronological age, constituting a highly reflective snapshot of an individual's overall health. Accelerated vascular ageing is of major concern, effectively lowering disease threshold. Age-related chronic illness involves a complex interplay between many biological processes and is modulated by non-modifiable and modifiable risk factors. These alter the static genome by a number of epigenetic mechanisms, which change gene expression in an age and lifestyle dependent manner. This 'epigenetic drift' impacts health and contributes to the etiology of chronic illness. Lifestyle factors may cause acceleration of this epigenetic "clock", pre-disposing individuals to cardiovascular disease. Nutrition and physical activity are modifiable lifestyle choices, synergistically contributing to cardiovascular health. They represent a powerful potential epigenetic intervention point for effective cardiovascular protective and management strategies. Thus, together with traditional risk factors, monitoring the epigenetic signature of ageing may prove beneficial for tailoring lifestyle to fit biology - supporting the increasingly popular concept of "ageing well". Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of Time Management Behaviors and Its Related Factors in the Senior Nurse Managers, Kermanshah-Iran

PubMed Central

Ziapour, Arash; Khatony, Alireza; Jafari, Faranak; Kianipour, Neda

2015-01-01

Background and Objective: Time management is an extensive concept that is associated with promoting the performance of managers. The present study was carried out to investigate the time management behaviors along with its related factors among senior nurse mangers. Materials and Methods: In this descriptive-analytical study, 180 senior nurse managers were selected using census method. The instrument for data collection was a standard time behavior questionnaire. Data were analyzed by descriptive and analytical statistics. Results: The findings showed that among the dimensions of time management behaviors, setting objectives and prioritization, and mechanics of time management dimensions obtained the highest and lowest frequency, respectively. Comparison of the mean scores of time management behaviors indicated a significant difference in the gender (p<0.05), age (p<0.001), education (p=0.015), job experience (p<0.001), managerial experience (p<0.001) and management rank management (p<0.029). Conclusion: On the whole, senior nurse managers enjoyed a favorable time management skill. Given the importance of time management behaviors, it seems that teaching these behaviors more seriously through regular educational programs can effectively promote the performance of senior nurse managers. PMID:25716413

Nurses' perception of their manager's leadership style and unit climate: are there generational differences?

PubMed

Farag, Amany A; Tullai-McGuinness, Susan; Anthony, Mary K

2009-01-01

To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager's leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. Nurse manager's might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.

Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature

PubMed Central

Johnson, Liza-Marie; Church, Christopher L.; Gomez-Garcia, Wendy C.; Popescu, Marcela I.; Margolin, Judith F.; Ribeiro, Raul C.

2014-01-01

The usual age range of acute lymphoblastic malignancies (acute lymphoblastic leukemia and advanced-stage lymphoblastic lymphoma) includes teenagers and young adults (<22 years of age) and coincides with the age of fertility. Concurrence of acute lymphoblastic malignancy with pregnancy is therefore most likely to happen during the younger childbearing ages. However, the therapeutic challenges posed by the dual diagnosis of lymphoblastic malignancy and pregnancy have not specifically been studied in the context of age, and management guidelines for pregnant young patients are lacking. Inconsistency in defining the legal decision-making rights of pregnant teenaged patients adds a further level of complexity in this age group. Management of this challenging combination in the young patient therefore entails unique ethical considerations. Here we present two illustrative cases of teenage pregnancy complicated by acute lymphoblastic malignancy, review the available literature, and offer suggestions for the therapeutic management of such cases in adolescent and young adult patients. Importantly, practical management recommendations are provided in the context of clinical ethics principles that are universally applicable, including in developing countries, where the highest incidence of adolescent pregnancies has been documented. PMID:25538861

[Drug management for coronary artery disease in the elderly].

PubMed

Meune, C

2006-11-01

The incidence of side effects increases dramatically with age. It is estimated that almost one third of side effects could be avoided by an appropriate prescription. On the other hand, age is the main factor associated to the non-prescription of major pharmacological classes, which have evidenced their efficacy in younger patients with coronary artery disease. The estimation of the benefit/risk ratio is therefore highly important in the old/very old patient. It seems important to integrate the results of studies and registries including old patients, evidencing the efficacy of the majority of pharmacological classes validated in younger patients, especially antiplatelets, beta-blockers and statins. The assessment of the benefit/risk ratio should also take into account the tolerance profile of the drug and the patient. The prescription should be adapted to the "age-related" changes of pharmacokinetics and pharmacodynamics.

Silvicultural systems for managing ponderosa pine

Treesearch

Andrew Youngblood

2005-01-01

Silviculturists have primarily relied on classical even-aged silvicultural systems (the planned series of treatments for tending, harvesting, and re-establishing a stand) for ponderosa pine, with uneven-aged systems used to a lesser degree. Current management practices involve greater innovation because of conflicting management objectives. Silvicultural systems used...

Environmental Change and Disease Dynamics: Effects of Intensive Forest Management on Puumala Hantavirus Infection in Boreal Bank Vole Populations

PubMed Central

Voutilainen, Liina; Savola, Sakeri; Kallio, Eva Riikka; Laakkonen, Juha; Vaheri, Antti; Vapalahti, Olli; Henttonen, Heikki

2012-01-01

Intensive management of Fennoscandian forests has led to a mosaic of woodlands in different stages of maturity. The main rodent host of the zoonotic Puumala hantavirus (PUUV) is the bank vole (Myodes glareolus), a species that can be found in all woodlands and especially mature forests. We investigated the influence of forest age structure on PUUV infection dynamics in bank voles. Over four years, we trapped small mammals twice a year in a forest network of different succession stages in Northern Finland. Our study sites represented four forest age classes from young (4 to 30 years) to mature (over 100 years) forests. We show that PUUV-infected bank voles occurred commonly in all forest age classes, but peaked in mature forests. The probability of an individual bank vole to be PUUV infected was positively related to concurrent host population density. However, when population density was controlled for, a relatively higher infection rate was observed in voles trapped in younger forests. Furthermore, we found evidence of a “dilution effect” in that the infection probability was negatively associated with the simultaneous density of other small mammals during the breeding season. Our results suggest that younger forests created by intensive management can reduce hantaviral load in the environment, but PUUV is common in woodlands of all ages. As such, the Fennoscandian forest landscape represents a significant reservoir and source of hantaviral infection in humans. PMID:22745755

Effect of surfactant and partial liquid ventilation treatment on gas exchange and lung mechanics in immature lambs: influence of gestational age.

PubMed

Rey-Santano, Carmen; Mielgo, Victoria; Gastiasoro, Elena; Valls-i-Soler, Adolfo; Murgia, Xabier

2013-01-01

Surfactant (SF) and partial liquid ventilation (PLV) improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored. Experimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital. Prospective, randomized study using sealed envelopes. 36 preterm lambs were exposed (at 125 or 133-days of gestational age) by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery. All the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV), surfactant (Curosurf®, 200 mg/kg) or (3) no pulmonary treatment (Controls) for 3 h. Cardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters. SF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent.

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients.

PubMed

Fenny, Ama P; Hansen, Kristian S; Enemark, Ulrika; Asante, Felix A

2014-07-24

The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana's three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients' age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective management of the disease demands proper diagnosis and treatment and therefore facilities need to be adequately supplied with RDTs or be equipped with well functioning laboratories to provide adequate testing.

Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients

PubMed Central

2014-01-01

Introduction The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. Method A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana’s three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Results Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients’ age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Conclusion Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective management of the disease demands proper diagnosis and treatment and therefore facilities need to be adequately supplied with RDTs or be equipped with well functioning laboratories to provide adequate testing. PMID:25056139

Psychosocial Issues in Acne Management: Disease Burden, Treatment Adherence, and Patient Support.

PubMed

Zaenglein, Andrea L

2015-09-01

Physical and emotional scarring are equally important burdens of acne vulgaris in patients of any age. Effective therapeutic regimens are readily available, and the consistent and correct use of these medications results in effective disease management, reduced risk for scarring, as well as improvement in various factors that affect quality of life. Nevertheless, adherence to treatment recommendations generally is poor. Clinicians can help improve adherence with a variety of strategies, including counseling, education, and choosing treatment options that are most consistent with a patient's lifestyle. Semin Cutan Med Surg 34(supp5):S92-S94 © 2015 published by Frontline Medical Communications. 2015 published by Frontline Medical Communications.

[Experience of the surgical management of the esophageal achalasia in a tertiary care hospital].

PubMed

Barajas-Fregoso, Elpidio Manuel; Romero-Hernández, Teodoro; Sánchez-Fernández, Patricio Rogelio; Fuentes-Orozco, Clotilde; González-Ojeda, Alejandro; Macías-Amezcua, Michel Dassaejv

2015-01-01

Achalasia is a primary esophageal motor disorder. The most common symptoms are: dysphagia, chest pain, reflux and weight loss. The esophageal manometry is the standard for diagnosis. The aim of this paper is to determine the effectiveness of the surgical management in patients with achalasia in a tertiary care hospital. A case series consisting of achalasia patients, treated surgically between January and December of 2011. Clinical charts were reviewed to obtain data and registries of the type of surgical procedure, morbidity and mortality. Fourteen patients were identified, with an average age of 49.1 years. The most common symptoms were: dysphagia, vomiting, weight loss and pyrosis. Eight open approaches were performed and six by laparoscopy, with an average length of cardiomyotomy of 9.4 cm. Eleven patients received an antireflux procedure. The effectiveness of procedures performed was 85.7 %. Surgical management offered at this tertiary care hospital does not differ from that reported in other case series, giving effectiveness and safety for patients with achalasia.

Entrepreneurial stressors as predictors of entrepreneurial burnout.

PubMed

Wei, Xueyan; Cang, Shuangxin; Hisrich, Robert D

2015-02-01

Research on the effects of entrepreneurial stressors is limited, especially regarding its relation to the burnout that frequently occurs in the process of starting and growing a venture. The effect of the role of entrepreneurial stressors (workload, competitive comparison, demands-of-knowledge, managing responsibility, and resource requirements) on burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) was examined in a Chinese sample of entrepreneurs. Entrepreneurial stressors emerged as a significant predictor of burnout in the process of entrepreneurship in a sample of 289 entrepreneurs (63.8% men; M age = 26.2 yr.; 39.6% of their parents have been self-employed). The findings clarify the functional relationship between entrepreneurial stressors and burnout. Entrepreneurial stressors played multiple roles. Managing responsibility was an active contributor to the sense of achievement and to emotional exhaustion. Workload was an active contributor to emotional exhaustion. Demands-of-knowledge negatively affected three of the dimensions of burnout. Theoretical and practical implications for management of the effect of these relationships are discussed.

Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study.

PubMed

Epstein, David; Bojke, Laura; Sculpher, Mark J

2009-07-14

To describe the long term costs, health benefits, and cost effectiveness of laparoscopic surgery compared with those of continued medical management for patients with gastro-oesophageal reflux disease (GORD). We estimated resource use and costs for the first year on the basis of data from the REFLUX trial. A Markov model was used to extrapolate cost and health benefit over a lifetime using data collected in the REFLUX trial and other sources. The model compared laparoscopic surgery and continued proton pump inhibitors in male patients aged 45 and stable on GORD medication. Laparoscopic surgery versus continued medical management. We estimated quality adjusted life years and GORD related costs to the health service over a lifetime. Sensitivity analyses considered other plausible scenarios, in particular size and duration of treatment effect and the GORD symptoms of patients in whom surgery is unsuccessful. Main results The base case model indicated that surgery is likely to be considered cost effective on average with an incremental cost effectiveness ratio of pound2648 (euro3110; US$4385) per quality adjusted life year and that the probability that surgery is cost effective is 0.94 at a threshold incremental cost effectiveness ratio of pound20 000. The results were sensitive to some assumptions within the extrapolation modelling. Surgery seems to be more cost effective on average than medical management in many of the scenarios examined in this study. Surgery might not be cost effective if the treatment effect does not persist over the long term, if patients who return to medical management have poor health related quality of life, or if proton pump inhibitors were cheaper. Further follow-up of patients from the REFLUX trial may be valuable. ISRCTN15517081.

Neonatal pain

PubMed Central

Walker, Suellen M

2014-01-01

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback. PMID:24330444

An Australasian model license reassessment procedure for identifying potentially unsafe drivers.

PubMed

Fildes, Brian N; Charlton, Judith; Pronk, Nicola; Langford, Jim; Oxley, Jennie; Koppel, Sjaanie

2008-08-01

Most licensing jurisdictions in Australia currently employ age-based assessment programs as a means to manage older driver safety, yet available evidence suggests that these programs have no safety benefits. This paper describes a community referral-based model license re assessment procedure for identifying and assessing potentially unsafe drivers. While the model was primarily developed for assessing older driver fitness to drive, it could be applicable to other forms of driver impairment associated with increased crash risk. It includes a three-tier process of assessment, involving the use of validated and relevant assessment instruments. A case is argued that this process is a more systematic, transparent and effective process for managing older driver safety and thus more likely to be widely acceptable to the target community and licensing authorities than age-based practices.

Managing Sarcopenia and Its Related-Fractures to Improve Quality of Life in Geriatric Populations

PubMed Central

Hida, Tetsuro; Harada, Atsushi; Imagama, Shiro; Ishiguro, Naoki

2014-01-01

Sarcopenia, an aging-induced generalized decrease in muscle mass, strength, and function, is known to affect elderly individuals by decreasing mobile function and increasing frailty and imbalance that lead to falls and fragile fractures. Sarcopenia is a known risk factor for osteoporotic fractures, infections, and early death in some specific situations. The number of patients with sarcopenia is estimated to increase to 500 million people in the year 2050. Sarcopenia is believed to be caused by multiple factors such as disuse, malnutrition, age-related cellular changes, apoptosis, and genetic predisposition; however, this remains to be determined. Various methods have been developed, but no safe or effective treatment has been found to date. This paper is a review on the association between sarcopenia and its related-fractures and their diagnoses and management methods to prevent fractures. PMID:25110607

Validation of a contemporary adherence measure for children with Type 1 diabetes: the Diabetes Management Questionnaire

PubMed Central

Mehta, S. N.; Nansel, T. R.; Volkening, L. K.; Butler, D. A.; Haynie, D. L.; Laffel, L. M. B.

2016-01-01

Aims To evaluate the psychometric properties of the Diabetes Management Questionnaire, a brief, self-report measure of adherence to contemporary diabetes management for young people with Type 1 diabetes and their caregivers. Methods A total of 273 parent-child dyads completed parallel versions of the Diabetes Management Questionnaire. Eligible children (aged 8–18 years) had Type 1 diabetes for ≥1 year. A multidisciplinary team designed the Diabetes Management Questionnaire as a brief, self-administered measure of adherence to Type 1 diabetes management over the preceding month; higher scores reflect greater adherence. Psychometrics were evaluated for the entire sample and according to age of the child. Results The children (49% female) had a mean ± SD (range) age 13.3 ± 2.9 (8–18) years and their mean ± SD HbA1c was 71 ± 15 mmol/mol (8.6 ± 1.4%). Internal consistency was good for parents (α = 0.83) and children (a = 0.79). Test-retest reliability was excellent for parents (intraclass correlation coefficient =0.83) and good for children (intraclass correlation coefficient = 0.65). Parent and child scores had moderate agreement (intraclass correlation coefficient = 0.54). Diabetes Management Questionnaire scores were inversely associated with HbA1c (parents: r = –0.41, P < 0.0001; children: r = –0.27, P < 0.0001). Psychometrics were stronger in the children aged ≥13 years compared with those aged < 13 years, but were acceptable in both age groups. Mean ± SD Diabetes Management Questionnaire scores were higher among children who were receiving insulin pump therapy (n = 181) than in children receiving multiple daily injections (n = 92) according to parent (75.9 ± 11.8 vs. 70.5 ± 15.5; P = 0.004) and child report (72.2 ± 12.1 vs. 67.6 ± 13.9; P = 0.006). Conclusions The Diabetes Management Questionnaire is a brief, valid self-report measure of adherence to contemporary diabetes self-management for people aged 8–18 years who are receiving either multiple daily injections or insulin pump therapy. PMID:26280463

POLICY IMPLICATIONS OF ADJUSTING RANDOMIZED TRIAL DATA FOR ECONOMIC EVALUATIONS: A DEMONSTRATION FROM THE ASCUS-LSIL TRIAGE STUDY

PubMed Central

Campos, Nicole G.; Castle, Philip E.; Schiffman, Mark; Kim, Jane J.

2013-01-01

Background Although the randomized controlled trial (RCT) is widely considered the most reliable method for evaluation of health care interventions, challenges to both internal and external validity exist. Thus, the efficacy of an intervention in a trial setting does not necessarily represent the real-world performance that decision makers seek to inform comparative effectiveness studies and economic evaluations. Methods Using data from the ASCUS-LSIL Triage Study (ALTS), we performed a simplified economic evaluation of age-based management strategies to detect cervical intraepithelial neoplasia grade 3 (CIN3) among women who were referred to the study with low-grade squamous intraepithelial lesions (LSIL). We used data from the trial itself to adjust for 1) potential lead time bias and random error that led to variation in the observed prevalence of CIN3 by study arm, and 2) potential ascertainment bias among providers in the most aggressive management arm. Results We found that using unadjusted RCT data may result in counterintuitive cost-effectiveness results when random error and/or bias are present. Following adjustment, the rank order of management strategies changed for two of the three age groups we considered. Conclusion Decision analysts need to examine study design, available trial data and cost-effectiveness results closely in order to detect evidence of potential bias. Adjustment for random error and bias in RCTs may yield different policy conclusions relative to unadjusted trial data. PMID:22147881

Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms.

PubMed

Hogendoorn, Wouter; Lavida, Anthi; Hunink, M G Myriam; Moll, Frans L; Geroulakos, George; Muhs, Bart E; Sumpio, Bauer E

2015-06-01

Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and CONS for the treatment of SAAs. A decision analysis model was developed using TreeAge Pro 2013 software (TreeAge Inc, Williamstown, Mass) to evaluate the cost-effectiveness of the different treatments for SAAs. A hypothetical cohort of 10,000 55-year-old female patients with SAAs was assessed in the reference-case analysis. Perioperative mortality, disease-specific mortality rates, complications, rupture risks, and reinterventions were retrieved from a recent and extensive meta-analysis. Costs were analyzed with the 2014 Medicare database. The willingness to pay was set to $60,000/quality-adjusted life years (QALYs). Outcomes evaluated were QALYs, costs from the health care perspective, and the incremental cost-effectiveness ratio (ICER). Extensive sensitivity analyses were performed and different clinical scenarios evaluated. Probabilistic sensitivity analysis was performed to include the uncertainty around the variables. A flowchart for clinical decision-making was developed. For a 55-year-old female patient with a SAA, EV has the highest QALYs (11.32; 95% credibility interval [CI], 9.52-13.17), followed by OPEN (10.48; 95% CI, 8.75-12.25) and CONS (10.39; 95% CI, 8.96-11.87). The difference in effect for 55-year-old female patients between EV and OPEN is 0.84 QALY (95% CI, 0.42-1.34), comparable with 10 months in perfect health. EV is more effective and less costly than OPEN and more effective and more expensive compared with CONS, with an ICER of $17,154/QALY. Moreover, OPEN, with an ICER of $223,166/QALY, is not cost-effective compared with CONS. In elderly individuals (age >78 years), the ICER of EV vs CONS is $60,503/QALY and increases further with age, making EV no longer cost-effective. Very elderly patients (age >93 years) have higher QALYs and lower costs when treated with CONS. The EV group has the highest number of expected reinterventions, followed by CONS and OPEN, and the number of expected reinterventions decreases with age. EV is the most cost-effective treatment for most patient groups with SAAs, independent of the sex and risk profile of the patient. EV is superior to OPEN, being both cost-saving and more effective in all age groups. Elderly patients should be considered for CONS, based on the high costs in relation to the very small gain in health when treated with EV. The very elderly should be treated with CONS. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Emerging adulthood and Type 1 diabetes: insights from the DAWN2 Study.

PubMed

Vallis, M; Willaing, I; Holt, R I G

2018-02-01

To compare clinical, psychological, education and social variables in emerging adults (aged 18-30 years) with Type 1 diabetes with their adult counterparts aged >30 years. A single assessment multinational sample was surveyed as part of the larger second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Participants completed a series of surveys incorporating demographic as well as clinical questions (comorbidities, hypoglycaemia) and validated self-report scales concerning psychosocial (health impact, quality of life, beliefs and attitudes, self-management behaviours, healthcare experience and family support) and diabetes education factors. Emerging adults differed from adults aged >30 years with regard to a number of psychosocial variables. Emerging adults reported better overall quality of life, social support and support from their healthcare team compared with adults aged >30 years of age; however, emerging adults experienced greater diabetes-specific distress and were less engaged in self-management. Diabetes education was related to a number of indicators, while experience of discrimination was harmful, but these impacts did not differ between emerging adults and adults aged >30 years. An analysis of geographical regions suggested that emerging adults in North America and Europe had better well-being than older adults, while the opposite was observed in Asia. Emerging adults, particularly those in the later phase (ages 25-30 years) are especially at risk in terms of diabetes-specific distress. There is a need for novel interventions to meet the needs of these vulnerable emerging adults more effectively. © 2017 Diabetes UK.

Observer aging and long-term avian survey data quality

PubMed Central

Farmer, Robert G; Leonard, Marty L; Mills Flemming, Joanna E; Anderson, Sean C

2014-01-01

Long-term wildlife monitoring involves collecting time series data, often using the same observers over multiple years. Aging-related changes to these observers may be an important, under-recognized source of error that can bias management decisions. In this study, we used data from two large, independent bird surveys, the Atlas of the Breeding Birds of Ontario (“OBBA”) and the North American Breeding Bird Survey (“BBS”), to test for age-related observer effects in long-term time series of avian presence and abundance. We then considered the effect of such aging phenomena on current population trend estimates. We found significantly fewer detections among older versus younger observers for 13 of 43 OBBA species, and declines in detection as an observer ages for 4 of 6 vocalization groups comprising 59 of 64 BBS species. Consistent with hearing loss influencing this pattern, we also found evidence for increasingly severe detection declines with increasing call frequency among nine high-pitched bird species (OBBA); however, there were also detection declines at other frequencies, suggesting important additional effects of aging, independent of hearing loss. We lastly found subtle, significant relationships between some species' published population trend estimates and (1) their corresponding vocalization frequency (n ≥ 22 species) and (2) their estimated declines in detectability among older observers (n = 9 high-frequency, monotone species), suggesting that observer aging can negatively bias long-term monitoring data for some species in part through hearing loss effects. We recommend that survey designers and modelers account for observer age where possible. PMID:25360286

Nonlinear Programming Models to Optimize Uneven-Aged Shortleaf Pine Management

Treesearch

Benedict J. Schulte; Joseph Buongiorno

2002-01-01

Nonlinear programming models of uneven-aged shortleaf pine (Pinus echinata Mill.) management were developed to identify sustainable management regimes that optimize soil expectation value (SEV) or annual sawtimber yields. The models recognize three species groups (shortleaf pine and other softwoods, soft hardwoods and hard hardwoods) and 13 2-inch...

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 2

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

Not Available

This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities. This Part 2 includes chapters on implementation guidance for operational configuration management, implementation guidance for design reconstitution, and implementation guidance for material condition and aging management. Appendices are included on design control, examples of design information, conduct of walkdowns, and content of design information summaries.

[Effects of Self-management Program applying Dongsasub Training on Self-efficacy, Self-esteem, Self-management Behavior and Blood Pressure in Older Adults with Hypertension].

PubMed

Kim, Myoungsuk; Song, Misoon

2015-08-01

The purpose of this study was to develop a self-management program applying Dongsasub training based on self-efficacy theory, and to verify the program effectiveness on self-esteem as well as self-efficacy, self-management behaviors, and blood pressure. The study design was a non-equivalent, pre-post controlled quasi-experiment study. Thirty-eight patients aged 65 and older from a senior welfare center in Seoul participated in this study (20 patients in the experimental group and 18 patients in the control group). The self-management program applying Dongsasub training consisted of eight sessions. After development was complete the program was used with the experimental group. Outcome variables included self-efficacy, self-esteem, self-management behaviors measured by questionnaires, and blood pressure measured by electronic manometer. Self-efficacy (t=2.42, p=.021), self-esteem (t=2.57, p=.014) and self-management behaviors (t=2.21, p=.034) were significantly higher and systolic blood pressure (t=-2.14, p=.040) was significantly lower in the experimental group compared to the control group. However, diastolic blood pressure (t=-.85, p=.400) was not significantly different between the two groups. The results indicate that the self-management program applying Dongsasub training can be used as a nursing intervention in community settings for improving self-management behaviors for older adults with hypertension.

Knowledge, attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States.

PubMed

Long, Everett; Ponder, Monica; Bernard, Stephanie

2017-05-01

Perceptions of illness affect cardiovascular disease (CVD) self-management. This study explores knowledge, attitudes, and beliefs regarding hypertension and hyperlipidemia management among 34 African-American men with hypertension and/or hyperlipidemia, age 40-65, living in the Southeastern United States. In-person focus groups were conducted using semi-structured interview questions informed by the Health Belief Model (HBM). Participants had a high level of knowledge about hypertension self-management, but less about cholesterol self-management. Perceived severity of both conditions was acknowledged, though participants perceived hypertension as more severe. Barriers to self-management included medication side effects and unhealthy dietary patterns. Facilitators included social support, positive healthcare experiences, and the value placed on family. Cultural implications highlighted the importance of food in daily life and social settings. Participants expressed how notions of masculinity affected self-management-noting the impact of feelings of vulnerability and perceived lack of control stemming from diagnosis and treatment expectations. The findings highlight gaps in knowledge of hyperlipidemia versus hypertension, and the impact of cultural context and perceptions on engagement in self-management behaviors. Public health practitioners and healthcare providers serving African-American men should address cultural factors and notions of masculinity which can hinder effective disease management among this population. Copyright © 2017 Elsevier B.V. All rights reserved.

The implementation of European Association of Urology guidelines in the management of acute epididymo-orchitis.

PubMed

Garthwaite, Mary A E; Johnson, G; Lloyd, S; Eardley, I

2007-11-01

Acute epididymo-orchitis is a common and increasing problem. This retrospective study reviewed whether the European Association of Urology guidelines for the management of acute epididymo-orchitis, which form the basis of this Trust's present inter-departmental guidelines, are being effectively implemented. Case notes of 53 patients attending the emergency department with acute epididymo-orchitis over a 6-month period were reviewed retrospectively. The hospital results' database was used to confirm the diagnostic tests requested on patients at the time of their initial presentation. Of the study cohort, 26 patients were aged 35 years. The results demonstrated that a sexual history was documented in only 43.4% of cases. A mid-stream urine sample was sent for routine culture in 54.7% of cases whilst urine for the Chlamydia polymerase chain reaction (PCR) test was obtained in 17% and a urethral swab performed in 5.6%. Antibiotics were prescribed in 81% of cases. Of these patients, 46.5% received ciprofloxacin alone (mean age, 52 years; range, 18-87 years), 25.5% received doxycycline alone (mean age, 30 years; range, 18-45 years) and 21% received both ciprofloxacin and doxycycline (mean age, 33 years; range 18-49 years). In 26.4% of cases, verbal advice to attend a genito-urinary medicine clinic was given, whilst a formal telephone referral was made in only one case. Formal urological follow-up was arranged for only three out of 11 patients aged > 50 years. Although a joint emergency department/urology clinical protocol for the investigation and treatment of acute epididymo-orchitis already exists within the Trust, our current management conforms to this in only a minority of cases. Many different strategies can be employed in the implementation of clinical practice guidelines and all are associated with variable degrees of success. The regular movement of junior staff through each department necessitates that the distribution of management protocols and guidelines occurs at frequent intervals throughout the year and that their implementation is continuously monitored so that, if necessary, further implementation strategies can be employed.