Survey of Irish general practitioners' preferences for continuing professional development.

PubMed

Maher, B; O'Neill, R; Faruqui, A; Bergin, C; Horgan, M; Bennett, D; O'Tuathaigh, C M P

2018-01-01

Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.

Study of Current Practice and Future Advancements in Blood Management and Effectiveness of a Multimodality Training Program on Improving Transfusion Knowledge, Practice and Outcomes

DTIC Science & Technology

2012-08-01

to trauma, surgery or blood diseases such as anemia, hemophilia or sickle- cell disease. But transfusions carry risks. Current practices are often...Blood Management Topic 4: Diagnosis of Red cell disorders and oxygen carrying capacity Topic 5: Diagnosis of Disorders in homeostasis Topic 6...the Clinical Transfusion Medicine Committee of the AABB. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med

How to Survive the Next Five Years.

PubMed

Jackson, Rem

2016-01-01

The rapid pace of change in medical practice combined with increasingly heavy regulation has created a negative mindset for many practitioners. Although the future of medical practice is uncertain, there are fundamentals that, if understood, can ensure the success of private practitioners. These include efficient practice management and effective practice marketing.

A systems engineering management approach to resource management applications

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller

1989-01-01

The author presents a program management response to the following question: How can the traditional practice of systems engineering management, including requirements specification, be adapted, enhanced, or modified to build future planning and scheduling systems for effective operations? The systems engineering management process, as traditionally practiced, is examined. Extensible resource management systems are discussed. It is concluded that extensible systems are a partial solution to problems presented by requirements that are incomplete, partially immeasurable, and often dynamic. There are positive indications that resource management systems have been characterized and modeled sufficiently to allow their implementation as extensible systems.

Fatigue risk management in aviation maintenance : current best practices and potential future countermeasures.

DOT National Transportation Integrated Search

2011-06-01

The unregulated hours and frequent night work characteristic of maintenance can produce significant levels of : employee fatigue, with a resultant risk of maintenance error. Fatigue Risk Management Systems (FRMS) are : widely used to manage fatigue a...

American Veterinary Medical Association

MedlinePlus

... Awards Veterinary Education Economics & Practice Economics & Finance Practice Management Client Materials Insurance Advocacy Hot Issues National Issues State & Local Issues Get Involved Meetings & Events AVMA Convention Veterinary Leadership Conference Future AVMA Meeting Dates Meetings & CE Calendar ...

Will Large DSO-Managed Group Practices Be the Predominant Setting for Oral Health Care by 2025? Two Viewpoints: Viewpoint 1: Large DSO-Managed Group Practices Will Be the Setting in Which the Majority of Oral Health Care Is Delivered by 2025 and Viewpoint 2: Increases in DSO-Managed Group Practices Will Be Offset by Models Allowing Dentists to Retain the Independence and Freedom of a Traditional Practice.

PubMed

Cole, James R; Dodge, William W; Findley, John S; Young, Stephen K; Horn, Bruce D; Kalkwarf, Kenneth L; Martin, Max M; Winder, Ronald L

2015-05-01

This Point/Counterpoint article discusses the transformation of dental practice from the traditional solo/small-group (partnership) model of the 1900s to large Dental Support Organizations (DSO) that support affiliated dental practices by providing nonclinical functions such as, but not limited to, accounting, human resources, marketing, and legal and practice management. Many feel that DSO-managed group practices (DMGPs) with employed providers will become the setting in which the majority of oral health care will be delivered in the future. Viewpoint 1 asserts that the traditional dental practice patterns of the past are shifting as many younger dentists gravitate toward employed positions in large group practices or the public sector. Although educational debt is relevant in predicting graduates' practice choices, other variables such as gender, race, and work-life balance play critical roles as well. Societal characteristics demonstrated by aging Gen Xers and those in the Millennial generation blend seamlessly with the opportunities DMGPs offer their employees. Viewpoint 2 contends the traditional model of dental care delivery-allowing entrepreneurial practitioners to make decisions in an autonomous setting-is changing but not to the degree nor as rapidly as Viewpoint 1 professes. Millennials entering the dental profession, with characteristics universally attributed to their generation, see value in the independence and flexibility that a traditional practice allows. Although DMGPs provide dentists one option for practice, several alternative delivery models offer current dentists and future dental school graduates many of the advantages of DMGPs while allowing them to maintain the independence and freedom a traditional practice provides.

Practice transitions--past, present, and future.

PubMed

Prokes, Ronald I

2014-01-01

Until the 1960s, the value of a practice upon the retirement of the dentist was considered to be nil. In the next several decades, the value of a practice as a going business concern was recognized and formulas based on productivity were used to establish the sales price of "walkaway" practice transitions. Increasingly creative means, such as pre-sale, deferred pre-sale, shareholder process, incremental practice sale, and practice mergers have been created to make practice transitions more flexible, thereby maximizing the financial value of transitions. Dentists at the beginning of their careers will have an increasing range of opportunities in the future, with various combinations of financial security, freedom from manage- ment concerns, control over the practice, and accumulation of equity. Those in the 45- to 55-year age range should be planning in detail for their transition. Those older than 55 should begin exercising their plans since the future will involve much longer transitions.

Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework.

PubMed

Boet, Sylvain; Patey, Andrea M; Baron, Justine S; Mohamed, Karim; Pigford, Ashlee-Ann E; Bryson, Gregory L; Brehaut, Jamie C; Grimshaw, Jeremy M

2017-06-01

Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period. After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour. Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management. This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.

From Administrative Theory and Practice to Sport and Lifestyle Management: Past, Present and Future.

ERIC Educational Resources Information Center

Moriarty, Dick

The field of sport and lifestyle management (SLM) includes three major eras which parallel cycles of conflict or stages of growth, development, and decline outlined in research. A review of relevant literature and examination of the situation in both Canada and the United States indicate that in the future SLM should return to a goal of service…

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

NASA Technical Reports Server (NTRS)

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

2016-01-01

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

Chronic disease management: teaching medical students to incorporate community.

PubMed

Dent, M Marie; Mathis, Mary W; Outland, Monita; Thomas, McKinley; Industrious, DeShawn

2010-01-01

As a response to the growing prevalence of chronic disease, models of chronic care have emerged as salient approaches to address dynamic health care changes and to manage the burden of suffering of these diseases. Concurrently, there has been a growing call to address chronic disease management within medical school curricula. This article describes the development and evaluation of a curricular intervention designed to prepare students to integrate patient-centered care with an understanding of the patients' community, provide care within rural settings, and experience clinical education specific to chronic disease management. Second-year medical students completed a chronic disease management project as part of a 4-week community visit in rural and/or medically underserved sites. Paired pre- and post-survey data were collected using the Community Oriented Health Care Competency Scale to assess the student's knowledge, intent to practice, and attitudes toward incorporating community-oriented primary care into future practice. Matched pre- and post-project surveys were identified for 170 respondents out of 219 students (77.6% response rate). Post-assessment items were found to be statistically different from measures collected prior to the students' entrance into the community: all knowledge questions indicated significant advancements toward community responsiveness, as did one question related to attitude and three of the intent to practice community-oriented health care questions. Community-based rotations can play a positive role in developing the competencies needed for future practice. The development of curricular opportunities designed to train future physicians on the value of incorporating models of chronic care within rural and underserved communities should remain at the forefront of medical education.

A system management methodology for building successful resource management systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1989-01-01

This paper presents a system management methodology for building successful resource management systems that possess lifecycle effectiveness. This methodology is based on an analysis of the traditional practice of Systems Engineering Management as it applies to the development of resource management systems. The analysis produced fifteen significant findings presented as recommended adaptations to the traditional practice of Systems Engineering Management to accommodate system development when the requirements are incomplete, unquantifiable, ambiguous and dynamic. Ten recommended adaptations to achieve operational effectiveness when requirements are incomplete, unquantifiable or ambiguous are presented and discussed. Five recommended adaptations to achieve system extensibility when requirements are dynamic are also presented and discussed. The authors conclude that the recommended adaptations to the traditional practice of Systems Engineering Management should be implemented for future resource management systems and that the technology exists to build these systems extensibly.

Audiology practice management in South Africa: What audiologists know and what they should know

PubMed Central

Kritzinger, Alta; Soer, Maggi

2015-01-01

Background In future, the South African Department of Health aims to purchase services from accredited private service providers. Successful private audiology practices can assist to address issues of access, equity and quality of health services. It is not sufficient to be an excellent clinician, since audiology practices are businesses that must also be managed effectively. Objective The objective was to determine the existing and required levels of practice management knowledge as perceived by South African audiologists. Method An electronic descriptive survey was used to investigate audiology practice management amongst South African audiologists. A total of 147 respondents completed the survey. Results were analysed by calculating descriptive statistics. The Z-proportional test was used to identify significant differences between existing and required levels of practice management knowledge. Results Significant differences were found between existing and required levels of knowledge regarding all eight practice management tasks, particularly legal and ethical issues and marketing and accounting. There were small differences in the knowledge required for practice management tasks amongst respondents working in public and private settings. Conclusion Irrespective of their work context, respondents showed that they need significant expansion of practice management knowledge in order to be successful, to compete effectively and to make sense of a complex marketplace. PMID:26809158

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

Ha, Kyoo-Man, E-mail: ha1999@hotmail.com

In Korea, there is a pervasive feeling of invincibility to the point that people and organizations do not believe that disasters can strike them. This has impact on the level of preparedness for disasters. This study aims to delve into how Korea has to change its governmental policies/practices with some private partners' efforts to mitigate disaster risks. A case study was utilized as the major methodology by comparing exclusive management with inclusive management. These two approaches have been comparatively analyzed via four variables, namely the central government, the local governments, the incident commander, and other stakeholders. The major finding ismore » that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management. Moreover, the importance of communication, cooperation, collaboration, and multi-discipline coordination is discussed. Additionally, the problem of reductionism and equal participation among all stakeholders, as well as the resistance from vested interests, are recognized and elaborated for Korea and the international community. - Highlights: • Only a few stakeholders in Korea believe that disaster can happen to anyone. This study aims to delve into how Korea has to change its current practices to mitigate disaster risks. • To compare exclusive management with inclusive management, we have examined four comparative variables, namely the central government's policy, local government's strategy, the incident commander's post, and other stakeholders' efforts. • The major finding is that Korea's practices and policies have to evolve from the current exclusive management into future-oriented inclusive management.« less

Assessment of Subsurface Drainage Management Practices to Reduce Nitrogen Loadings Using AnnAGNPS

EPA Science Inventory

The goal of the Future Midwest Landscape project is to quantify current and future landscape services across the region and examine changes expected to occur as a result of two alternative drivers of future change: the growing demand for biofuels; and hypothetical increases in in...

ASSESSING EFFECTS OF ALTERNATIVE AGRICULTURAL PRACTICES ON WILDLIFE HABITAT IN IOWA, USA

EPA Science Inventory

A habitat-change model was used to compare past, present, and future land cover and management practices to assess potential impacts of alternative agricultural practices on wildlife in two agricultural watersheds, Walnut Creek and Buck Creek, in central Iowa, USA. This approach ...

Succession Planning and Management: The Backbone of the Radiology Group's Future.

PubMed

Donner, E Michael; Gridley, Daniel; Ulreich, Sidney; Bluth, Edward I

2017-01-01

The transition of leadership within radiology practices is often not a planned replacement process with formal development of potential future leaders. To ensure their ongoing success, however, practices need to develop comprehensive succession plans that include a robust developmental program for potential leaders consisting of mentoring, coaching, structured socialization, 360-degree feedback, developmental stretch assignments, job rotation, and formal education. Succession planning and leadership development will be necessary in the future for a practice to be successful in its business relationships and to be financially viable. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Stormwater quality management in rail transportation--past, present and future.

PubMed

Vo, Phuong Tram; Ngo, Huu Hao; Guo, Wenshan; Zhou, John L; Listowski, Andrzej; Du, Bin; Wei, Qin; Bui, Xuan Thanh

2015-04-15

Railways currently play an important role in sustainable transportation systems, owing to their substantial carrying capacity, environmental friendliness and land-saving advantages. Although total pollutant emissions from railway systems are far less than that of automobile vehicles, the pollution from railway operations should not be underestimated. To date, both scientific and practical papers dealing with stormwater management for rail tracks have solely focused on its drainage function. Unlike roadway transport, the potential of stormwater pollution from railway operations is currently mishandled. There have been very few studies into the impact of its operations on water quality. Hence, upon the realisation on the significance of nonpoint source pollution, stormwater management priorities should have been re-evaluated. This paper provides an examination of past and current practices of stormwater management in the railway industry, potential sources of stormwater pollution, obstacles faced in stormwater management and concludes with strategies for future management directions. Copyright © 2015 Elsevier B.V. All rights reserved.

Prescribed Fire Education at Oklahoma State University: Training Our Future Pyros

Treesearch

John R. Weir

2008-01-01

The Rangeland Ecology and Management program at Oklahoma State University recognized the need for a practical, hands-on course designed for undergraduate and graduate students, with instruction on conducting prescribed fires for vegetation management, wildlife management, and livestock management. Two separate prescribed fire courses were initiated in the spring of...

Are Leadership and Management Essential for Good Research? An Interview Study of Genetic Researchers

PubMed Central

Antes, Alison L.; Mart, Adelina; DuBois, James M.

2016-01-01

Principal investigators are responsible for a myriad of leadership and management activities in their work. The practices they employ to navigate these responsibilities ultimately influence the quality and integrity of research. However, leadership and management roles in research have received scant empirical examination. Semi-structured interviews with 32 National Institutes of Health (NIH)-funded genetic researchers revealed that they considered leadership and management essential for effective research, but their scientific training inadequately prepared them. We also report management practices that the researchers described employing in their labs, as well as their perceptions of a proposed intervention to enhance laboratory leadership. These findings suggest best practices for the research community, future directions for scientific training, and implications for research on leadership and management in science. PMID:27646401

Are Leadership and Management Essential for Good Research? An Interview Study of Genetic Researchers.

PubMed

Antes, Alison L; Mart, Adelina; DuBois, James M

2016-12-01

Principal investigators are responsible for a myriad of leadership and management activities in their work. The practices they use to navigate these responsibilities ultimately influence the quality and integrity of research. However, leadership and management roles in research have received scant empirical examination. Semi-structured interviews with 32 National Institutes of Health (NIH)-funded genetic researchers revealed that they considered leadership and management essential for effective research, but their scientific training inadequately prepared them. We also report management practices that the researchers described using in their labs, as well as their perceptions of a proposed intervention to enhance laboratory leadership. These findings suggest best practices for the research community, future directions for scientific training, and implications for research on leadership and management in science.

Timber productivity research gaps for extensive forest management

Treesearch

L.C. Irland

2011-01-01

On extensive areas of small scale forests, significant opportunities for improving the value of future timber harvests while also improving other resource values are now being missed. A new focus on practical extensive management research is needed, especially as implementation of intensive practices has been declining in many areas, and new ‘‘close to nature’’...

Interaction of ice storms and management practices on current carbon sequestration in forests with potential mitigation under future CO2 atmosphere

Treesearch

Heather R. McCarthy; Ram Oren; Hyun-Seok Kim; Kurt H. Johnsen; Chris Maier; Seth G. Pritchard; Michael A. Davis

2006-01-01

Ice storms are disturbance events with potential impacts on carbon sequestration. Common forest management practices, such as fertilization and thinning, can change wood and stand properties and thus may change vulnerability to ice storm damage. At the same time, increasing atmospheric CO2 levels may also influence ice storm vulnerability. Here...

Stand development and yields of Appalachian hardwood stands managed with single-tree selection for at least 30 years

Treesearch

Neil I Lamson; H. Clay Smith; H. Clay Smith

1991-01-01

Appalachian hardwood stands in West Virginia were managed for 30 or more years using single-tree selection regeneration practices. Stand yield data suggest that current stand growth will provide economical harvest cuts for several future cutting cycles. This case study indicates that the single-tree selection practice has potential for landowners who want to maintain...

Capturing Creative Program Management Best Practices

DTIC Science & Technology

2013-04-01

Maryland Bottleneck Analysis on the DoD Pre-Milestone B Acquisition Processes Danielle Worger and Teresa Wu, Arizona State University Eugene Rex Jalao...Creative Program Management Best Practices Brandon Keller and J. Robert Wirthlin Air Force Institute of Technology The RITE Approach to Agile ...Mechanism for Adaptive Change Kathryn Aten and John T . Dillard Naval Postgraduate School A Comparative Assessment of the Navy’s Future Naval Capabilities

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

Peggy Robinson

This report summarizes activities that have taken place in the last 6 months (July 2004-December 2004) under the DOE-NETL cooperative agreement ''Adaptive Management and Planning Models for Cultural Resources in Oil and Gas Fields, New Mexico and Wyoming'' DE-FC26-02NT15445. This project examines the practices and results of cultural resource investigation and management in two different oil and gas producing areas of the US: southeastern New Mexico and the Powder River Basin of Wyoming. The project evaluates how cultural resource investigations have been conducted in the past and considers how investigation and management could be pursued differently in the future. Themore » study relies upon full database population for cultural resource inventories and resources and geomorphological studies. These are the basis for analysis of cultural resource occurrence, strategies for finding and evaluating cultural resources, and recommendations for future management practices. Activities can be summarized as occurring in either Wyoming or New Mexico.« less

An Assessment of Regional Water Resources and Agricultural Sustainability in the Mississippi River Alluvial Aquifer System of Mississippi and Arkansas Under Current and Future Climate

NASA Astrophysics Data System (ADS)

Rigby, J.; Reba, M.

2011-12-01

The Lower Mississippi River Alluvial Plain is a highly productive agricultural region for rice, soy beans, and cotton that depends heavily on irrigation. Development of the Mississippi River Alluvial Aquifer (MRAA), one of the more prolific agricultural aquifers in the country, has traditionally been the primary source for irrigation in the region yielding over 1,100 Mgal/day to irrigation wells. Increasingly, the realities of changing climate and rapidly declining water tables have highlighted the necessity for new water management practices. Tail-water recovery and reuse is a rapidly expanding practice due in part to the efforts and cost-sharing of the NRCS, but regional studies of the potential for such practices to alleviate groundwater mining under current and future climate are lacking. While regional studies of aquifer geology have long been available, including assessments of regional groundwater flow, much about the aquifer is still not well understood including controls on recharge rates, a crucial component of water management design. We review the trends in regional availability of surface and groundwater resources, their current status, and the effects of recent changes in management practices on groundwater decline in Mississippi and Arkansas. Global and regional climate projections are used to assess scenarios of sustainable aquifer use under current land use and management along with the potential for more widely practiced surface water capture and reuse to alleviate groundwater decline. Finally, we highlight crucial knowledge gaps and challenges associated with the development of water management practices for sustainable agricultural use in the region.

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

PubMed

Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001). It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

Non-face-to-face consultations and communications in primary care: the role and perspective of general practice managers in Scotland.

PubMed

Hanna, Lisa; May, Carl; Fairhurst, Karen

2011-01-01

Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers' attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients. To investigate practice managers' attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies. We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews. Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand. Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics. Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/communication technologies.

76 FR 31590 - Endangered and Threatened Species; Take of Anadromous Fish

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

... proposed research programs are intended to increase knowledge of the species and to help guide management... management efforts, and to determine what salmonid life stages suffer the lowest survival and should be a focus of future management practices. Study 1 is a summer/fall juvenile salmonid population abundance...

Palliative care for cirrhosis: a UK survey of health professionals’ perceptions, current practice and future needs

PubMed Central

Low, Joseph; Vickerstaff, Victoria; Davis, Sarah; Bichard, Julia; Greenslade, Lynda; Hopkins, Katherine; Marshall, Aileen; Thorburn, Douglas; Jones, Louise

2016-01-01

Objective To determine the knowledge and practice patterns of a UK cohort of relevant healthcare professionals (HCPs) about delivering palliative care in cirrhosis, and to inform priorities for future research. Design An on-line questionnaire survey with closed and open responses. Setting HCPs identified from the mailing list of special interest groups in hepatology and gastroenterology (liver), general practice and specialist palliative care (SPC) across the UK. Results Of the 6181 potential contacts identified, 517 HCPs responded. Most believed a role exists for SPC in caring for people with cirrhosis, but many SPC HCPs felt ill prepared to provide good care to those facing death. Further training was needed in managing liver-related symptoms, symptom control and end of life issues. All HCP groups wished to increase community provision of palliative care support, but many general practitioners felt unable to manage advanced cirrhosis in the community. There were differences in the optimal trigger for SPC referral with liver HCPs less likely to refer at symptom deterioration. Prognostication, symptom management and service configuration were key areas identified for future research. Conclusions All who responded acknowledged the role of SPC in caring for those dying with cirrhosis and need for further training to improve confidence and enable joint working between SPC, general practice and liver teams. Low response rates make it difficult to generalise these findings, which require further validation. PMID:28839829

Integrated Talent Management Enterprise as a Framework for Future Army Talent Management

DTIC Science & Technology

2015-06-12

http://usacac.army.mil/CAC2/MilitaryReview/Archives/ English ...hav e pockets of innovative TM practices that it should bolster? 04. What tools (big dat a, pred ictive analytics, etc.) and techniques (customized

[Marketing mix in a radiology department: challenges for future radiologists in management].

PubMed

Claikens, B

1998-08-01

Radiology has gained an enviable position among medial specialities. Developments in new technology expand its horizons and the volume of radiologic imaging techniques and procedures increase far more than the overall growth in health care services. In this position radiology has become a prime target for restrictions, cutbacks, controlled financing in an area of managed care and new national health care policy based on partially fixed budgets. Future health care takers have to choose the best available diagnostic and therapeutic techniques. Evidence based medicine, cost-utility analysis, diagnostic performance analysis, patient outcome analysis, technology assessment and guidelines for practice are means to guide us through our obligatory choice. Our major objective is to use the most performant available imaging technique or intervention to achieve the best possible outcome for our patient at lower possible costs. A strategic response from radiologists is required to meet the imperatives of this new management situation. They must do far more than interpret imaging procedures. They must work as efficient managers of imaging resources, organise their practices and define their marketing-strategies using the different, so-called, marketing-mix elements. The challenges will be great but the rewards are worth our best efforts. In this article we highlight the marketing responsibilities of future radiologists and their clinical practice in this new socio-economic environment and we present different useful marketing tools.

The Future of Management as Design: A Thought Experiment

ERIC Educational Resources Information Center

Bouchard, Veronique; del Forno, Leon

2012-01-01

Purpose: Management practices and education are presently in a stage of reappraisal and a growing number of scholars and experts are suggesting that managers should be taught and adopt the approach and methodologies of designers. The purpose of this paper is to imagine the impact of this move and to try and foresee whether "management as design"…

Current Practices in Runway Configuration Management (RCM) and Arrival/Departure Runway Balancing (ADRB)

NASA Technical Reports Server (NTRS)

Lohr, Gary W.; Williams, Daniel M.

2008-01-01

Significant air traffic increases are anticipated for the future of the National Airspace System (NAS). To cope with future traffic increases, fundamental changes are required in many aspects of the air traffic management process including the planning and use of NAS resources. Two critical elements of this process are the selection of airport runway configurations, and the effective management of active runways. Two specific research areas in NASA's Airspace Systems Program (ASP) have been identified to address efficient runway management: Runway Configuration Management (RCM) and Arrival/Departure Runway Balancing (ADRB). This report documents efforts in assessing past as well as current work in these two areas.

How would case managers' practice change in a consumer-directed care environment in Australia?

PubMed

You, Emily Chuanmei; Dunt, David; Doyle, Colleen

2017-01-01

The aim of this study was to explore case managers' perceived changes in their practice in the future when consumer-directed care (CDC) is widely implemented in Australia's community aged care system. Purposeful sampling was used and semi-structured individual and group interviews were conducted between September 2012 and March 2013. Participants were drawn from a list of all case managers who administered publicly funded community aged care packages in Victoria, Australia. Empowerment theory was used to guide the analysis and interpretation of the data. The thematic analysis revealed that case managers had mixed views about CDC. They also perceived changes in case managers' practice in the future when CDC is widely implemented. These might specifically include: first, case managers would not directly manage clients' budgets. While some case managers were concerned about losing power for this change, others believed that they would still have important financial roles to perform, such as setting rules, providing financial support and monitoring clients' use of budgets. Second, case managers would focus on performing roles in providing information, and empowering, facilitating and educating clients. These would help to strengthen clients' capacities and assist them to self-manage their care. Third, case managers would work in partnership with clients through frequent or skilful communication, mutual goal setting and goal facilitation. Fourth, case managers would manage more clients. In addition, they would provide less support to each individual client and perform less care co-ordination role. The findings suggest case managers paying attention to power balance regarding budget management in a CDC environment. Furthermore, they might frequently or skilfully communicate with, empower, facilitate and educate clients; work together with them to set up goals; and facilitate them to achieve goals. New research using empowerment theory to examine the actual practice of case managers in a well-established CDC system is warranted. © 2015 John Wiley & Sons Ltd.

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.

Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

PubMed

Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

2007-08-01

Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

Payer Negotiations in the New Healthcare Environment: How to Prepare for and Succeed in a Value-Based World.

PubMed

Howrigon, Ron

2016-01-01

Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed.

The Future Role of Information Technology in Erosion Modelling

USDA-ARS?s Scientific Manuscript database

Natural resources management and decision-making is a complex process requiring cooperation and communication among federal, state, and local stakeholders balancing biophysical and socio-economic concerns. Predicting soil erosion is common practice in natural resource management for assessing the e...

Future prospects of health management systems using cellular phones.

PubMed

Kim, Hun-Sung; Hwang, Yunji; Lee, Jae-Ho; Oh, Hye Young; Kim, Yi-Jun; Kwon, Hyeon Yoon; Kang, Hyoseung; Kim, Hyunah; Park, Rae Woong; Kim, Ju Han

2014-06-01

Cellular phones enable communication between healthcare providers and patients for prevention, diagnosis, and treatment of diseases. However, few studies have examined the user-friendliness or effectiveness of cellular phone-based medical informatics (CPBMI) for healthcare. This study investigated the use of CPBMI to identify its current status within the medical field, advantages and disadvantages, practicability, clinical effectiveness, costs, and cost-saving potential. CPBMI was validated in terms of practicality and provision of medical benefits. It is critical to use CPBMI in accordance with the different features of each disease and condition. Use of CPBMI is expected to be especially useful for patients with chronic disease. We discussed the current status of the clinical use, benefits, and risks of CPBMI. CPBMI and information technology-based health management tools are anticipated to become useful and effective components of healthcare management in the future.

Homeland Security. Management Challenges Facing Federal Leadership

DTIC Science & Technology

2002-12-01

Security Management Challenges Facing Federal Leadership 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...including attention to management practices and key success factors. HOMELAND SECURITY Management Challenges Facing Federal Leadership www.gao.gov/cgi...significant management and coordination challenges if it is to provide this leadership and be successful in preventing and responding to any future

The Missouri Ozark Forest Ecosystem Project: past, present, and future

Treesearch

Brian L. Brookshire; Randy Jensen; Daniel C. Dey

1997-01-01

In 1989, the Missouri Department of Conservation initiated a research project to examine the impacts of forest management practices on multiple ecosystem components. The Missouri Ozark Forest Ecosystem Project (MOFEP) is a landscape experiment comparing the impacts of even-aged management, uneven-aged management, and no harvesting on a wide array of ecosystem...

Best management practices: Managing cropping systems for soil protection and bioenergy production

USDA-ARS?s Scientific Manuscript database

Interest in renewable alternatives to fossil fuels has increased. Crop residue such as corn stover or wheat straw can be used for bioenergy including a substitution for natural gas or coal. Harvesting crop residue needs to be managed to protect the soil and future soil productivity. The amount of bi...

Watershed management perspectives in the Southwest: Past, present, and future

Treesearch

Peter F. Ffolliott; Malchus B. Baker; Vicente L. Lopes

2000-01-01

Watershed management perspectives in the Southwest have been, are, and will be reflected by the nature of watershed management practices. Past perspectives evolved from considerations of increasing water yields and water quality concerns. Present perspectives are centered on minimizing adverse impacts to soil and water resources, sustaining high-quality water flows,...

Let the market help prescribe forest management practices

Treesearch

Gary W. Zinn; Edward Pepke

1989-01-01

To obtain the best economic returns from a hardwood forest, you must consider markets. Management decisions made now will affect a stand's future character and value, whether or not the decision results in immediate timber sales. Progressive forest landowners will have a management plan for their woodlots. Typically, such plans are largely land- and resource-...

[Risk management for medical devices].

PubMed

Xie, Ying-jie; Xu, Xing-gang

2007-07-01

Based on the practices of the risk management activities by Chinese medical device manufacturers and theoretical study of the latest international standard ISO 14971:2007, this article analyses the risk management in medical device manufacturing industry by introducing the status quo of applications, four requirements at operational stages, and future trends of development. Methods and suggestions are therefore given to medical device manufacturers for risk management.

Nurse manager succession planning: synthesis of the evidence.

PubMed

Titzer, Jennifer; Phillips, Tracy; Tooley, Stephanie; Hall, Norma; Shirey, Maria

2013-10-01

The literature supporting nurse manager succession planning is reviewed and synthesised to discover best practice for identifying and developing future nurse managers. Healthcare succession planning practices are lacking. Nurse managers are historically selected based on clinical skills and lack formal leadership preparation. A systematic literature search appraises and summarises the current literature supporting nurse manager succession planning. Multiple reviewers were used to increase the reliability and validity of article selection and analysis. New nurse managers require months to adapt to their positions. Deliberate nurse manager succession planning should be integrated in the organisation's strategic plan and provide a proactive method for identifying and developing potential leaders. Organisations that identify and develop internal human capital can improve role transition, reduce nurse manager turnover rates and decrease replacement costs. Despite the clear benefits of succession planning, studies show that resource allocation for proactive, deliberate development of current and future nurse leaders is lacking. Additionally, systematic evaluation of succession planning is limited. Deliberate succession planning efforts and appropriate resource allocation require strategic planning and evaluation methods. Detailed evaluation methods demonstrating a positive return on investment utilising a cost-benefit analysis and empirical outcomes are necessary. © 2013 John Wiley & Sons Ltd.

Potential roles of past, present, and future urbanization characteristics in producing varied stream responses

EPA Science Inventory

Urban wastewater and stormwater management practices are one of the primary pathways through which urbanization degrades streams. In particular the long-term development and management phases create a complex spatiotemporal layering of infrastructure technologies. These phases re...

Multidisciplinary management of chronic heart failure: principles and future trends.

PubMed

Davidson, Patricia M; Newton, Phillip J; Tankumpuan, Thitipong; Paull, G; Dennison-Himmelfarb, Cheryl

2015-10-01

Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design, implementation, and evaluation of the interventions. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

PubMed

Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

2009-10-08

Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support

PubMed Central

2009-01-01

Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment. PMID:19814826

Current and future risks of asbestos exposure in the Australian community

PubMed Central

2016-01-01

Background Australia mined asbestos for more than 100 years and manufactured and imported asbestos products. There is a legacy of in situ asbestos throughout the built environment. Methods The aim of this study was to identify the possible sources of current and future asbestos exposure from the built environment. Telephone interviews with environmental health officers, asbestos removalists, and asbestos assessors in Australia sought information about common asbestos scenarios encountered. Results There is a considerable amount of asbestos remaining in situ in the Australian built environment. Potential current and future sources of asbestos exposure to the public are from asbestos-containing roofs and fences, unsafe asbestos removal practices, do-it-yourself home renovations and illegal dumping. Conclusion This research has highlighted a need for consistent approaches in the regulation and enforcement of safe practices for the management and removal of asbestos to ensure that in situ asbestos in the built environment is managed appropriately. PMID:27611196

Current and future risks of asbestos exposure in the Australian community.

PubMed

Gray, Corie; Carey, Renee N; Reid, Alison

2016-10-01

Australia mined asbestos for more than 100 years and manufactured and imported asbestos products. There is a legacy of in situ asbestos throughout the built environment. The aim of this study was to identify the possible sources of current and future asbestos exposure from the built environment. Telephone interviews with environmental health officers, asbestos removalists, and asbestos assessors in Australia sought information about common asbestos scenarios encountered. There is a considerable amount of asbestos remaining in situ in the Australian built environment. Potential current and future sources of asbestos exposure to the public are from asbestos-containing roofs and fences, unsafe asbestos removal practices, do-it-yourself home renovations and illegal dumping. This research has highlighted a need for consistent approaches in the regulation and enforcement of safe practices for the management and removal of asbestos to ensure that in situ asbestos in the built environment is managed appropriately.

Impact of environmental policies on the adoption of manure management practices in the Chesapeake Bay watershed.

PubMed

Savage, Jeff A; Ribaudo, Marc O

2013-11-15

Pollution in the Chesapeake Bay is a problem and has been a focus of federal and state initiatives to reduce nutrient pollution from agriculture and other sources since 1983. In 2010 EPA established a TMDL for the watershed. Producers may voluntarily respond to intense and focused policy scrutiny by adopting best management practices. A detailed analysis of water quality best management practices by animal feeding operations inside and outside the watershed yield insight into this relationship. Our findings support the hypothesis that farmers will adopt water quality measures if links are made clear and there is an expectation of future regulations. Published by Elsevier Ltd.

Strategic planning: today's hot buttons.

PubMed

Bohlmann, R C

1998-01-01

The first generation of mergers and managed care hasn't slowed down group practices' need for strategic planning. Even groups that already went through one merger are asking about new mergers or ownership possibilities, the future of managed care, performance standards and physician unhappiness. Strategic planning, including consideration of bench-marking, production of ancillary services and physician involvement, can help. Even if only a short, general look at the future, strategic planning shows the proactive leadership needed in today's environment.

Putting the process of care into practice.

PubMed

Houck, S; Baum, N

1997-01-01

"Putting the process of care into practice" provides an interactive, visual model of outpatient resources and processes. It illustrates an episode of care from a fee-for-service as well as managed care perspective. The Care Process Matrix can be used for planning and staffing, as well as retrospectively to assess appropriate resource use within a practice. It identifies effective strategies for reducing the cost per episode of care and optimizing quality while moving from managing costs to managing the care process. Because of an overbuilt health care system, including an oversupply of physicians, success in the future will require redesigning the process of care and a coherent customer service strategy. The growing complexities of practice will require physicians to focus on several key competencies while outsourcing other functions such as billing and contracting.

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

Peggy Robinson

This report summarizes activities that have taken place in the last six (6) months (January 2005-June 2005) under the DOE-NETL cooperative agreement ''Adaptive Management and Planning Models for Cultural Resources in Oil and Gas Fields, New Mexico and Wyoming'' DE-FC26-02NT15445. This project examines the practices and results of cultural resource investigation and management in two different oil and gas producing areas of the United States: southeastern New Mexico and the Powder River Basin of Wyoming. The project evaluates how cultural resource investigations have been conducted in the past and considers how investigation and management could be pursued differently in themore » future. The study relies upon full database population for cultural resource inventories and resources and geomorphological studies. These are the basis for analysis of cultural resource occurrence, strategies for finding and evaluating cultural resources, and recommendations for future management practices. Activities can be summarized as occurring in either Wyoming or New Mexico. Gnomon as project lead, worked in both areas.« less

Landfill taxes and Enhanced Waste Management: Combining valuable practices with respect to future waste streams.

PubMed

Hoogmartens, Rob; Eyckmans, Johan; Van Passel, Steven

2016-09-01

Both landfill taxes and Enhanced Waste Management (EWM) practices can mitigate the scarcity issue of landfill capacity by respectively reducing landfilled waste volumes and valorising future waste streams. However, high landfill taxes might erode incentives for EWM, even though EWM creates value by valorising waste. Concentrating on Flanders (Belgium), the paper applies dynamic optimisation modelling techniques to analyse how landfill taxation and EWM can reinforce each other and how taxation schemes can be adjusted in order to foster sustainable and welfare maximising ways of processing future waste streams. Based on the Flemish simulation results, insights are offered that are generally applicable in international waste and resource management policy. As shown, the optimal Flemish landfill tax that optimises welfare in the no EWM scenario is higher than the one in the EWM scenario (93 against €50/ton). This difference should create incentives for applying EWM and is driven by the positive external effects that are generated by EWM practices. In Flanders, as the current landfill tax is slightly lower than these optimal levels, the choice that can be made is to further increase taxation levels or show complete commitment to EWM. A first generally applicable insight that was found points to the fact that it is not necessarily the case that the higher the landfill tax, the more effective waste management improvements can be realised. Other insights are about providing sufficient incentives for applying EMW practices and formulating appropriate pleas in support of technological development. By these insights, this paper should provide relevant information that can assist in triggering the transition towards a resource-efficient, circular economy in Europe. Copyright © 2016 Elsevier Ltd. All rights reserved.

The glass ceiling in nursing management.

PubMed

Crawford, D I

1993-01-01

Women managers in business and health care have experienced discrimination related to advancement in management. Nurse executives must understand the strategies to overcome the barriers, the "glass ceiling," as well as implications for future practice. Women executives need an organized blueprint and the tools to dismantle the glass ceiling and overcome the political and discriminatory barriers to success.

Competencies of Front-Line Managers in Supported Accommodation: Issues for Practice and Future Research

ERIC Educational Resources Information Center

Clement, Tim; Bigby, Christine

2012-01-01

Background: Front-line managers of supported accommodation for people with intellectual disability are assumed to have a key role in the realisation of outcomes for service users. Yet, their job has been little researched. A job analysis from Minnesota that identified 142 competencies required of effective front-line managers was used to examine…

Spatial impact assessment of conifer stands in the Hoosier National Forest

Treesearch

Richard Thurau; Craig Wayson; Dale Weigel; Jeff Ehman

2011-01-01

Forest management decisions on Federal lands must be administered at many spatial and temporal scales. Forest condition, size class, and cover type at the stand level determine how silvicultural practices today will impact management area and overall forest goals in the future. The Hoosier National Forest (HNF) Land Resource Management Plan lists eight goals for...

The past, present, and future of selective progesterone receptor modulators in the management of uterine fibroids.

PubMed

Singh, Sukhbir S; Belland, Liane; Leyland, Nicholas; von Riedemann, Sarah; Murji, Ally

2017-12-21

Uterine fibroids are common in women of reproductive age and can have a significant impact on quality of life and fertility. Although a number of international obstetrics/gynecology societies have issued evidence-based clinical practice guidelines for the management of symptomatic uterine fibroids, many of these guidelines do not yet reflect the most recent clinical evidence and approved indication for one of the key medical management options: the selective progesterone receptor modulator class. This article aims to share the clinical experience gained with selective progesterone receptor modulators in Europe and Canada by reviewing the historical development of selective progesterone receptor modulators, current best practices for selective progesterone receptor modulator use based on available data, and potential future uses for selective progesterone receptor modulators in uterine fibroids and other gynecologic conditions. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Future Prospects of Health Management Systems Using Cellular Phones

PubMed Central

Kim, Hun-Sung; Hwang, Yunji; Lee, Jae-Ho; Oh, Hye Young; Kim, Yi-Jun; Kwon, Hyeon Yoon; Kang, Hyoseung; Kim, Hyunah; Park, Rae Woong

2014-01-01

Abstract Background: Cellular phones enable communication between healthcare providers and patients for prevention, diagnosis, and treatment of diseases. However, few studies have examined the user-friendliness or effectiveness of cellular phone-based medical informatics (CPBMI) for healthcare. Materials and Methods: This study investigated the use of CPBMI to identify its current status within the medical field, advantages and disadvantages, practicability, clinical effectiveness, costs, and cost-saving potential. Results: CPBMI was validated in terms of practicality and provision of medical benefits. It is critical to use CPBMI in accordance with the different features of each disease and condition. Use of CPBMI is expected to be especially useful for patients with chronic disease. Conclusions: We discussed the current status of the clinical use, benefits, and risks of CPBMI. CPBMI and information technology–based health management tools are anticipated to become useful and effective components of healthcare management in the future. PMID:24693986

Hospital administrative characteristics and volunteer resource management practices.

PubMed

Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug

2016-05-16

Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices.

Potential drivers of virulence evolution in aquaculture

USGS Publications Warehouse

Kennedy, David A.; Kurath, Gael; Brito, Ilana L.; Purcell, Maureen K.; Read, Andrew F.; Winton, James R.; Wargo, Andrew R.

2016-01-01

Infectious diseases are economically detrimental to aquaculture, and with continued expansion and intensification of aquaculture, the importance of managing infectious diseases will likely increase in the future. Here, we use evolution of virulence theory, along with examples, to identify aquaculture practices that might lead to the evolution of increased pathogen virulence. We identify eight practices common in aquaculture that theory predicts may favor evolution toward higher pathogen virulence. Four are related to intensive aquaculture operations, and four others are related specifically to infectious disease control. Our intention is to make aquaculture managers aware of these risks, such that with increased vigilance, they might be able to detect and prevent the emergence and spread of increasingly troublesome pathogen strains in the future.

Implementation of BMP Strategies for Adaptation to Climate Change and Land Use Change in a Pasture-Dominated Watershed

PubMed Central

Chiang, Li-Chi; Chaubey, Indrajeet; Hong, Nien-Ming; Lin, Yu-Pin; Huang, Tao

2012-01-01

Implementing a suite of best management practices (BMPs) can reduce non-point source (NPS) pollutants from various land use activities. Watershed models are generally used to evaluate the effectiveness of BMP performance in improving water quality as the basis for watershed management recommendations. This study evaluates 171 management practice combinations that incorporate nutrient management, vegetated filter strips (VFS) and grazing management for their performances in improving water quality in a pasture-dominated watershed with dynamic land use changes during 1992–2007 by using the Soil and Water Assessment Tool (SWAT). These selected BMPs were further examined with future climate conditions (2010–2069) downscaled from three general circulation models (GCMs) for understanding how climate change may impact BMP performance. Simulation results indicate that total nitrogen (TN) and total phosphorus (TP) losses increase with increasing litter application rates. Alum-treated litter applications resulted in greater TN losses, and fewer TP losses than the losses from untreated poultry litter applications. For the same litter application rates, sediment and TP losses are greater for summer applications than fall and spring applications, while TN losses are greater for fall applications. Overgrazing management resulted in the greatest sediment and phosphorus losses, and VFS is the most influential management practice in reducing pollutant losses. Simulations also indicate that climate change impacts TSS losses the most, resulting in a larger magnitude of TSS losses. However, the performance of selected BMPs in reducing TN and TP losses was more stable in future climate change conditions than in the BMP performance in the historical climate condition. We recommend that selection of BMPs to reduce TSS losses should be a priority concern when multiple uses of BMPs that benefit nutrient reductions are considered in a watershed. Therefore, the BMP combination of spring litter application, optimum grazing management and filter strip with a VFS ratio of 42 could be a promising alternative for use in mitigating future climate change. PMID:23202767

Users/consumers differences regarding ergonomics and design theory and practice.

PubMed

Dejean, Pierre-Henri; Wagstaff, Peter

2012-01-01

This paper presents the concept of direct and indirect users, a key issue to cooperation between ergonomists, designers and managers involved in a sustainable approach to design. What issues for Ergonomics and Design are launched by this concept? User/consumer differences should be approached taking into account Ergonomics and Design theory and practice. What dialogue and tools could help the ergonomist/designer/manager to respond to all the requirements of the future clients of the product?

Probabilistic objective functions for sensor management

NASA Astrophysics Data System (ADS)

Mahler, Ronald P. S.; Zajic, Tim R.

2004-08-01

This paper continues the investigation of a foundational and yet potentially practical basis for control-theoretic sensor management, using a comprehensive, intuitive, system-level Bayesian paradigm based on finite-set statistics (FISST). In this paper we report our most recent progress, focusing on multistep look-ahead -- i.e., allocation of sensor resources throughout an entire future time-window. We determine future sensor states in the time-window using a "probabilistically natural" sensor management objective function, the posterior expected number of targets (PENT). This objective function is constructed using a new "maxi-PIMS" optimization strategy that hedges against unknowable future observation-collections. PENT is used in conjuction with approximate multitarget filters: the probability hypothesis density (PHD) filter or the multi-hypothesis correlator (MHC) filter.

Current Fault Management Trends in NASA's Planetary Spacecraft

NASA Technical Reports Server (NTRS)

Fesq, Lorraine M.

2009-01-01

The key product of this three-day workshop is a NASA White Paper that documents lessons learned from previous missions, recommended best practices, and future opportunities for investments in the fault management domain. This paper summarizes the findings and recommendations that are captured in the White Paper.

Trust in management, communication and organisational commitment: Factors influencing readiness for change management in organisation

NASA Astrophysics Data System (ADS)

Ahmad, Mohd Hafis; Ismail, Syuhaida; Rani, Wan Nurul Mardiah Wan Mohd; Wahab, Mohammad Hussaini

2017-10-01

Organisational change occurs when an organisation makes a transition from its current state to some desired future state in minimising employee resistance and cost to the organisation while simultaneously maximising the effectiveness of the change effort. This paper, aims at appraising the change management of organisation in Malaysia since limited research has been done to examine readiness for change by the employees in the organisation. This paper is materialising its objectives of (1) investigating the current practice of organisation and employees in the organisation towards change management and (2) assessing the factors influencing readiness of organisation and employees in the organisation towards change management. It is found via literature review that change management is a structured approach for ensuring that changes are thoroughly and smoothly implemented to transitioning individuals, teams, and organisations to a desired future state by focusing on the wider impacts of change, particularly on people, where change does not happen in isolation and it impacts the whole organisation. Furthermore, it is found that current practice of organisation and employees in the organisation towards change management involved in three main factors, namely trust in management, communication and organisational commitment; with the factor for trust in management is the positive vision for the future by management team, meanwhile for communication, it is found that there is good communication between supervisors and employees about the organisation's policy toward the changes. The factor found in organisational commitment is employees enjoying discussing about their organisation with outsiders. The findings of this paper provide a positive impact on change management planning, which ultimately help in ensuring more effective change programme implementation in the organisation in Malaysia.

The second 'D.D.S.' degree: a formula for practice success.

PubMed

Paquette, Jacinthe M; Sheets, Cherilyn G

2004-09-01

Planning for success is critical in clinical dentistry and in the management of a dental practice. Dentists need to apply basic business principles to planning their dental careers as they develop a vision, deliver quality products and services, and surpass patients,' staff members' and their own expectations. By applying general business management principles, dental practices can develop a logical, systematic approach to the management of a professional services business. For many dental professionals, these concepts were not learned in an undergraduate dental educational program and need to be mastered after professional school. Ideally, each dentist will establish a philosophical course that provides direction to the practice of dentistry. For a private dental practitioner, part of his or her goal is to create a tangible, transferable asset and a solid business plan that can benefit the practitioner in the present, as well as in the future practice transition.

Recycling of Waste Acetone by Fractional Distillation

ERIC Educational Resources Information Center

Weires, Nicholas A.; Johnston, Aubrey; Warner, Don L.; McCormick, Michael M.; Hammond, Karen; McDougal, Owen M.

2011-01-01

Distillation is a ubiquitous technique in the undergraduate organic chemistry curriculum; the technique dates back to ca. 3500 B.C.E. With the emergence of green chemistry in the 1990s, the importance of emphasizing responsible waste management practices for future scientists is paramount. Combining the practice of distillation with the message…

Physician practice management organizations: their prospects and performance.

PubMed

Conrad, D A; Koos, S; Harney, A; Haase, M

1999-09-01

As physician organizations adapt their incentives, processes, and structures to accommodate the demands of an increasingly competitive and performance-sensitive external environment, the development of more effective administrative and managerial mechanisms becomes critical to success. The emergence of physician practice management companies (PPMCs) represents a potentially positive step for physician practices seeking increased economies of scale through consolidation, as well as enhanced access to financial capital. However, economic and finance theory, coupled with some empirical "arithmetic" regarding the financial and operational performance of leading publicly traded PPMCs, suggest caution in one's forecasts of the future prospects for these evolving corporate forms.

Changing landowners, changing ecosystem? Land-ownership motivations as drivers of land management practices.

PubMed

Sorice, Michael G; Kreuter, Urs P; Wilcox, Bradford P; Fox, William E

2014-01-15

Motivations for owning rural land are shifting from an agricultural-production orientation to a preference for natural and cultural amenities. Resultant changes in land management have significant implications for the type and distribution of landscape-level disturbances that affect the delivery of ecosystem services. We examined the relationship between motivations for owning land and the implementation of conservation land management practices by landowners in the Southern Great Plains of the United States. Using a mail survey, we classified landowners into three groups: agricultural production, multiple-objective, and lifestyle-oriented. Cross tabulations of landowner group with past, current, and future use of 12 different land management practices (related to prescribed grazing, vegetation management, restoration, and water management) found that lifestyle-oriented landowners were overall less likely to adopt these practices. To the degree that the cultural landscape of rural lands transitions from production-oriented to lifestyle-oriented landowners, the ecological landscape and the associated flow of ecosystem services will likely change. This poses new challenges to natural resource managers regarding education, outreach, and policy; however, a better understanding about the net ecological consequences of lower rates of adoption of conservation management practices requires consideration of the ecological tradeoffs associated with the changing resource dependency of rural landowners. Copyright © 2013 Elsevier Ltd. All rights reserved.

Diffusion of pain management research into nursing practice.

PubMed

Dooks, P

2001-04-01

The promotion of evidence based practice is a challenge within nursing. Pain management is a prime example of this practice research gap. There is solid evidence for 20 years to promote positive change in our methods of pain management, yet outdated approaches are still amazingly evident. Even among oncology nurses, who place a high value on promoting patient comfort, there is a lack of evidence-based pain management. Rogers' Diffusion of Innovation Theory provides an interesting framework for examining the issues and possible solutions to this complex problem. Rogers' theory examines how changes diffuse through a social system over time and also exposes some of the barriers and facilitators to this process. The theory looks at adopters, the nature of the innovation, the social system, and communication patterns. Identifying the barriers of the past will help nursing to overcome these same barriers and increase the adoption of evidence-based pain management approaches in the future.

Impacts of agricultural management and climate change on future soil organic carbon dynamics in North China Plain.

PubMed

Wang, Guocheng; Li, Tingting; Zhang, Wen; Yu, Yongqiang

2014-01-01

Dynamics of cropland soil organic carbon (SOC) in response to different management practices and environmental conditions across North China Plain (NCP) were studied using a modeling approach. We identified the key variables driving SOC changes at a high spatial resolution (10 km × 10 km) and long time scale (90 years). The model used future climatic data from the FGOALS model based on four future greenhouse gas (GHG) concentration scenarios. Agricultural practices included different rates of nitrogen (N) fertilization, manure application, and stubble retention. We found that SOC change was significantly influenced by the management practices of stubble retention (linearly positive), manure application (linearly positive) and nitrogen fertilization (nonlinearly positive) - and the edaphic variable of initial SOC content (linearly negative). Temperature had weakly positive effects, while precipitation had negligible impacts on SOC dynamics under current irrigation management. The effects of increased N fertilization on SOC changes were most significant between the rates of 0 and 300 kg ha-1 yr-1. With a moderate rate of manure application (i.e., 2000 kg ha-1 yr-1), stubble retention (i.e., 50%), and an optimal rate of nitrogen fertilization (i.e., 300 kg ha-1 yr-1), more than 60% of the study area showed an increase in SOC, and the average SOC density across NCP was relatively steady during the study period. If the rates of manure application and stubble retention doubled (i.e., manure application rate of 4000 kg ha-1 yr-1 and stubble retention rate of 100%), soils across more than 90% of the study area would act as a net C sink, and the average SOC density kept increasing from 40 Mg ha-1 during 2010s to the current worldwide average of ∼ 55 Mg ha-1 during 2060s. The results can help target agricultural management practices for effectively mitigating climate change through soil C sequestration.

Impacts of Agricultural Management and Climate Change on Future Soil Organic Carbon Dynamics in North China Plain

PubMed Central

Wang, Guocheng; Li, Tingting; Zhang, Wen; Yu, Yongqiang

2014-01-01

Dynamics of cropland soil organic carbon (SOC) in response to different management practices and environmental conditions across North China Plain (NCP) were studied using a modeling approach. We identified the key variables driving SOC changes at a high spatial resolution (10 km×10 km) and long time scale (90 years). The model used future climatic data from the FGOALS model based on four future greenhouse gas (GHG) concentration scenarios. Agricultural practices included different rates of nitrogen (N) fertilization, manure application, and stubble retention. We found that SOC change was significantly influenced by the management practices of stubble retention (linearly positive), manure application (linearly positive) and nitrogen fertilization (nonlinearly positive) – and the edaphic variable of initial SOC content (linearly negative). Temperature had weakly positive effects, while precipitation had negligible impacts on SOC dynamics under current irrigation management. The effects of increased N fertilization on SOC changes were most significant between the rates of 0 and 300 kg ha−1 yr−1. With a moderate rate of manure application (i.e., 2000 kg ha−1 yr−1), stubble retention (i.e., 50%), and an optimal rate of nitrogen fertilization (i.e., 300 kg ha−1 yr−1), more than 60% of the study area showed an increase in SOC, and the average SOC density across NCP was relatively steady during the study period. If the rates of manure application and stubble retention doubled (i.e., manure application rate of 4000 kg ha−1 yr−1 and stubble retention rate of 100%), soils across more than 90% of the study area would act as a net C sink, and the average SOC density kept increasing from 40 Mg ha−1 during 2010s to the current worldwide average of ∼55 Mg ha−1 during 2060s. The results can help target agricultural management practices for effectively mitigating climate change through soil C sequestration. PMID:24722689

Managing caries: the need to close the gap between the evidence base and current practice.

PubMed

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

The influence of ethics on leadership.

PubMed

Kraemer, A M

1995-05-01

Value driven ethical leadership is needed today. The housekeeping field employs a diverse work force, and managers must develop and empower workers to attain organization goals. As managers, we must understand and develop our personal value structures that affect our decision making. This paper reviews Lawrence Kohlberg's study of moral behavior and how those stages are relevant to ethical management practices. It also addresses ways to overcome some obstacles in understanding and dealing with personal values that may threaten moral and ethical practices. Mature ethical principles and good communication are the foundation for and foster strong leadership for the future.

Sustainable agriculture, soil management and erosion from prehistoric times to 2100

NASA Astrophysics Data System (ADS)

Vanwalleghem, Tom; Gómez, Jose Alfonso; Infante Amate, Juan; González Molina, Manuel; Fernández, David Soto; Guzmán, Gema; Vanderlinden, Karl; Laguna, Ana; Giráldez, Juan Vicente

2015-04-01

The rational use of soil requires the selection of management practices to take profit of the beneficial functions of plant growth, water and nutrient storage, and pollutants removal by filtering and decomposition without altering its properties. However, the first evidence of important and widespread erosion peaks can generally be found with the arrival of the first farmers all over the world. In areas with a long land-use history such as the Mediterranean, clear signs indicating the advanced degradation status of the landscape, such as heavily truncated soils, are visible throughout. Soil conservation practices are then aimed at reducing erosion to geological rates, in equilibrium with long-term soil formation rates, while maximizing agricultural production. The adoption of such practices in most areas of the world are as old as the earliest soil erosion episodes themselves. This work firstly reviews historical evidence linking soil management and soil erosion intensity, with examples from N Europe and the Mediterranean. In particular, work by the authors in olive orchards will be presented that shows how significant variations in soil erosion rates between could be linked to the historical soil management. The potential of historical documents for calibrating a soil erosion model is shown as the model, in this case RUSLE-based and combining tillage and water erosion, adequately represents the measured erosion rate dynamics. Secondly, results from present-day, long-term farm experiments in the EU are reviewed to evaluate the effect of different soil management practices on physical soil properties, such as bulk density, penetration resistance, aggregate stability, runoff coefficient or sediment yield. Finally, we reflect upon model and field data that indicate how future global climate change is expected to affect soil management and erosion and how the examples used above hold clues about sustainable historical management practices that can be used successfully in the future.

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

Wood, Craig; Halpern, Jonathan; Wrons, Ralph

This Supplemental Information Source Document for Waste Management was prepared in support of future analyses including those that may be performed as part of the Sandia National Laboratories, New Mexico (SNL/NM) Site-Wide Environmental Impact Statement. This document presents information about waste management practices at SNL/NM, including definitions, inventory data, and an overview of current activities.

[Health agencies and the every day management of bioethics].

PubMed

Byk, Christian

2014-06-01

Taking into account their acquired experience, would not health agencies become the place where biomedical practices will be managed on an every day basis? Would in a near future these agencies have the role to interprete the principles of the bioethics law to adapt them to concrete issues?

Development of a sensitivity and uncertainty analysis tool in R for parametrization of the APEX model

USDA-ARS?s Scientific Manuscript database

Hydrologic models are used to simulate the responses of agricultural systems to different inputs and management strategies to identify alternative management practices to cope up with future climate and/or geophysical changes. The Agricultural Policy/Environmental eXtender (APEX) is a model develope...

Prototype development and demonstration for response, emergency staging, communications, uniform management, and evacuation (R.E.S.C.U.M.E.) : information broker framework analysis.

DOT National Transportation Integrated Search

2015-03-01

Through the Dynamic Mobility Applications (DMA) Program, U.S. DOT desires to improve current operational practices and transform management of future surface transportation systems. The DMA program is designed to enhance deployment of emerging techno...

Modeling potential outcomes of fire and fuel management scenarios on the structure of forested habitats in northeast Oregon, USA.

Treesearch

B.C. Wales; L.H. Suring; M.A. Hemstrom

2007-01-01

Thinning and prescribed fire are being used extensively across the interior Western United States to reduce the risk of large, severe wildfires. However, the full ecological consequences of implementing these management practices on the landscape have not been completely evaluated. We projected future vegetation trends resulting from four management scenarios and...

Risk management: Core principles and practices, and their relevance to wildland fire

Treesearch

Matthew P. Thompson; Donald G. MacGregor; Dave Calkin

2016-01-01

The Forest Service, U.S. Department of Agriculture faces a future of increasing complexity and risk, pressing financial issues, and the inescapable possibility of loss of human life. These issues are perhaps most acute for wildland fire management, the highest risk activity in which the Forest Service engages. Risk management (RM) has long been put forth as an...

The Future of Asset Management for Human Space Exploration: Supply Classification and an Integrated Database

NASA Technical Reports Server (NTRS)

Shull, Sarah A.; Gralla, Erica L.; deWeck, Olivier L.; Shishko, Robert

2006-01-01

One of the major logistical challenges in human space exploration is asset management. This paper presents observations on the practice of asset management in support of human space flight to date and discusses a functional-based supply classification and a framework for an integrated database that could be used to improve asset management and logistics for human missions to the Moon, Mars and beyond.

Recruitment and Hiring Strategies of Private Practitioners and Implications for Practice Management Training of Veterinary Students.

PubMed

Kogan, Lori R; Hellyer, Peter W; Stewart, Sherry M; Dowers, Kristy L

2015-01-01

Hiring new employees is one of the most important and difficult decisions all veterinary practice managers and owners face. In an effort to improve hiring decisions, many employers are choosing to screen potential employees more thoroughly through the use of interviews, background checks, personality assessments, and online research including social and professional networking websites. The current study reports results from an anonymous online survey created to evaluate practicing veterinarians' attitudes and practices related to the use of recruitment and hiring tools. Results suggest that, compared to those in other professions, veterinarians underutilize these evaluative tools. The profession could benefit from more opportunities for both practitioners and veterinary students to learn how to utilize a broader range of hiring and recruitment techniques. One area of particular and growing concern is the use of Internet social media for evaluation of potential employees. Despite the fairly low number of participants who indicated they currently research applicants online, a significant number plan to implement this practice in the future. Many students are unaware of how their online postings can affect their future job possibilities and career. It is therefore important to designate time within continuing education programs and professional veterinary curricula to educate these populations about hiring and recruitment tool options and about how to manage their personal Internet interactions (especially social media) to enhance and maintain their professional image (e-professionalism).

Energy futures: Trading opportunities for the 1980's

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

Treat, J.E.; Cowie, S.; Davidson, F.E.

1984-01-01

This text gives a broad background in both theory and practice of energy futures trading. It details successful contract requirements. It analyzes fundamental and technical pricing and using both to manage risk and achieve trading objectives. Hedging strategy, financial aspects of trading, accounting procedures, internal control systems and tax implications are all expertly covered. The book concludes with the potential impact of futures trading on the structure of world markets. Contents: Energy futures: an overview; Exchanges and their contracts; Fundamental analysis and the theory of hedging; The principles of technical analysis; Putting it all together; Integrated trading strategies; Energy futures;more » Financing and exposure management in the oil industry; Accounting principles, taxation, and internal control; The potential impacts of trading in oil futures on the world oil market; Appendix; Glossary; Index.« less

Strategies and methods for aligning current and best medical practices. The role of information technologies.

PubMed

Schneider, E C; Eisenberg, J M

1998-05-01

Rapid change in American medicine requires that physicians adjust established behaviors and acquire new skills. In this article, we address three questions: What do we know about how to change physicians' practices? How can physicians take advantage of new and evolving information technologies that are likely to have an impact on the future practice of medicine? and What strategic educational interventions will best enable physicians to show competencies in information management and readiness to change practice? We outline four guiding principles for incorporating information systems tools into both medical education and practice, and we make eight recommendations for the development of a new medical school curriculum. This curriculum will produce a future medical practitioner who is capable of using information technologies to systematically measure practice performance, appropriateness, and effectiveness while updating knowledge efficiently.

Exploring Bim for Operational Integrated Asset Management - a Preliminary Study Utilising Real-World Infrastructure Data

NASA Astrophysics Data System (ADS)

Boyes, G. A.; Ellul, C.; Irwin, D.

2017-10-01

The use of 3D information models within collaborative working environments and the practice of Building Information Modelling (BIM) are becoming more commonplace within infrastructure projects. Currently used predominantly during the design and construction phase, the use of BIM is capable in theory of providing the information at handover that will satisfy the Asset Information Requirements (AIRs) of the future Infrastructure Manager (IM). One particular challenge is establishing a link between existing construction-centric information and the asset-centric information needed for future operations. Crossrail, a project to build a new high-frequency railway underneath London, is handling many such challenges as they prepare to handover their digital information to the future operator, in particular the need to provide a two-way link between a federated 3D CAD model and an object-relational Asset Information Management System (AIMS). This paper focusses on the potential for improved Asset Management (AM) by integrating BIM and GIS systems and practices, and makes a preliminary report on how 3D spatial queries can be used to establish a two-way relational link between two information systems (3D geometry and asset lists), as well as the challenges being overcome to transform the data to be suitable for AM.

Manufacturing of tattoo ink products today and in future: Europe.

PubMed

Michel, Ralf

2015-01-01

The article describes the European market situation and the legal framework in Europe. It shows the state-of-the-art production under ISO 9001:2008 quality management and describes the future of tattoo ink production based on good manufacturing practice guidelines for tattoo inks. © 2015 S. Karger AG, Basel.

Inferences from growing trees backwards

Treesearch

David W. Green; Kent A. McDonald

1997-01-01

The objective of this paper is to illustrate how longitudinal stress wave techniques can be useful in tracking the future quality of a growing tree. Monitoring the quality of selected trees in a plantation forest could provide early input to decisions on the effectiveness of management practices, or future utilization options, for trees in a plantation. There will...

Perspectives for geographically oriented management of fusarium mycotoxins in the cereal supply chain.

PubMed

van der Fels-Klerx, H J; Booij, C J H

2010-06-01

This article provides an overview of available systems for management of Fusarium mycotoxins in the cereal grain supply chain, with an emphasis on the use of predictive mathematical modeling. From the state of the art, it proposes future developments in modeling and management and their challenges. Mycotoxin contamination in cereal grain-based feed and food products is currently managed and controlled by good agricultural practices, good manufacturing practices, hazard analysis critical control points, and by checking and more recently by notification systems and predictive mathematical models. Most of the predictive models for Fusarium mycotoxins in cereal grains focus on deoxynivalenol in wheat and aim to help growers make decisions about the application of fungicides during cultivation. Future developments in managing Fusarium mycotoxins should include the linkage between predictive mathematical models and geographical information systems, resulting into region-specific predictions for mycotoxin occurrence. The envisioned geographically oriented decision support system may incorporate various underlying models for specific users' demands and regions and various related databases to feed the particular models with (geographically oriented) input data. Depending on the user requirements, the system selects the best fitting model and available input information. Future research areas include organizing data management in the cereal grain supply chain, developing predictive models for other stakeholders (taking into account the period up to harvest), other Fusarium mycotoxins, and cereal grain types, and understanding the underlying effects of the regional component in the models.

Fort Collins Science Center: Policy Analysis and Science Assistance

USGS Publications Warehouse

Lamb, Berton L.

2004-01-01

PASA's mission is to integrate biological, social, and economic research so that resource managers can use the resulting information to make informed decisions and resolve resource management conflicts. PASA scientists pursue and conduct scientific analyses that help agencies and Native American tribes to (1) identify impending policy controversies and areas where social and natural science research is needed to address future policy questions; (2) develop methods and approaches to assist researchers in preparing scientific evidence; (3) assess habitat alteration in a manner consistent with policy needs; and (4) evaluate policy options. Branch scientists also evaluate policy options (e.g., effects of different land treatments, fish and wildlife management practices, or visitor/recreation management practices) in response to specific questions faced by policymakers and managers.

Summary of the East Africa Training Consortium Biorisk Management Practices and Training Needs Survey

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

Wilder, Julie; Mancini, Giulio M.; Wakabi, Timothy

A survey was designed to query former Biorisk management (BRM) trainees in the East Africa region about their practices post-training and their perceived future training needs. A subset of those surveyed had been trained as BRM trainers. The survey was conducted to obtain a baseline of BRM practices that can serve as a benchmark for performance monitoring, to identify priorities for future BRM training and to gauge local BRM trainers' abilities to deliver effective training. The survey revealed that less than 50% of the respondents could identify evidence of a BRM system in their institute. Coaching and mentoring by BRMmore » experts was identified as being of highest benefit to enable success as BRM practitioners. Local trainers reached 1538 trainees in the previous year and reported that trainings positively correlated with desired BRM behavior. Acknowledgements The authors wish to sincerely thank all of the former biorisk management trainees in East Africa who agreed to participate in this survey. Their candid and honest input was extremely insightful. We also thank Lora Grainger (06826) and Ben Brodsky (Manager, 06824) for careful and critical review of the report. We are grateful for the financial support of the Defense Threat Reduction Agency, Cooperative Biological Engagement Program.« less

Prognostics and Health Management of Wind Turbines -- Current Status and Future Opportunities

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

Sheng, Shuangwen

The global wind industry has seen tremendous growth during the past two decades. However, the industry is challenged by premature component failures, which lead to increased turbine downtime and subsequently, cost of energy for wind power. To mitigate the impacts from these failures, the wind industry has been exploring various areas for improvements ranging from product design, new materials or lubricants, to operation and maintenance (O&M) practices. Condition-based maintenance or prognostics and health management (PHM) has been explored as one enabling technology for improving O&M practices. This chapter provides a brief overview of wind turbine PHM with a focus onmore » operational data mining and condition monitoring of drivetrains. Some future research and development opportunities in wind turbine PHM are also briefly discussed.« less

"Further Education, Future Prosperity? The Implications of Marketisation on Further Education Working Practices"

ERIC Educational Resources Information Center

Illsley, Rachael; Waller, Richard

2017-01-01

This paper examines how the marketised funding system of vocational further education is affecting lecturers' working practices and professional integrity. Semi-structured interviews were conducted with a number of lecturing staff and managers within two vocational areas at an English FE college to examine the implications of working under the…

Summary of performance data for technologies to control gaseous, odor, and particulate emissions from livestock operations: Air management practices assessment tool (AMPAT)

PubMed Central

Maurer, Devin L.; Koziel, Jacek A.; Harmon, Jay D.; Hoff, Steven J.; Rieck-Hinz, Angela M.; Andersen, Daniel S.

2016-01-01

The livestock and poultry production industry, regulatory agencies, and researchers lack a current, science-based guide and data base for evaluation of air quality mitigation technologies. Data collected from science-based review of mitigation technologies using practical, stakeholders-oriented evaluation criteria to identify knowledge gaps/needs and focuses for future research efforts on technologies and areas with the greatest impact potential is presented in the Literature Database tab on the air management practices tool (AMPAT). The AMPAT is web-based (available at www.agronext.iastate.edu/ampat) and provides an objective overview of mitigation practices best suited to address odor, gaseous, and particulate matter (PM) emissions at livestock operations. The data was compiled into Excel spreadsheets from a literature review of 265 papers was performed to (1) evaluate mitigation technologies performance for emissions of odor, volatile organic compounds (VOCs), ammonia (NH3), hydrogen sulfide (H2S), particulate matter (PM), and greenhouse gases (GHGs) and to (2) inform future research needs. PMID:27158660

A residency clinic chronic condition management quality improvement project.

PubMed

Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon

2007-02-01

Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

Quantifying human impact on hydrological drought using an Earth System Model

NASA Astrophysics Data System (ADS)

van Huijgevoort, Marjolein; Chaney, Nathaniel; Malyshev, Sergey; Shevliakova, Elena; Milly, Chris

2017-04-01

Predicting the human impact on the present and future hydrological cycle remains a significant scientific challenge. Anthropogenic impact includes water management practices like diverting water for irrigation, abstraction of groundwater, and reservoirs. Hydrological extremes, in particular, are heavily affected by water management practices, due to the existing stress on the system during droughts and floods. Therefore, to prepare adaptation plans for hydrological extremes in the future, it is essential to account for water management and other human influences in Earth System Models. In this study we have implemented water management practices in the state-of-the-art GFDL land model, which includes terrestrial water, energy, and carbon balances. Both irrigation practices and reservoirs have been added in the land surface model component of the model. Irrigation amounts are determined from the soil water balance, the evaporative demand of the vegetation and fractional coverage of croplands. The resulting water demand is fulfilled by abstractions from surface water and groundwater. Reservoir outflow is dynamically coupled to the downstream water demand and available reservoir storage. Retrospective model simulations over the contiguous United States indicate a strong human influence on hydrological drought. A water management attribution analysis shows a significant impact on the water availability, mostly in the Midwest of the United States and California. Implementation of reservoirs alters the flow regime, thereby decreasing the short-term drought impact, however, in the case of multi-year drought, impacts are delayed due to the dependency on the reservoir outflow. Irrigation, on the other hand, decreases the water availability in rivers due to increased evapotranspiration leading to a higher drought impact. The average increase in evapotranspiration amounted up to 2 mm/day for cropland areas in California and Texas. Overall, the results show the importance of including water management in global scale models. This new modelling framework can be used to understand how humans will impact future water availability, water scarcity, and drought. Next steps will include coupled model simulations to investigate the human impact on feedbacks in land-atmosphere interactions.

Elaborating on theory with middle managers' experience implementing healthcare innovations in practice.

PubMed

Birken, Sarah A; DiMartino, Lisa D; Kirk, Meredith A; Lee, Shoou-Yih D; McClelland, Mark; Albert, Nancy M

2016-01-04

The theory of middle managers' role in implementing healthcare innovations hypothesized that middle managers influence implementation effectiveness by fulfilling the following four roles: diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. The theory also suggested several activities in which middle managers might engage to fulfill the four roles. The extent to which the theory aligns with middle managers' experience in practice is unclear. We surveyed middle managers (n = 63) who attended a nursing innovation summit to (1) assess alignment between the theory and middle managers' experience in practice and (2) elaborate on the theory with examples from middle managers' experience overseeing innovation implementation in practice. Middle managers rated all of the theory's hypothesized four roles as "extremely important" but ranked diffusing and synthesizing information as the most important and selling innovation implementation as the least important. They reported engaging in several activities that were consistent with the theory's hypothesized roles and activities such as diffusing information via meetings and training. They also reported engaging in activities not described in the theory such as appraising employee performance. Middle managers' experience aligned well with the theory and expanded definitions of the roles and activities that it hypothesized. Future studies should assess the relationship between hypothesized roles and the effectiveness with which innovations are implemented in practice. If evidence supports the theory, the theory should be leveraged to promote the fulfillment of hypothesized roles among middle managers, doing so may promote innovation implementation.

The new Waste Law: Challenging opportunity for future landfill operation in Indonesia.

PubMed

Meidiana, Christia; Gamse, Thomas

2011-01-01

The Waste Law No. 18/2008 Article 22 and 44 require the local governments to run environmentally sound landfill. Due to the widespread poor quality of waste management in Indonesia, this study aimed to identify the current situation by evaluating three selected landfills based on the ideal conditions of landfill practices, which are used to appraise the capability of local governments to adapt to the law. The results indicated that the local governments have problems of insufficient budget, inadequate equipment, uncollected waste and unplanned future landfill locations. All of the selected landfills were partially controlled landfills with open dumping practices predominating. In such inferior conditions the implementation of sanitary landfill is not necessarily appropriate. The controlled landfill is a more appropriate solution as it offers lower investment and operational costs, makes the selection of a new landfill site unnecessary and can operate with a minimum standard of infrastructure and equipment. The sustainability of future landfill capacity can be maintained by utilizing the old landfill as a profit-oriented landfill by implementing a landfill gas management or a clean development mechanism project. A collection fee system using the pay-as-you-throw principle could increase the waste income thereby financing municipal solid waste management.

High-performance work systems in health care management, part 1: development of an evidence-informed model.

PubMed

Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

2011-01-01

: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

CVE and the Corporate Market: A Case Study of the Experience of Warwick Business School.

ERIC Educational Resources Information Center

Antonazzi, Leoni

1998-01-01

Reviews the promotion and practice of continuing vocational education (CVE) at Warwick Business School (United Kingdom) for executives within the corporate sector. Highlights include relationship management, brand building, an MBA (Masters in Business Education) refresher course, a strategic management refresher course, and future developments.…

Twenty-One Leadership Responsibilities and Quality Management in the Context of Educational Baldrige Systems

ERIC Educational Resources Information Center

Ibach, Kimberly L.

2014-01-01

This body of work presents the summary of findings; explanation of implications; discussion of conclusions; and recommendations about practice, policy and future research regarding principal leadership in school districts recognized as national Baldrige Award winners. This study widened the scope and definition of quality management in education…

Climate Project Screening Tool

Treesearch

Forest Service U.S. Department of Agriculture

2011-01-01

Climate change poses a challenge for resource managers as they review current management practices. Adaptation is a critical means of addressing climate change in the near future because, due to inherent time lags in climate impacts, the effects of increased atmospheric greenhouse gases will be felt for decades even if effective mitigation begins now. To address the...

A Survey of Current and Future Perceived Multi-National Corporation Manufacturing Training Needs in Tianjin, (T.E.D.A.) China.

ERIC Educational Resources Information Center

Hickey, Will

2001-01-01

Describes a study that surveyed current and perceived future employer-provided training practices among multinational corporations manufacturing companies in the Tianjin Economic Development Area (T.E.D.A.) of China. Highlights include labor market; human resources management in China; workforce productivity; and return on investment. (Author/LRW)

Looking back: a review of classic ostomy literature in the WOCN society's official publication.

PubMed

Colwell, Janice C; Schuller, Nancy

2013-01-01

In recognition of the 40-year anniversary of the Journal of Wound, Ostomy and Continence Nursing, a review of ostomy-related articles in the Society's official publications was done. The goal was to find what were considered classic ostomy articles, articles that contributed to the practice of ostomy care nursing, and articles that as clinicians practicing in the late 70s we felt helped to shape the future of ostomy care nursing. The review began with the 1975 ET Journal and continued forward ending in 1990. A classic article was defined as one that described a new or unique use of an ostomy product, a new procedure that impacted ostomy practice, the evolution of evidence-based ostomy practice, concepts that would drive our future practice, and management of stoma complications. These articles are a glimpse into the unique, creative, and evolving practice that makes our ostomy specialty distinctive.

PRISM: Priority Symptom Management Project phase I: assessment.

PubMed

Ropka, M E; Spencer-Cisek, P

2001-01-01

To provide an overview of the process, goals, and outcome recommendations from the assessment phase of the Oncology Nursing Society's Priority Symptom Management (PRISM) project and to provide the foundation for a series of evidence-based practice and qualitative systematic review articles generated from the first phase of PRISM. Published articles, abstracts, and books; computerized databases; nonpublished research; personal communications; and proceedings of the PRISM summit meeting. Symptom management is a key component in quality cancer care. The assessment phase of PRISM yielded systematic reviews with an evidence-based framework to evaluate key symptoms, developed a framework for teaching and evaluating other symptoms, and recommended future ONS initiatives. Outcome recommendations from the PRISM summit targeted practice; professional and public education; research; and health policy. These activities provide background for subsequent evidence-based practice and qualitative systematic review articles that will focus on cancer symptom management.

openSE: a Systems Engineering Framework Particularly Suited to Particle Accelerator Studies and Development Projects

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

Bonnal, P.; Féral, B.; Kershaw, K.

Particle accelerator projects share many characteristics with industrial projects. However, experience has shown that best practice of industrial project management is not always well suited to particle accelerator projects. Major differences include the number and complexity of technologies involved, the importance of collaborative work, development phases that can last more than a decade, and the importance of telerobotics and remote handling to address future preventive and corrective maintenance requirements due to induced radioactivity, to cite just a few. The openSE framework it is a systems engineering and project management framework specifically designed for scientific facilities’ systems and equipment studies andmore » development projects. Best practices in project management, in systems and requirements engineering, in telerobotics and remote handling and in radiation safety management were used as sources of inspiration, together with analysis of current practices surveyed at CERN, GSI and ESS.« less

Statewide Transportation Needs & Funding Study

DOT National Transportation Integrated Search

1995-05-01

The State Transportation Policy Initiative (STPI)is multi-phase study to examine : current transportation planning, growth management, and transportation funding : practices in Florida and to develop recommendations that can be the basis of : future ...

Developmental Structural Tooth Defects in Dogs – Experience From Veterinary Dental Referral Practice and Review of the Literature

PubMed Central

Boy, Sonja; Crossley, David; Steenkamp, Gerhard

2016-01-01

Developmental tooth abnormalities in dogs are uncommon in general veterinary practice but understanding thereof is important for optimal management in order to maintain masticatory function through preservation of the dentition. The purpose of this review is to discuss clinical abnormalities of the enamel and general anatomy of dog teeth encountered in veterinary dental referral practice and described in the literature. More than 900 referral cases are seen annually between the two referral practices. The basis of the pathogenesis, resultant clinical appearance, and the principles of management for each anomaly will be described. Future research should be aimed toward a more detailed analysis of these conditions so rarely described in the literature. PMID:26904551

Innovative Approaches in Chronic Disease Management: Health Literacy Solutions and Opportunities for Research Validation.

PubMed

Villaire, Michael; Gonzalez, Diana Peña; Johnson, Kirby L

2017-01-01

This chapter discusses the need for innovative health literacy solutions to combat extensive chronic disease prevalence and costs. The authors explore the intersection of chronic disease management and health literacy. They provide specific examples of successful health literacy interventions for managing several highly prevalent chronic diseases. This is followed by suggestions on pairing research and practice to support effective disease management programs. In addition, the authors discuss strategies for collection and dissemination of knowledge gained from collaborations between researchers and practitioners. They identify current challenges specific to disseminating information from the health literacy field and offer potential solutions. The chapter concludes with a brief look at future directions and organizational opportunities to integrate health literacy practices to address the need for effective chronic disease management.

Supportive Care Treatment Guidelines: Value, Limitations, and Opportunities

PubMed Central

Peterson, Douglas E.; Bensadoun, Rene-Jean; Lalla, Rajesh V.; McGuire, Deborah B.

2013-01-01

Evidence-based guidelines in clinical oncology practice are now prominent, with emphasis on clinical, health outcome and economic perspectives. Given the complexity of cancer management, a multidisciplinary approach is essential. Evidence-based guidelines to address supportive cancer care have merged expert opinion, systematic evaluation of clinical and research data, and meta-analyses of clinical trials. Production of supportive care guidelines by the interdisciplinary team is dependent on sufficient high-quality research studies. Once published, it is essential they be customized at institutional and national levels. Implementation in clinical practice is perhaps the greatest challenge. Optimal management occurs through integration of country-specific issues, including care access, healthcare resources, information technology, and national coordination of healthcare practices. The purpose of this article is to: (1) provide an overview of interdisciplinary cancer management using evidence-based guidelines; (2) delineate the theory and practice of guideline dissemination, utilization and outcome assessment; and (3) recommend future research strategies to maximize guidelines use in clinical practice. PMID:21600365

Translating Change into Improved Practice: Analysis of Teachers' Attempts to Generate a New Emerging Pedagogy in Scotland

ERIC Educational Resources Information Center

Thorburn, Malcolm; Carse, Nicola; Jess, Mike; Atencio, Matthew

2011-01-01

In Scotland, substantial changes in the management of education at national, local authority and school/community levels are afoot. Central to future improvements are how teachers translate curriculum guidelines, with an increased focus on health and wellbeing and holistic learning experiences, into constructivist inclined pedagogical practices.…

Converting Virginia pine stump diameters to diameters breast high

Treesearch

Thomas W., Jr. Church

1953-01-01

Up until the last decade, practically no forest-management work had been done in stands of Virginia pine (Pinus virginiana Miller). It is still common practice to clear-cut the stand - with no consideration for a future crop. In some places this has resulted in satisfactory establishment of another pine stand. But usually hardwoods take over the site...

Managers' perspectives on recruitment and human resource development practices in primary health care.

PubMed

Lammintakanen, Johanna; Kivinen, Tuula; Kinnunen, Juha

2010-12-01

The aim of this study is to describe primary health care managers' attitudes and views on recruitment and human resource development in general and to ascertain whether there are any differences in the views of managers in the southern and northern regions of Finland. A postal questionnaire was sent to 315 primary health care managers, of whom 55% responded. The data were analysed using descriptive statistics and cross-tabulation according to the location of the health centre. There were few differences in managers' attitudes and views on recruitment and human resource development. In the southern region, managers estimated that their organization would be less attractive to employees in the future and they were more positive about recruiting employees abroad. Furthermore, managers in the northern region were more positive regarding human resource development and its various practices. Although the results are preliminary in nature, it seems that managers in different regions have adopted different strategies in order to cope with the shrinking pool of new recruits. In the southern region, managers were looking abroad to find new employees, while in the northern region, managers put effort into retaining the employees in the organization with different human resource development practices.

Improving Soil Seed Bank Management.

PubMed

Haring, Steven C; Flessner, Michael L

2018-05-08

Problems associated with simplified weed management motivate efforts for diversification. Integrated weed management uses fundamentals of weed biology and applied ecology to provide a framework for diversified weed management programs; the soil seed bank comprises a necessary part of this framework. By targeting seeds, growers can inhibit the propagule pressure on which annual weeds depend for agricultural invasion. Some current management practices affect weed seed banks, such as crop rotation and tillage, but these tools are often used without specific intention to manage weed seeds. Difficulties quantifying the weed seed bank, understanding seed bank phenology, and linking seed banks to emerged weed communities challenge existing soil seed bank management practices. Improved seed bank quantification methods could include DNA profiling of the soil seed bank, mark and recapture, or 3D LIDAR mapping. Successful and sustainable soil seed bank management must constrain functionally diverse and changing weed communities. Harvest weed seed controls represent a step forward, but over-reliance on this singular technique could make it short-lived. Researchers must explore tools inspired by other pest management disciplines, such as gene drives or habitat modification for predatory organisms. Future weed seed bank management will combine multiple complementary practices that enhance diverse agroecosystems. This article is protected by copyright. All rights reserved.

Options for national parks and reserves for adapting to climate change.

PubMed

Baron, Jill S; Gunderson, Lance; Allen, Craig D; Fleishman, Erica; McKenzie, Donald; Meyerson, Laura A; Oropeza, Jill; Stephenson, Nate

2009-12-01

Past and present climate has shaped the valued ecosystems currently protected in parks and reserves, but future climate change will redefine these conditions. Continued conservation as climate changes will require thinking differently about resource management than we have in the past; we present some logical steps and tools for doing so. Three critical tenets underpin future management plans and activities: (1) climate patterns of the past will not be the climate patterns of the future; (2) climate defines the environment and influences future trajectories of the distributions of species and their habitats; (3) specific management actions may help increase the resilience of some natural resources, but fundamental changes in species and their environment may be inevitable. Science-based management will be necessary because past experience may not serve as a guide for novel future conditions. Identifying resources and processes at risk, defining thresholds and reference conditions, and establishing monitoring and assessment programs are among the types of scientific practices needed to support a broadened portfolio of management activities. In addition to the control and hedging management strategies commonly in use today, we recommend adaptive management wherever possible. Adaptive management increases our ability to address the multiple scales at which species and processes function, and increases the speed of knowledge transfer among scientists and managers. Scenario planning provides a broad forward-thinking framework from which the most appropriate management tools can be chosen. The scope of climate change effects will require a shared vision among regional partners. Preparing for and adapting to climate change is as much a cultural and intellectual challenge as an ecological challenge.

Options for national parks and reserves for adapting to climate change

USGS Publications Warehouse

Baron, Jill S.; Gunderson, Lance; Allen, Craig D.; Fleishman, Erica; McKenzie, Donald; Meyerson, Laura A.; Oropeza, Jill; Stephenson, Nathan L.

2009-01-01

Past and present climate has shaped the valued ecosystems currently protected in parks and reserves, but future climate change will redefine these conditions. Continued conservation as climate changes will require thinking differently about resource management than we have in the past; we present some logical steps and tools for doing so. Three critical tenets underpin future management plans and activities: (1) climate patterns of the past will not be the climate patterns of the future; (2) climate defines the environment and influences future trajectories of the distributions of species and their habitats; (3) specific management actions may help increase the resilience of some natural resources, but fundamental changes in species and their environment may be inevitable. Science-based management will be necessary because past experience may not serve as a guide for novel future conditions. Identifying resources and processes at risk, defining thresholds and reference conditions, and establishing monitoring and assessment programs are among the types of scientific practices needed to support a broadened portfolio of management activities. In addition to the control and hedging management strategies commonly in use today, we recommend adaptive management wherever possible. Adaptive management increases our ability to address the multiple scales at which species and processes function, and increases the speed of knowledge transfer among scientists and managers. Scenario planning provides a broad forward-thinking framework from which the most appropriate management tools can be chosen. The scope of climate change effects will require a shared vision among regional partners. Preparing for and adapting to climate change is as much a cultural and intellectual challenge as an ecological challenge.

Review of Ecologically-Based Pest Management in California Vineyards

PubMed Central

Wilson, Houston

2017-01-01

Grape growers in California utilize a variety of biological, cultural, and chemical approaches for the management of insect and mite pests in vineyards. This combination of strategies falls within the integrated pest management (IPM) framework, which is considered to be the dominant pest management paradigm in vineyards. While the adoption of IPM has led to notable and significant reductions in the environmental impacts of grape production, some growers are becoming interested in the use of an explicitly non-pesticide approach to pest management that is broadly referred to as ecologically-based pest management (EBPM). Essentially a subset of IPM strategies, EBPM places strong emphasis on practices such as habitat management, natural enemy augmentation and conservation, and animal integration. Here, we summarize the range and known efficacy of EBPM practices utilized in California vineyards, followed by a discussion of research needs and future policy directions. EBPM should in no way be seen in opposition, or as an alternative to the IPM framework. Rather, the further development of more reliable EBPM practices could contribute to the robustness of IPM strategies available to grape growers. PMID:29019946

Review of Ecologically-Based Pest Management in California Vineyards.

PubMed

Wilson, Houston; Daane, Kent M

2017-10-11

Grape growers in California utilize a variety of biological, cultural, and chemical approaches for the management of insect and mite pests in vineyards. This combination of strategies falls within the integrated pest management (IPM) framework, which is considered to be the dominant pest management paradigm in vineyards. While the adoption of IPM has led to notable and significant reductions in the environmental impacts of grape production, some growers are becoming interested in the use of an explicitly non-pesticide approach to pest management that is broadly referred to as ecologically-based pest management (EBPM). Essentially a subset of IPM strategies, EBPM places strong emphasis on practices such as habitat management, natural enemy augmentation and conservation, and animal integration. Here, we summarize the range and known efficacy of EBPM practices utilized in California vineyards, followed by a discussion of research needs and future policy directions. EBPM should in no way be seen in opposition, or as an alternative to the IPM framework. Rather, the further development of more reliable EBPM practices could contribute to the robustness of IPM strategies available to grape growers.

Possible ways for Public Health Surveillance practices evaluation.

PubMed

Vilela, Maria Filomena de Gouveia; Santos, Dario Nunes Dos; Kemp, Brigina

2017-10-01

This is an evaluative and qualitative study that proposes to investigate self-assessment evaluation as a device to analyze Health Surveillance practices through a questionnaire built by researchers, adapted from the Self-Assessment of Improved Access and Primary Care Quality (AMAQ) and available on the FORMSUS platform. Forty-one Health Surveillance workers and managers of a large municipality from São Paulo State evaluated the realms of "management", "teamwork" and their respective sub-realms. Two categories were created to analyze the results: "Management" and "Team" in dialogue with references from Management, Evaluation and Health Surveillance. Most "management" and "teamwork" sub-realms were deemed satisfactory. Self-assessment evaluation through an applied evaluation tool was shown to be a powerful resource for the analysis of Health Surveillance practices in combination with other devices adopted by the Unified Health System (SUS). Unlike usual evaluation processes guided by quantitative markers, this self-assessable evaluative process included subjects and enabled the possibility of incorporating a new look at itself to the way Health Surveillance is carried out and support future management contracts between workers and managers.

The influence of leadership practices and empowerment on Canadian nurse manager outcomes.

PubMed

Spence Laschinger, Heather K; Wong, Carol A; Grau, Ashley L; Read, Emily A; Pineau Stam, Lisa M

2012-10-01

To examine the influence of senior nurse leadership practices on middle and first-line nurse managers' experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers' turnover intentions. This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders. © 2011 Blackwell Publishing Ltd.

Representational Approach: A Conceptual Framework to Guide Patient Education Research and Practice.

PubMed

Arida, Janet A; Sherwood, Paula R; Flannery, Marie; Donovan, Heidi S

2016-11-01

Illness representations are cognitive structures that individuals rely on to understand and explain their illnesses and associated symptoms. The Representational Approach (RA) to patient education offers a theoretically based, clinically useful model that can support oncology nurses to develop a shared understanding of patients' illness representations to collaboratively develop highly personalized plans for symptom management and other important self-management behaviors. This article discusses theoretical underpinnings, practical applications, challenges, and future directions for incorporating illness representations and the RA in clinical and research endeavors.

Simulating secondary succession of elk forage values in a managed forest landscape, western Washington

USGS Publications Warehouse

Jenkins, Kurt J.; Starkey, Edward E.

1996-01-01

Modern timber management practices often influence forage production for elk (Cervus elaphus) on broad temporal and spatial scales in forested landscapes. We incorporated site-specific information on postharvesting forest succession and forage characteristics in a simulation model to evaluate past and future influences of forest management practices on forage values for elk in a commercially managed Douglas fir (Pseudotsuga menziesii, PSME)-western hemlock (Tsuga heterophylla, TSHE) forest in western Washington. We evaluated future effects of: (1) clear-cut logging 0, 20, and 40% of harvestable stands every five years; (2) thinning 20-year-old Douglas fir forests; and (3) reducing the harvesting cycle from 60 to 45 years. Reconstruction of historical patterns of vegetation succession indicated that forage values peaked in the 1960s and declined from the 1970s to the present, but recent values still were higher than may have existed in the unmanaged landscape in 1945. Increased forest harvesting rates had little short-term influence on forage trends because harvestable stands were scarce. Simulations of forest thinning also produced negligible benefits because thinning did not improve forage productivity appreciably at the stand level. Simulations of reduced harvesting cycles shortened the duration of declining forage values from approximately 30 to 15 years. We concluded that simulation models are useful tools for examining landscape responses of forage production to forest management strategies, but the options examined provided little potential for improving elk forages in the immediate future.

Driving Safely into the Future with Applied Technology

DOT National Transportation Integrated Search

2013-06-19

This report highlights key recommendations and noteworthy practices identified at the peer exchange on Introducing Performance Management into the Metropolitan Planning Organization (MPO) Planning Process held on June, 19, 2013 in Bismarck, Nor...

Embattled and embittered or empowered and evolving: nurse practitioner attitudes toward managed care.

PubMed

Hayes, Eileen F

2007-03-01

To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them. NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice. The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.

Patient engagement with infection management in secondary care: a qualitative investigation of current experiences

PubMed Central

Rawson, Timothy M; Moore, Luke S P; Hernandez, Bernard; Castro-Sanchez, Enrique; Charani, Esmita; Georgiou, Pantelis; Ahmad, Raheelah; Holmes, Alison H

2016-01-01

Objective To understand patient engagement with decision-making for infection management in secondary care and the consequences associated with current practices. Design A qualitative investigation using in-depth focus groups. Participants Fourteen members of the public who had received antimicrobials from secondary care in the preceding 12 months in the UK were identified for recruitment. Ten agreed to participate. All participants had experience of infection management in secondary care pathways across a variety of South-East England healthcare institutes. Study findings were subsequently tested through follow-up focus groups with 20 newly recruited citizens. Results Participants reported feelings of disempowerment during episodes of infection in secondary care. Information is communicated in a unilateral manner with individuals ‘told’ that they have an infection and will receive an antimicrobial (often unnamed), leading to loss of ownership, frustration, anxiety and ultimately distancing them from engaging with decision-making. This poor communication drives individuals to seek information from alternative sources, including online, which is associated with concerns over reliability and individualisation. Failures in communication and information provision by clinicians in secondary care influence individuals’ future ideas about infections and their management. This alters their future actions towards antimicrobials and can drive prescription non-adherence and loss to follow-up. Conclusions Current infection management and antimicrobial prescribing practices in secondary care fail to engage patients with the decision-making process. Secondary care physicians must not view infection management episodes as discrete events, but as cumulative experiences which have the potential to shape future patient behaviour and understanding of antimicrobial use. PMID:27799238

Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

PubMed

Welton, William E

2004-01-01

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

Technological innovations in digital data management and changing roles of imaging specialists in Japan.

PubMed

Ehara, Shigeru

2010-11-28

Technical innovations in digital data management pose a threat to radiologists in that can we remain in the process of clinical decision making or be assigned to a secondary role in future clinical practice. The value added to the imaging studies by diagnostic radiologists, or imaging specialists, has never been questioned more seriously.

A biologically-based individual tree model for managing the longleaf pine ecosystem

Treesearch

Rick Smith; Greg Somers

1998-01-01

Duration: 1995-present Objective: Develop a longleaf pine dynamics model and simulation system to define desirable ecosystem management practices in existing and future longleaf pine stands. Methods: Naturally-regenerated longleaf pine trees are being destructively sampled to measure their recent growth and dynamics. Soils and climate data will be combined with the...

Indiana forest management history and practices

Treesearch

Sam F. Carman

2013-01-01

Indiana's landscape and forests today are largely the result of Ice Age glaciations, Native Americans' use of fire, and over-harvesting in the late 19th and early 20th centuries. Any intentional management of the forest was not generally apparent until the early 1900s. Early visionaries at that time recognized the future impact forest depletion would have on...

The watershed-riparian connection: A recent concern?

Treesearch

Warren Clary; Larry Schmidt; Leonard DeBano

2000-01-01

Management impacts on a watershed can cause a variety of complex responses by the encompassed riparian-stream system. Information about these responses will help land managers select practices that provide the riparian area with the best chance for future health and stability. Since we now recognize that people have been impacting riparian areas for a long time through...

Managing the space-time-load continuum in TMDL planning: A case study for understanding groundwater loads through advanced mapping techniques

EPA Science Inventory

The lag time between groundwater recharge and discharge in a watershed and the potential groundwater load to streams is an important factor in forecasting responses to future land use practices. We call this concept managing the “space-time-load continuum”. It’s understood that i...

A Curriculum for the New Dental Practitioner: Preparing Dentists for a Prospective Oral Health Care Environment

PubMed Central

Polverini, Peter J.

2012-01-01

The emerging concept of prospective health care would shift the focus of health care from disease management to disease prevention and health management. Dentistry has a unique opportunity to embrace this model of prospective and collaborative care and focus on the management of oral health. Academic dentistry must better prepare future dentists to succeed in this new health care environment by providing them with the scientific and technical knowledge required to understand and assess risk and practice disease prevention. Dental schools must consider creating career pathways for enabling future graduates to assume important leadership roles that will advance a prospective oral health care system. PMID:22390456

Planning, Zoning, & the Consistency Doctrine: The Florida Experience

DOT National Transportation Integrated Search

1995-10-01

State Transportation Policy Initiative (STPI)is multi-phase study to examine : current transportation planning, growth management, and transportation funding : practices in Florida and to develop recommendations that can be the basis of : future legi...

Future Challenges for the Residential Conference Center.

ERIC Educational Resources Information Center

Kasworm, Carol E.; Simpson, Edward G., Jr.

1990-01-01

Creation of learning sanctuaries in residential adult education programs requires (1) development and renewal of leadership; (2) skilled management practices; (3) research on the concept and its effect on adult learning; and (4) professional development. (SK)

High Flyers: Glorious Past, Gloomy Present, Any Future?

ERIC Educational Resources Information Center

Baruch, Yehuda; Peiperl, Maury

1997-01-01

New types of psychological contracts, in which promotions cannot be guaranteed or expected, are emerging. Former methods of selecting and assessing high-potential candidates are obsolete, and human resource management practices must change. (SK)

Risk Management in the Human Spaceflight Program

NASA Technical Reports Server (NTRS)

Hoffman, William

2009-01-01

The contents include:1) NASA Mission and Organization; 2) Major Mission Failures and Causes; 3) Cultural Changes Resulting from Failures; 3) Safety at NASA Today; 4) Best Safety Practices; 5) Safety Challenges; and 6) Future Commitment.

What Shapes Adolescents' Future Perceptions? The Effects of Hearing Loss, Social Affiliation, and Career Self-Efficacy.

PubMed

Michael, Rinat; Cinamon, Rachel Gali; Most, Tova

2015-10-01

The current study examined the contribution of hearing loss, social affiliation, and career self-efficacy to adolescents' future perceptions. Participants were 191 11th and 12th grade students: 60 who were deaf, 36 who were deaf or hard of hearing, and 95 who were hearing. They completed the Future Perceptions Scale, the Career Decision-Making Self-Efficacy (CDMSE) Scale, and the Self-Efficacy for the Management of Work-Family Conflict Scale. Results indicated that participants who were deaf reported significantly higher levels of future clarity and intensity than the other groups. However, no significant differences were found in career self-efficacy. Hearing status and affiliation and the efficacy to manage future conflict between work and family roles were significant predictors of participants' future clarity. CDMSE was a significant predictor of future planning. Implications for theory and practice are discussed. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Case Report: Activity Diagrams for Integrating Electronic Prescribing Tools into Clinical Workflow

PubMed Central

Johnson, Kevin B.; FitzHenry, Fern

2006-01-01

To facilitate the future implementation of an electronic prescribing system, this case study modeled prescription management processes in various primary care settings. The Vanderbilt e-prescribing design team conducted initial interviews with clinic managers, physicians and nurses, and then represented the sequences of steps carried out to complete prescriptions in activity diagrams. The diagrams covered outpatient prescribing for patients during a clinic visit and between clinic visits. Practice size, practice setting, and practice specialty type influenced the prescribing processes used. The model developed may be useful to others engaged in building or tailoring an e-prescribing system to meet the specific workflows of various clinic settings. PMID:16622168

Recruiting, Educating, and Training Librarians for Collection Development. New Directions in Information Management, Number 33.

ERIC Educational Resources Information Center

Johnson, Peggy, Ed.; Intner, Sheila S., Ed.

Collection development as it is practiced now, and as it will continue to be practiced, is presented in its varying aspects. This book is a collection of 15 papers related to recruiting, educating, and training librarians for collection development as well as implications for the future. The titles include: "Book Selection and Collection…

[Case management process identified from experience of nurse case managers].

PubMed

Park, Eun-Jun; Kim, Chunmi

2008-12-01

The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

New clinical practice guidelines on the classification, evaluation and management of childhood interstitial lung disease in infants: what do they mean?

PubMed

Wambach, Jennifer A; Young, Lisa R

2014-12-01

The American Thoracic Society (ATS) recently published a clinical practice guideline regarding the classification, evaluation, and management of childhood interstitial lung disease in infancy (chILD). As disease entities among infants with ILD are often distinct from forms seen in older children and adults, the guideline encourages an age-based classification system and focuses on the diagnostic approach to neonates and infants <2 years of age. The guideline reviews current evidence and recommendations for the evaluation, relevant genetic studies, and management of symptomatic infants. Here, we summarize the ATS guideline, highlight the major concepts, and discuss future strategies aimed at addressing current gaps in knowledge.

Parenteral nutrition.

PubMed

Inayet, N; Neild, P

2015-03-01

Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility; however, it may also be associated with a number of potentially life-threatening complications. A recent NCEPOD report (2010) identified a number of inadequacies in the overall provision and management of parenteral nutrition and recommendations were made with the aim of improving clinical practice in the future. This paper focuses on the practical aspects relating to parenteral nutrition for adults, including important concepts, such as patient selection, as well as general management. We also explore the various pitfalls and potential complications and how these may be minimised.

Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

PubMed

Sellars, Marcus; Detering, Karen M; Silvester, William

2015-04-23

Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects.

PubMed

Francis, Caitlin F; Feyer, Anne-Marie; Smith, Ben J

2007-11-01

The evaluation of the Sharing Health Care Initiative addressed the translation of different models of chronic disease self-management into health and community service contexts in Australia. Across seven projects, four intervention models were adopted: (1) the Stanford Chronic Disease Self Management course; (2) generic disease management planning, training and support; (3) tailored disease management planning, training and support, and; (4) telephone coaching. Targeted recruitment through support groups and patient lists was most successful for reaching high-needs clients. Projects with well developed organisational structures and health system networks demonstrated more effective implementation. Engagement of GPs in recruitment and client support was limited. Future self-management programs will require flexible delivery methods in the primary health care setting, involving practice nurses or the equivalent. After 12 months there was little evidence of potential sustainability, although structures such as consumer resource centres and client support clubs were established in some locations. Only one project was able to use Medicare chronic disease-related items to integrate self-management support into routine general practice. Participants in all projects showed improvements in self-management practices, but those receiving Model 3, flexible and tailored support, and Model 4, telephone coaching, reported the greatest benefits.

Obesity Management in Europe: Current Status and Objectives for the Future

PubMed Central

Uerlich, Magdalena F.; Yumuk, Volkan; Finer, Nick; Basdevant, Arnaud; Visscher, Tommy L.S.

2016-01-01

Objective This study aims at assessing the status of obesity management in the European region and identifying future goals and objectives of professionals working in the field of obesity. Methods Presidents of all 31 EASO-affiliated (EASO = European Association for the Study of Obesity) national associations for the study of obesity were asked to invite 5 obesity experts from their country to participate in a survey. A total of 74 obesity professionals out of 23 countries participated. Questions addressed the development of guidelines, the status of obesity management, and goals and objectives for the future in obesity management. Further, EASO's three vice-presidents participated in in-depth, semi-structured interviews, in which they were asked to provide their reflection on the survey data. Results Most countries define obesity as a clinical and chronic disease, but various differences in obesity management standards exist across Europe. Existing guidelines mainly focus on the acute treatment of obesity rather than on long-term approaches. Conclusion Multidisciplinary approaches for obesity management and the collaboration between general practitioners and hospitals as well as between professionals at the local level and networks of obesity management centers need to be improved across Europe. Good practices and evidence are available. PMID:27553443

Ecological models supporting environmental decision making: a strategy for the future

USGS Publications Warehouse

Schmolke, Amelie; Thorbek, Pernille; DeAngelis, Donald L.; Grimm, Volker

2010-01-01

Ecological models are important for environmental decision support because they allow the consequences of alternative policies and management scenarios to be explored. However, current modeling practice is unsatisfactory. A literature review shows that the elements of good modeling practice have long been identified but are widely ignored. The reasons for this might include lack of involvement of decision makers, lack of incentives for modelers to follow good practice, and the use of inconsistent terminologies. As a strategy for the future, we propose a standard format for documenting models and their analyses: transparent and comprehensive ecological modeling (TRACE) documentation. This standard format will disclose all parts of the modeling process to scrutiny and make modeling itself more efficient and coherent.

A horizon scan of future threats and opportunities for pollinators and pollination.

PubMed

Brown, Mark J F; Dicks, Lynn V; Paxton, Robert J; Baldock, Katherine C R; Barron, Andrew B; Chauzat, Marie-Pierre; Freitas, Breno M; Goulson, Dave; Jepsen, Sarina; Kremen, Claire; Li, Jilian; Neumann, Peter; Pattemore, David E; Potts, Simon G; Schweiger, Oliver; Seymour, Colleen L; Stout, Jane C

2016-01-01

Background. Pollinators, which provide the agriculturally and ecologically essential service of pollination, are under threat at a global scale. Habitat loss and homogenisation, pesticides, parasites and pathogens, invasive species, and climate change have been identified as past and current threats to pollinators. Actions to mitigate these threats, e.g., agri-environment schemes and pesticide-use moratoriums, exist, but have largely been applied post-hoc. However, future sustainability of pollinators and the service they provide requires anticipation of potential threats and opportunities before they occur, enabling timely implementation of policy and practice to prevent, rather than mitigate, further pollinator declines. Methods.Using a horizon scanning approach we identified issues that are likely to impact pollinators, either positively or negatively, over the coming three decades. Results.Our analysis highlights six high priority, and nine secondary issues. High priorities are: (1) corporate control of global agriculture, (2) novel systemic pesticides, (3) novel RNA viruses, (4) the development of new managed pollinators, (5) more frequent heatwaves and drought under climate change, and (6) the potential positive impact of reduced chemical use on pollinators in non-agricultural settings. Discussion. While current pollinator management approaches are largely driven by mitigating past impacts, we present opportunities for pre-emptive practice, legislation, and policy to sustainably manage pollinators for future generations.

A horizon scan of future threats and opportunities for pollinators and pollination

PubMed Central

Dicks, Lynn V.; Paxton, Robert J.; Baldock, Katherine C.R.; Barron, Andrew B.; Chauzat, Marie-Pierre; Freitas, Breno M.; Goulson, Dave; Jepsen, Sarina; Kremen, Claire; Li, Jilian; Neumann, Peter; Pattemore, David E.; Potts, Simon G.; Schweiger, Oliver; Seymour, Colleen L.; Stout, Jane C.

2016-01-01

Background. Pollinators, which provide the agriculturally and ecologically essential service of pollination, are under threat at a global scale. Habitat loss and homogenisation, pesticides, parasites and pathogens, invasive species, and climate change have been identified as past and current threats to pollinators. Actions to mitigate these threats, e.g., agri-environment schemes and pesticide-use moratoriums, exist, but have largely been applied post-hoc. However, future sustainability of pollinators and the service they provide requires anticipation of potential threats and opportunities before they occur, enabling timely implementation of policy and practice to prevent, rather than mitigate, further pollinator declines. Methods.Using a horizon scanning approach we identified issues that are likely to impact pollinators, either positively or negatively, over the coming three decades. Results.Our analysis highlights six high priority, and nine secondary issues. High priorities are: (1) corporate control of global agriculture, (2) novel systemic pesticides, (3) novel RNA viruses, (4) the development of new managed pollinators, (5) more frequent heatwaves and drought under climate change, and (6) the potential positive impact of reduced chemical use on pollinators in non-agricultural settings. Discussion. While current pollinator management approaches are largely driven by mitigating past impacts, we present opportunities for pre-emptive practice, legislation, and policy to sustainably manage pollinators for future generations. PMID:27602260

Water and wastewater in developing countries: present reality and strategy for the future.

PubMed

Ujang, Z; Buckley, C

2002-01-01

This paper summarises the paper presentation sessions at the Conference, as well giving insights on the issues related to developing countries. It also discusses the present status of practice and research on water and wastewater management, and projected future scenario based not only on the papers presented in the Conference, but also on other sources. The strategy is presented to overcome many problems in developing countries such as rapid urbanization, industrialization, population growth, financial and institutional problems and, depleting water resources. The strategy consists of Integrated Urban Water Management (IUWM), cleaner industrial production, waste minimisation and financial arrangements.

Contemporary Australian outcomes in childhood and adolescent type 1 diabetes: 10 years post the Diabetes Control and Complications Trial.

PubMed

Ambler, Geoffrey R; Fairchild, Jan; Craig, Maria E; Cameron, Fergus J

2006-01-01

The reporting of the results of the Diabetes Control and Complications Trial in 1993 has led to a major reappraisal of management practices and outcomes in type 1 diabetes in children and adolescents. A considerable body of outcome data has been generated from Australia in this post-Diabetes Control and Complications Trial era relating to incidence, metabolic control, growth, hypoglycaemia, microvascular and macrovascular complications, cognition, behaviour and quality of life. These data are important in planning future management strategies and resource allocation and as a basis for future research.

Tradeoffs between Maize Silage Yield and Nitrate Leaching in a Mediterranean Nitrate-Vulnerable Zone under Current and Projected Climate Scenarios

PubMed Central

Basso, Bruno; Giola, Pietro; Dumont, Benjamin; Migliorati, Massimiliano De Antoni; Cammarano, Davide; Pruneddu, Giovanni; Giunta, Francesco

2016-01-01

Future climatic changes may have profound impacts on cropping systems and affect the agronomic and environmental sustainability of current N management practices. The objectives of this work were to i) evaluate the ability of the SALUS crop model to reproduce experimental crop yield and soil nitrate dynamics results under different N fertilizer treatments in a farmer’s field, ii) use the SALUS model to estimate the impacts of different N fertilizer treatments on NO3- leaching under future climate scenarios generated by twenty nine different global circulation models, and iii) identify the management system that best minimizes NO3- leaching and maximizes yield under projected future climate conditions. A field experiment (maize-triticale rotation) was conducted in a nitrate vulnerable zone on the west coast of Sardinia, Italy to evaluate N management strategies that include urea fertilization (NMIN), conventional fertilization with dairy slurry and urea (CONV), and no fertilization (N0). An ensemble of 29 global circulation models (GCM) was used to simulate different climate scenarios for two Representative Circulation Pathways (RCP6.0 and RCP8.5) and evaluate potential nitrate leaching and biomass production in this region over the next 50 years. Data collected from two growing seasons showed that the SALUS model adequately simulated both nitrate leaching and crop yield, with a relative error that ranged between 0.4% and 13%. Nitrate losses under RCP8.5 were lower than under RCP6.0 only for NMIN. Accordingly, levels of plant N uptake, N use efficiency and biomass production were higher under RCP8.5 than RCP6.0. Simulations under both RCP scenarios indicated that the NMIN treatment demonstrated both the highest biomass production and NO3- losses. The newly proposed best management practice (BMP), developed from crop N uptake data, was identified as the optimal N fertilizer management practice since it minimized NO3- leaching and maximized biomass production over the long term. PMID:26784113

[Practice guidelines for the management of acute perioperative pain].

PubMed

Guevara-López, Uriah; Covarrubias-Gómez, Alfredo; Delille-Fuentes, Ramón; Hernández-Ortiz, Andrés; Carrillo-Esper, Raúl; Moyao-García, Diana

2005-01-01

The inadequacy of perioperative management causes a severe adverse outcome, a prolonged time of hospitalization and unnecessary suffering. Therefore, it is important to provide an effective management approach to the patient with perioperative pain. A task force with experience in this field systematically develops practice guidelines and the primary goal is to facilitate, to health care professionals, decision-making regarding pain relief. The well-known concept of "administer as needed" is inaccurate and must be eliminated from hospital's management protocols in order to facilitate the staff education to decrease the painful experience. A method to evaluate and document pain in an objective and periodic way shall be implemented. Also, analgesic therapy shall be individualized and chosen regarding pain intensity in every surgical procedure. The treatment options include the use of non-opiate and opiate drugs, regional analgesia and nonpharmacological techniques. The best analgesic will be the one that shall provide the highest relief of pain with the fewest side effects. In the pediatric and obstetric populations, special considerations for the ambulatory patient must be taken. Finally, these practice guidelines could be the reference for future practice guidelines on pain management in Mexico.

Management practices and performance of mergers and acquisitions in Pakistan: mediating role of psychological contract.

PubMed

Bari, Muhammad Waseem; Fanchen, Meng; Baloch, Muhammad Awais

2016-01-01

The objective of this study is to examine the direct and indirect effect of management practices (procedural justice, coordination approach, communication system, integration strategy, and coping programs) on merger and acquisition (M&A) performance in the Pakistan banking industry. Psychological contract (PC) acts as a mediator between Management practices and M&A performance. The Present study distributes a structured questionnaire to 700 bank employees of different management cadres. The useful response rate is 76 % (536 employees). It uses PLS-SEM technique for data analysis. (1) procedural justice is a key strategy which has highly significant direct and indirect effect on M&A performance; however integration strategy and the communication system have an only direct effect. (2) PC performs partial mediation at different levels between management practices and M&A financial and non-financial performance. This study provides an effective solution to solve the soft issues during and post-M&A process. This is one of the few studies which effectively integrate the five constructs into a single framework to study their effects on M&A performance. Limitations and future research directions are presented in the last section of the study.

Federal lands highway phase II benchmarking study

DOT National Transportation Integrated Search

2000-11-01

In order to determine the most effective use of existing and future staff, to quantify the appropriate number of engineers and technicians required to deliver the Federal Lands Highway Program and to identify recommended management practices in proje...

Global biomass production potentials exceed expected future demand without the need for cropland expansion

PubMed Central

Mauser, Wolfram; Klepper, Gernot; Zabel, Florian; Delzeit, Ruth; Hank, Tobias; Putzenlechner, Birgitta; Calzadilla, Alvaro

2015-01-01

Global biomass demand is expected to roughly double between 2005 and 2050. Current studies suggest that agricultural intensification through optimally managed crops on today's cropland alone is insufficient to satisfy future demand. In practice though, improving crop growth management through better technology and knowledge almost inevitably goes along with (1) improving farm management with increased cropping intensity and more annual harvests where feasible and (2) an economically more efficient spatial allocation of crops which maximizes farmers' profit. By explicitly considering these two factors we show that, without expansion of cropland, today's global biomass potentials substantially exceed previous estimates and even 2050s' demands. We attribute 39% increase in estimated global production potentials to increasing cropping intensities and 30% to the spatial reallocation of crops to their profit-maximizing locations. The additional potentials would make cropland expansion redundant. Their geographic distribution points at possible hotspots for future intensification. PMID:26558436

Global biomass production potentials exceed expected future demand without the need for cropland expansion.

PubMed

Mauser, Wolfram; Klepper, Gernot; Zabel, Florian; Delzeit, Ruth; Hank, Tobias; Putzenlechner, Birgitta; Calzadilla, Alvaro

2015-11-12

Global biomass demand is expected to roughly double between 2005 and 2050. Current studies suggest that agricultural intensification through optimally managed crops on today's cropland alone is insufficient to satisfy future demand. In practice though, improving crop growth management through better technology and knowledge almost inevitably goes along with (1) improving farm management with increased cropping intensity and more annual harvests where feasible and (2) an economically more efficient spatial allocation of crops which maximizes farmers' profit. By explicitly considering these two factors we show that, without expansion of cropland, today's global biomass potentials substantially exceed previous estimates and even 2050s' demands. We attribute 39% increase in estimated global production potentials to increasing cropping intensities and 30% to the spatial reallocation of crops to their profit-maximizing locations. The additional potentials would make cropland expansion redundant. Their geographic distribution points at possible hotspots for future intensification.

Managing Astronomy Research Data: Case Studies of Big and Small Research Projects

NASA Astrophysics Data System (ADS)

Sands, Ashley E.

2015-01-01

Astronomy data management refers to all actions taken upon data over the course of the entire research process. It includes activities involving the collection, organization, analysis, release, storage, archiving, preservation, and curation of research data. Astronomers have cultivated data management tools, infrastructures, and local practices to ensure the use and future reuse of their data. However, new sky surveys will soon amass petabytes of data requiring new data management strategies.The goal of this dissertation, to be completed in 2015, is to identify and understand data management practices and the infrastructure and expertise required to support best practices. This will benefit the astronomy community in efforts toward an integrated scholarly communication framework.This dissertation employs qualitative, social science research methods (including interviews, observations, and document analysis) to conduct case studies of data management practices, covering the entire data lifecycle, amongst three populations: Sloan Digital Sky Survey (SDSS) collaboration team members; Individual and small-group users of SDSS data; and Large Synoptic Survey Telescope (LSST) collaboration team members. I have been observing the collection, release, and archiving of data by the SDSS collaboration, the data practices of individuals and small groups using SDSS data in journal articles, and the LSST collaboration's planning and building of infrastructure to produce data.Preliminary results demonstrate that current data management practices in astronomy are complex, situational, and heterogeneous. Astronomers often have different management repertoires for working on sky surveys and for their own data collections, varying their data practices as they move between projects. The multitude of practices complicates coordinated efforts to maintain data.While astronomy expertise proves critical to managing astronomy data in the short, medium, and long term, the larger astronomy data workforce encompasses a greater breadth of educational backgrounds. Results show that teams of individuals with distinct expertise are key to ensuring the long-term preservation and usability of astronomy datasets.

Chapter 9: Understanding our changing public values, resource uses, and engagement processes and practices

Treesearch

Lee K. Cerveny; Emily Jane Davis; Rebecca McLain; Clare M. Ryan; Debra R. Whitall; Eric M. White

2018-01-01

The Northwest Forest Plan (NWFP, or Plan) signified a movement away from intensive focus on timber management that was common through the 1980s and toward an ecosystem management approach, which aims to conserve ecological conditions and restore natural resources while meeting the social, cultural, and economic needs of present and future generations (Brussard et al....

Technological innovations in digital data management and changing roles of imaging specialists in Japan

PubMed Central

Ehara, Shigeru

2010-01-01

Technical innovations in digital data management pose a threat to radiologists in that can we remain in the process of clinical decision making or be assigned to a secondary role in future clinical practice. The value added to the imaging studies by diagnostic radiologists, or imaging specialists, has never been questioned more seriously. PMID:21179309

Uses of Multivariate Analytical Techniques in Online and Blended Business Education: An Assessment of Current Practice and Recommendations for Future Research

ERIC Educational Resources Information Center

Arbaugh, J. B.; Hwang, Alvin

2013-01-01

Seeking to assess the analytical rigor of empirical research in management education, this article reviews the use of multivariate statistical techniques in 85 studies of online and blended management education over the past decade and compares them with prescriptions offered by both the organization studies and educational research communities.…

The Last 100 Days of a Presidency: What Boards Need to Know and Do

ERIC Educational Resources Information Center

Johnson, Sandra S.; Eckel, Peter

2013-01-01

Many boards will find themselves hiring a new president in the near future, as higher education faces unprecedented turnover in its top leaders. Not only must they manage the transition of a new president into the institution, but they must also manage the transition of the current president out. Best practices for the transition are discussed in…

Best Practice Irrigation Management and Extension in Peri-Urban Landscapes--Experiences and Insights from the Hawkesbury-Nepean Catchment, Australia

ERIC Educational Resources Information Center

Maheshwari, B. L.; Plunkett, M.

2015-01-01

Purpose: The aim of this article to examine key irrigation management issues and their implications for future research and extension developments. Design/Methodology/Approach: Peri-urban landscapes are important as they supply fresh fruit, vegetables, turf, ornamental plants and other farm products to the cities. In this study, the…

Assessing the relationship between different forms of landowner assistance and family forest owner behaviors and intentions

Treesearch

Michael A. Kilgore; Stephanie A. Snyder; Derya Eryilmaz; Marla A. Markowski-Lindsay; Brett J. Butler; David B. Kittredge; Paul F. Catanzaro; Jaketon H. Hewes; Kyle Andrejczyk

2015-01-01

In this study, we examine how family forest owners who receive various types of assistance differ from unassisted landowners with respect to their forestland management practices, attitudes and concerns, and future management, use, and ownership intentions. We do so by utilizing a national database containing information on private forest owners and the forestland they...

Water scarcity and institutional change: lessons in adaptive governance from the drought experience of Perth, Western Australia.

PubMed

Bettini, Y; Brown, R; de Haan, F J

2013-01-01

Urban water systems will be increasingly challenged under future climates and global pressures. Meeting challenges by reconfiguring water systems to integrate supplies and deliver multifunctional uses is technically well described. Adjusting the institutions that frame the management of these systems is not well operationalized in practice or conceptualized in theory. This study seeks to address this gap through an institutional analysis of Perth, Australia, a city where drought crisis has put under pressure both management practices and the institutional setting that underlies them. The study found that while trusted practices moderated water scarcity, the stability of the institutional setting may not facilitate a shift toward adaptable institutional configurations suited to future conditions. The results identified three key ingredients for a flexible institutional setting: (i) feedbacks in the system through better information management, (ii) reflexive dialogue and strategic use of projects to generate greater learning opportunities, and (iii) policy level support for sector-wide collaboration through progressive agendas, incentives for innovation and capacity building in stakeholder and community engagement. Further, the results suggest that a deeper understanding of institutional dynamics is needed to enable adaptive governance. The paper provides an analytical framework for diagnosing how greater adaptive capacity might be mobilized through influencing these dynamics.

Research experiences and mentoring practices in selected east Asian graduate programs: predictors of research productivity among doctoral students in molecular biology.

PubMed

Ynalvez, Ruby; Garza-Gongora, Claudia; Ynalvez, Marcus Antonius; Hara, Noriko

2014-01-01

Although doctoral mentors recognize the benefits of providing quality advisement and close guidance, those of sharing project management responsibilities with mentees are still not well recognized. We observed that mentees, who have the opportunity to co-manage projects, generate more written output. Here we examine the link between research productivity, doctoral mentoring practices (DMP), and doctoral research experiences (DRE) of mentees in programs in the non-West. Inspired by previous findings that early career productivity is a strong predictor of later productivity, we examine the research productivity of 210 molecular biology doctoral students in selected programs in Japan, Singapore, and Taiwan. Using principal component (PC) analysis, we derive two sets of PCs: one set from 15 DMP and another set from 16 DRE items. We model research productivity using Poisson and negative-binomial regression models with these sets as predictors. Our findings suggest a need to re-think extant practices and to allocate resources toward professional career development in training future scientists. We contend that doctoral science training must not only be an occasion for future scientists to learn scientific and technical skills, but it must also be the opportunity to experience, to acquire, and to hone research management skills. © 2014 The International Union of Biochemistry and Molecular Biology.

Recognition and Management of Sepsis in Children: Practice Patterns in the Emergency Department.

PubMed

Thompson, Graham C; Macias, Charles G

2015-10-01

Pediatric sepsis remains a leading cause of morbidity and mortality. Understanding current practice patterns and challenges is essential to inform future research and education strategies. Our aim was to describe the practice patterns of pediatric emergency physicians (PEPs) in the recognition and management of sepsis in children and to identify perceived priorities for future research and education. We conducted a cross-sectional, internet-based survey of members of the American Academy of Pediatrics, Section on Emergency Medicine and Pediatric Emergency Research Canada. The survey was internally derived, externally validated, and distributed using a modified Dillman methodology. Rank scores (RS) were calculated for responses using Likert-assigned frequency values. Tachycardia, mental-status changes, and abnormal temperature (RS = 83.7, 80.6, and 79.6) were the highest ranked clinical measures for diagnosing sepsis; white blood cell count, lactate, and band count (RS = 73.5, 70.9, and 69.1) were the highest ranked laboratory investigations. The resuscitation fluid of choice (85.5%) was normal saline. Dopamine was the first-line vasoactive medication (VAM) for cold (57.1%) and warm (42.2%) shock with epinephrine (18.5%) and norepinephrine (25.1%) as second-line VAMs (cold and warm, respectively). Steroid administration increased with complexity of presentation (all-comers 3.8%, VAM-resistant shock 54.5%, chronic steroid users 72.0%). Local ED-specific clinical pathways, national emergency department (ED)-specific guidelines, and identification of clinical biomarkers were described as future priorities. While practice variability exists among clinicians, PEPs continue to rely heavily on clinical metrics for recognizing sepsis. Improved recognition through clinical biomarkers and standardization of care were perceived as priorities. Our results provide a strong framework to guide future research and education strategies in pediatric sepsis. Copyright © 2015 Elsevier Inc. All rights reserved.

Defense AT and L. Volume 43, Number 1

DTIC Science & Technology

2014-02-01

community on the strategic direction of future space system acquisitions. Should we continue and/or improve aggregated space systems over time or move...desirable. Schedulers must have a firm command of project manage- ment theory and practice and possess leadership and communication skills. Scorecard...idea was recommended by the Defense Sci- ence Board’s Munitions System Reliability report. In the future, such systems conceivably could communicate

Herd health status and management practices on 16 Irish suckler beef farms

PubMed Central

2013-01-01

Background There have been few studies published internationally which document herd health management practices in suckler beef herds and no published Irish studies. The study objective was to document herd health status and management practices on sixteen Irish suckler beef herds over a two year period (2009–2010). The farms used in the study were part of the Teagasc BETTER farm beef programme. The mean (s.d.) herd size, stocking rate and farm size was 68 cows (27.6), 2.0 LU/ha (0.3) and 64.3 (21.6) adjusted hectares, respectively. Two questionnaires were designed; 1) a farmer questionnaire to collect information on farm background and current herd health control practices and 2) a veterinary questionnaire to collect information on the extent of animal health advice given by veterinarians to their clients and identification of any on-farm herd health issues. Results Dystocia, calf pneumonia, and calf diarrhoea, in that order, were identified as the primary herd health issues in these Irish suckler beef herds. In addition, substantial deficiencies in biosecurity practices were also identified on these farms. Conclusions The findings of this study may serve as the focus for future research in animal health management practices in Irish suckler beef herds. PMID:24195997

Forecasting the effects of land-use and climate change on wildlife communities and habitats in the lower Mississippi Valley

USGS Publications Warehouse

Faulkner, Stephen P.

2010-01-01

Landscape patterns and processes reflect both natural ecosystem attributes and the policy and management decisions of individual Federal, State, county, and private organizations. Land-use regulation, water management, and habitat conservation and restoration efforts increasingly rely on landscape-level approaches that incorporate scientific information into the decision-making process. Since management actions are implemented to affect future conditions, decision-support models are necessary to forecast potential future conditions resulting from these decisions. Spatially explicit modeling approaches enable testing of different scenarios and help evaluate potential outcomes of management actions in conjunction with natural processes such as climate change. The ability to forecast the effects of changing land use and climate is critically important to land and resource managers since their work is inherently site specific, yet conservation strategies and practices are expressed at higher spatial and temporal scales that must be considered in the decisionmaking process.

Science-based approach for credible accounting of mitigation in managed forests.

PubMed

Grassi, Giacomo; Pilli, Roberto; House, Jo; Federici, Sandro; Kurz, Werner A

2018-05-17

The credibility and effectiveness of country climate targets under the Paris Agreement requires that, in all greenhouse gas (GHG) sectors, the accounted mitigation outcomes reflect genuine deviations from the type and magnitude of activities generating emissions in the base year or baseline. This is challenging for the forestry sector, as the future net emissions can change irrespective of actual management activities, because of age-related stand dynamics resulting from past management and natural disturbances. The solution implemented under the Kyoto Protocol (2013-2020) was accounting mitigation as deviation from a projected (forward-looking) "forest reference level", which considered the age-related dynamics but also allowed including the assumed future implementation of approved policies. This caused controversies, as unverifiable counterfactual scenarios with inflated future harvest could lead to credits where no change in management has actually occurred, or conversely, failing to reflect in the accounts a policy-driven increase in net emissions. Instead, here we describe an approach to set reference levels based on the projected continuation of documented historical forest management practice, i.e. reflecting age-related dynamics but not the future impact of policies. We illustrate a possible method to implement this approach at the level of the European Union (EU) using the Carbon Budget Model. Using EU country data, we show that forest sinks between 2013 and 2016 were greater than that assumed in the 2013-2020 EU reference level under the Kyoto Protocol, which would lead to credits of 110-120 Mt CO 2 /year (capped at 70-80 Mt CO 2 /year, equivalent to 1.3% of 1990 EU total emissions). By modelling the continuation of management practice documented historically (2000-2009), we show that these credits are mostly due to the inclusion in the reference levels of policy-assumed harvest increases that never materialized. With our proposed approach, harvest is expected to increase (12% in 2030 at EU-level, relative to 2000-2009), but more slowly than in current forest reference levels, and only because of age-related dynamics, i.e. increased growing stocks in maturing forests. Our science-based approach, compatible with the EU post-2020 climate legislation, helps to ensure that only genuine deviations from the continuation of historically documented forest management practices are accounted toward climate targets, therefore enhancing the consistency and comparability across GHG sectors. It provides flexibility for countries to increase harvest in future reference levels when justified by age-related dynamics. It offers a policy-neutral solution to the polarized debate on forest accounting (especially on bioenergy) and supports the credibility of forest sector mitigation under the Paris Agreement.

Indicators of club management practices and biological measurements of patrons' drug and alcohol use.

PubMed

Byrnes, Hilary F; Miller, Brenda A; Johnson, Mark B; Voas, Robert B

2014-12-01

Electronic music and dance events in nightclubs attract patrons with heavy alcohol/drug use. Public health concerns are raised from risks related to these behaviors. Practices associated with increased risk in these club settings need to be identified. The relationship between club management practices and biological measures of patrons' alcohol/drug use is examined. Observational data from 25 events across six urban clubs were integrated with survey data (N = 738 patrons, 42.8% female) from patrons exiting these events, 2010-2012. Five indicators of club management practices were examined using mixed model regressions: club security, bar crowding, safety signs, serving intoxicated patrons, and isolation. Analyses revealed that serving intoxicated patrons and safety signs were related to substance use. Specifically, serving intoxicated patrons was related to heavy alcohol and drug use at exit, while safety signs were marginally related to less exit drug use. CONCLUSIONS/IMPORTANCE: Findings indicate observable measures in nightclubs provide important indicators for alcohol/drug use, suggesting practices to target. Study strengths include the use of biological measures of substance use on a relatively large scale. Limitations and future directions are discussed.

Radio frequency identification (RFID) tagging for material tracking and future asset management : research project capsule.

DOT National Transportation Integrated Search

2016-07-01

Current Louisiana Department of Transportation and Development (DOTD) : practice allows multiple mixtures or materials to be submitted and subsequently : used during a highway construction project. Such materials include mechanically : stabilized ear...

Managing the plant microbiome for biocontrol fungi: Examples from Hypocreales

USDA-ARS?s Scientific Manuscript database

Feeding an increasing global population requires continued improvements in agricultural efficiency and productivity. Meeting estimated future production levels requires the adoption of practices that increase output without environmental degradation associated with external inputs to supplement nut...

Sources of uncertainty in climate change impacts on groundwater recharge

NASA Astrophysics Data System (ADS)

Holman, I. P.

2007-12-01

This paper assesses the significance of the many sources of uncertainty in future groundwater recharge estimation, based on lessons learnt from an integrated approach to assessing the regional impacts of climate and socio-economic change on groundwater recharge in East Anglia, UK. Many factors affect simulations of future groundwater recharge including changed precipitation and temperature regimes, coastal flooding, urbanization, woodland establishment, and changes in cropping, rotations and management practices. Stochastic modelling of potential recharge showed median annual recharge decreasing under a High emissions future from 75 mm (1961-90) to 56 mm in the 2020s and 45 mm in the 2050s. However, the median values for individual simulations ranged from 46-75 mm (2020s) and 30-71 mm (2050s) highlighting a decreasing but uncertain trend. The impacts of (and uncertainty in) the climate scenarios are generally regionally more important than those of the socio-economic scenarios. However, locally, the impacts of the socio-economic scenarios can be significant, especially where there are large increases in urbanization, agricultural land cover, bioenergy production, or agricultural management practices. For example, management of soil conditions can increase potential groundwater recharge by around 5 %, but poor management can further reduce potential recharge by up to 15 %. The paper will demonstrate that to focus on the direct impacts of climate change is to neglect the potentially important role of policy, societal values and economic processes in shaping the landscape above aquifers. If the likely consequences of future changes of groundwater recharge, resulting from both climate and socio-economic change, are to be assessed, hydrogeologists must increasingly work with researchers from other disciplines, such as socio-economists, agricultural modellers and soil scientists

A question of dissemination: Assessing the practices and implications of research in tropical landscapes.

PubMed

Toomey, Anne H; Alvaro, María Eugenia Copa; Aiello-Lammens, Matthew; Loayza Cossio, Oscar; Barlow, Jos

2018-04-24

Current debates in the conservation sciences argue for better integration between research and practice, often citing the importance of the diffusion, dissemination and implementation of scientific knowledge for environmental management and policy. This paper focuses on a relatively well-researched protected area (Madidi National Park) in Bolivia in order to present different interpretations and understandings of the implications and availability of research findings. We draw on findings from quantitative and qualitative methods to determine the extent to which research carried out in the region was disseminated and/or implemented for management actions, and to understand subsequent implications for how local actors perceive the value of research and its role in management and conservation. We discuss the critical consequences of these findings for the future of conservation science and practice in biologically and culturally diverse landscapes, with an explicit call to action for academic institutions to support researchers in developing appropriate dissemination strategies.

The future water environment--using scenarios to explore the significant water management challenges in England and Wales to 2050.

PubMed

Henriques, C; Garnett, K; Weatherhead, E K; Lickorish, F A; Forrow, D; Delgado, J

2015-04-15

Society gets numerous benefits from the water environment. It is crucial to ensure that water management practices deliver these benefits over the long-term in a sustainable and cost-effective way. Currently, hydromorphological alterations and nutrient enrichment pose the greatest challenges in European water bodies. The rapidly changing climatic and socio-economic boundary conditions pose further challenges to water management decisions and the achievement of policy goals. Scenarios are a strategic tool useful in conducting systematic investigations of future uncertainties pertaining to water management. In this study, the use of scenarios revealed water management challenges for England and Wales to 2050. A set of existing scenarios relevant to river basin management were elaborated through stakeholder workshops and interviews, relying on expert knowledge to identify drivers of change, their interdependencies, and influence on system dynamics. In a set of four plausible alternative futures, the causal chain from driving forces through pressures to states, impacts and responses (DPSIR framework) was explored. The findings suggest that scenarios driven by short-term economic growth and competitiveness undermine current environmental legislative requirements and exacerbate the negative impacts of climate change, producing a general deterioration of water quality and physical habitats, as well as reduced water availability with adverse implications for the environment, society and economy. Conversely, there are substantial environmental improvements under the scenarios characterised by long-term sustainability, though achieving currently desired environmental outcomes still poses challenges. The impacts vary across contrasting generic catchment types that exhibit distinct future water management challenges. The findings suggest the need to address hydromorphological alterations, nutrient enrichment and nitrates in drinking water, which are all likely to be exacerbated in the future. Future-proofing river basin management measures that deal with these challenges is crucial moving forward. The use of scenarios to future-proof strategy, policy and delivery mechanisms is discussed to inform next steps. Copyright © 2014 Elsevier B.V. All rights reserved.

Variation in the management of hypothetical cases of acute agitation in Australasian emergency departments.

PubMed

Chan, Esther W; Taylor, David McD; Knott, Jonathan C; Kong, David C M

2011-02-01

To describe the prescribing practice of emergency medicine clinicians in the management of highly agitated patients and to identify perceived barriers to management and the gaps in training. We undertook an anonymous cross-sectional mail survey of the Australasian College for Emergency Medicine (ACEM) members (fellows and advanced trainees) between June and September 2009. A questionnaire including a case vignette of a hypothetical patient and three clinical scenarios was employed to ascertain prescribing practice and assess perceived barriers to management, confidence and the perceived usefulness of existing and future Clinical Practice Guidelines (CPGs). All 2052 ACEM members were surveyed. However, seven had incorrect postal addresses and could not be reached. Of the remaining 2045, 786/2052 (38.3%, 95% CI 36.2-40.5) responses were received. Of the 786 respondents, 783 were practicing clinicians. If monotherapy was chosen, 622/783 (79.4%, 95% CI 76.4-82.2) of respondents preferred midazolam to manage the common scenario where no history was available, followed by haloperidol 45/783 (5.8%, 95% CI 4.3-7.7) and olanzapine 38/783 (4.9%, 95% CI 3.5-6.7). Most respondents 500/783 (63.9%, 95% CI 60.4-67.2) would also administer another sedative (combination therapy). Important perceived barriers to agitation management included lack of both training (352/783 [45.0%, 95% CI 41.4-48.5]) and a national CPG (313/783 [40.0%, 95% CI 36.5-43.5]). Respondents were generally confident in all aspects of management, although relatively fewer trainees were confident in determining dosing. Institutional CPGs were considered most useful for 415/783 (53.0%, 95% CI 49.4-56.5) respondents. If an ACEM-endorsed CPG were to be developed in the future, 634/783 (81.0%, 95% CI 78.0-83.6) respondents would consider this useful. There is considerable variation in the management of hypothetical cases of acute agitation in Australasian EDs. Benzodiazepines and antipsychotics, either alone or in combination, are commonly used. An ACEM-endorsed, Australasian CPG was perceived as useful. © 2010 The Authors. EMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Consumer perceptions on sustainable practices implemented in foodservice organizations in Korea

PubMed Central

Ju, Seyoung

2016-01-01

BACKGROUND/OBJECTIVES Sustainable practices in foodservice organizations including commercial and noncommercial ones are critical to ensure the protection of the environment for the future. With the rapid growth of the foodservice industry, wiser usage of input sources such as food, utilities, and single use packaging should be reconsidered for future generations. Therefore, this study aims to investigate the customer's perceptions on sustainable practices and to identify the relationship among sustainable practices, social contribution and purchase intention. SUBJECTS/METHODS The study was conducted using content analyses by reviewing articles on sustainable food service practices published domestically and abroad. Thereafter, data were collected with a face-to-face survey using a questionnaire and analyzed with factor analyses and multiple regressions. RESULTS Sustainable practices classified with factor analysis consisted of 6 dimensions of green food material procurement, sustainable food preparation, green packaging, preservation of energy, waste management, and public relations on green activity, with a total of 25 green activities in foodservice operations. Consumers were not very familiar with the green activities implemented in the foodservice unit, with the lowest awareness of "green food material procurement (2.46 out of 5 points)", and the highest awareness of "green packaging (3.74)" and "waste management (3.28). The factors influencing the perception of social contribution by foodservice organizations among 6 sustainable practice dimensions were found to be public relations on green activity (β = 0.154), waste management (β = 0.204) and sustainable food preparation (β = 0.183). Green packaging (β = 0.107) and the social contribution of the foodservice organization (β = 0.761) had strong relationships with the image of the organization. The purchase intentions of customers was affected only by the foodservice image (β = 0.775). CONCLUSIONS The results of this study suggest that sustainable practices by foodservice organization present a good image to customers and increase the awareness of valuable contributions that benefit the customer as well as the community. PMID:26865923

Consumer perceptions on sustainable practices implemented in foodservice organizations in Korea.

PubMed

Ju, Seyoung; Chang, Hyeja

2016-02-01

Sustainable practices in foodservice organizations including commercial and noncommercial ones are critical to ensure the protection of the environment for the future. With the rapid growth of the foodservice industry, wiser usage of input sources such as food, utilities, and single use packaging should be reconsidered for future generations. Therefore, this study aims to investigate the customer's perceptions on sustainable practices and to identify the relationship among sustainable practices, social contribution and purchase intention. The study was conducted using content analyses by reviewing articles on sustainable food service practices published domestically and abroad. Thereafter, data were collected with a face-to-face survey using a questionnaire and analyzed with factor analyses and multiple regressions. Sustainable practices classified with factor analysis consisted of 6 dimensions of green food material procurement, sustainable food preparation, green packaging, preservation of energy, waste management, and public relations on green activity, with a total of 25 green activities in foodservice operations. Consumers were not very familiar with the green activities implemented in the foodservice unit, with the lowest awareness of "green food material procurement (2.46 out of 5 points)", and the highest awareness of "green packaging (3.74)" and "waste management (3.28). The factors influencing the perception of social contribution by foodservice organizations among 6 sustainable practice dimensions were found to be public relations on green activity (β = 0.154), waste management (β = 0.204) and sustainable food preparation (β = 0.183). Green packaging (β = 0.107) and the social contribution of the foodservice organization (β = 0.761) had strong relationships with the image of the organization. The purchase intentions of customers was affected only by the foodservice image (β = 0.775). The results of this study suggest that sustainable practices by foodservice organization present a good image to customers and increase the awareness of valuable contributions that benefit the customer as well as the community.

Upper Colorado River Basin Climate Effects Network

USGS Publications Warehouse

Belnap, Jayne; Campbell, Donald; Kershner, Jeff

2011-01-01

The Upper Colorado River Basin (UCRB) Climate Effects Network (CEN) is a science team established to provide information to assist land managers in future decision making processes by providing a better understanding of how future climate change, land use, invasive species, altered fire cycles, human systems, and the interactions among these factors will affect ecosystems and the services they provide to human communities. The goals of this group are to (1) identify science needs and provide tools to assist land managers in addressing these needs, (2) provide a Web site where users can access information pertinent to this region, and (3) provide managers technical assistance when needed. Answers to the team's working science questions are intended to address how interactions among climate change, land use, and management practices may affect key aspects of water availability, ecosystem changes, and societal needs within the UCRB.

The use of key indicators as a foundation for knowledge management: the experiences of Monterey County's Social and Employment Services Department.

PubMed

Lindberg, Arley

2012-01-01

While effective knowledge management practices are commonly sought by organizations, facilitating the use and ongoing engagement in these practices can be challenging. To this end, one agency developed a strategy for institutionalizing their knowledge management functions by appointing a team responsible for monitoring and implementing knowledge management functions, and creating a report for use as a tool by departments agency-wide. Aimed at increasing transparency both within the agency and with the surrounding community, the report provides an overview of individual departments' programs, goals, recent caseload trends, and latest achievements. The report is made available online and accessible by the general public. This case study describes the development of this team and report, as well as lessons learned and future knowledge management goals for the agency. Copyright © Taylor & Francis Group, LLC

Findings From the National Machine Guarding Program

PubMed Central

Parker, David L.; Yamin, Samuel; Xi, Min; Gordon, Robert; Most, Ivan; Stanley, Rod

2017-01-01

Objectives: This manuscript assesses safety climate data from the National Machine Guarding Program (NMGP)—a nationwide intervention to improve machine safety. Methods: Baseline safety climate surveys were completed by 2161 employees and 341 owners or managers at 115 businesses. A separate onsite audit of safety management practices and machine guarding equipment was conducted at each business. Results: Safety climate measures were not correlated with machine guarding or safety management practices. The presence of a safety committee was correlated with higher scores on the safety management audit when contrasted with those without one. Conclusions: The presence of a safety committee is easily assessed and provides a basis on which to make recommendations with regard to how it functions. Measures of safety climate fail to provide actionable information. Future research on small manufacturing firms should emphasize the presence of an employee-management safety committee. PMID:28930801

Does peatland restoration make a difference to the millennial scale carbon balance?

NASA Astrophysics Data System (ADS)

Quillet, Anne; Roulet, Nigel; Wu, Jianghua

2017-04-01

Millennial peatland carbon balance is of crucial importance to assess the past and future forcing of peatlands carbon sequestration on climate. However drainage and exploitation of peatlands over the last and current centuries greatly affect the carbon balance of 25% of the global peatlands (Parish et al. 2008). Moreover, the impact of drainage is likely to remain for unforeseeable time, modifying the hydrology and the ecology of peatlands. The aim of this study is to assess the influence on the long-term carbon balance of restoration practices over abandonment on vacuum-extracted peatlands. We modified the Holocene Peat Model (Frolking et al. 2010) to simulate peat extraction as well as different post-extraction management strategies: abandonment, drainage blocking and restoration. Simulation results enable the comparison of the response of the system to different management strategies. The carbon balance is estimated for the millennia following extraction for different management strategies and different climate conditions. The difference between restoration practices and abandonment allows the assessment of the net carbon gain associated with restoration. Although it is expected that successful restoration practices are beneficial to the carbon budget of the ecosystem, it will take millennia to restore what has been extracted. In cases where the site is left abandoned, it is estimated that peat would degrade within centuries. The management strategies and the duration of the period of latency between extraction and restoration are key factors controlling the magnitude of the future carbon loss or gain of a peatland.

An argument for competency-based training in pelvic floor physiotherapy practice.

PubMed

Frawley, Helena C; Neumann, Patricia; Delany, Clare

2018-05-10

Pelvic floor dysfunction has been described as "a silent epidemic," affecting many people in the community yet under-recognized and insufficiently managed. There is evidence that pelvic floor physiotherapy can manage many of these disorders, however a competency framework to guide and inform pelvic floor physiotherapy training and practice is lacking. The assessment and management of the pelvic floor complex is not addressed as a core component of most entry-to-practice physiotherapy programs despite being within the scope of physiotherapy practice which is in contrast with the knowledge and skills that physiotherapists graduate with in core areas of clinical practice. This results in a registration-competency gap, and the need for post-graduation training to ensure clinicians are appropriately skilled to practice safely and effectively in this area. In addition, there are potential ethical and legal issues unique to this area of physiotherapy practice to be considered. We use a series of clinical scenarios to highlight the domains of knowledge, skills and communication required for practice in this area, based on our experience in Australia. We propose a framework for the future which defines competence in pelvic floor physiotherapy to provide clarity to clinicians about their clinical, ethical and legal obligations to the public, our referrers and third-party payers.

Impact of the "Guidelines for infection prevention in dentistry" (2006) by the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch-Institute (KRINKO) on hygiene management in dental practices - analysis of a survey from 2009.

PubMed

Hübner, Nils-Olaf; Handrup, Stephan; Meyer, Georg; Kramer, Axel

2012-01-01

To assess trends in hygiene management in dental practices in comparison to an earlier survey in 2002/2003 and to point out key aspects for future efforts. The infection prevention management of all dental practices in Greifswald (n=35) was determined by a questionnaire in a personal interview in 2008/2009. 26% of the dentists did not use sufficient personal protective equipment during the general examination of the patient. In conservative and prosthetic dentistry, 15% still did not use adequate measures and 9% did not even in surgical interventions. Vaccination coverage was clearly too low, as only 35% of dentists were vaccinated against influenza and coverage with other vaccinations was also quite low. 11% of the dentists did not perform a documented anamnesis and in 29% of the dental practices no appointment system for risk patients existed.There were significant deficiencies in the reprocessing of medical devices and in the equipment needed for reprocessing. The opportunity to participate in further training in this field was rejected by 23% of the dentists.In 10 dental practices, the colony count in the dental unit water-conducting system was five times higher than the limit. A contamination with P. aeruginosa was discovered in 4 practices. All units were renovated. Overall, both the hygiene management and hygiene equipment in the practices have improved considerably compared to the previous survey in 2002/2003. This demonstrates the positive effect of the KRINKO guidelines from 2006. However, the survey again showed relevant deficiences in the hygiene management of dental practices, which agrees with a Germany-wide online survey from 2009. While the study revealed persistent deficiencies in hygiene management, especially in reprocessing, it confirms that the KRINKO guidelines for dental practices from 2006 led to significant improvements in hygiene management. Doubts about the impact of the guidelines are not backed by evidence.

The present status and future growth of maintenance in US manufacturing: results from a pilot survey.

PubMed

Jin, Xiaoning; Siegel, David; Weiss, Brian A; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented.

The present status and future growth of maintenance in US manufacturing: results from a pilot survey

PubMed Central

Jin, Xiaoning; Siegel, David; Weiss, Brian A.; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

2016-01-01

A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented. PMID:27525253

[Clinical practice guidelines and knowledge management in healthcare].

PubMed

Ollenschläger, Günter

2013-10-01

Clinical practice guidelines are key tools for the translation of scientific evidence into everyday patient care. Therefore guidelines can act as cornerstones of evidence based knowledge management in healthcare, if they are trustworthy, and its recommendations are not biased by authors' conflict of interests. Good medical guidelines should be disseminated by means of virtual (digital/electronic) health libraries - together with implementation tools in context, such as guideline based algorithms, check lists, patient information, a.s.f. The article presents evidence based medical knowledge management using the German experiences as an example. It discusses future steps establishing evidence based health care by means of combining patient data, evidence from medical science and patient care routine, together with feedback systems for healthcare providers.

Understanding the effects of fire management practices on forest health: implications for weeds and vegetation structure

Treesearch

Anne E. Black; Peter Landres

2012-01-01

Current fire policy to restore ecosystem function and resiliency and reduce buildup of hazardous fuels implies a larger future role for fire (both natural and human ignitions) (USDA Forest Service and U.S. Department of the Interior 2000). Yet some fire management (such as building fire line, spike camps, or helispots) potentially causes both short- and longterm...

Increasing Competition for Spares within AFLC (Air Force Logistics Center). Revision.

DTIC Science & Technology

1982-11-30

Managers 45 On Competing the Production of Weapon Systems 46 Sole Source and Competitive Price Trends in Spare Parts Acquisition 47 Controlled...future directions in research and policy . 3- TOPIC: Acquisition TYPE: AFIT Thesis TITLE: Spares Acquisition Integrated with Production and Its...evaluate Air Force management policies , procedures, practices, and controls over the acquisition and pricing of spare parts. Specific objectives

Human Systems Integration in Practice: Constellation Lessons Learned

NASA Technical Reports Server (NTRS)

Zumbado, Jennifer Rochlis

2012-01-01

NASA's Constellation program provided a unique testbed for Human Systems Integration (HSI) as a fundamental element of the Systems Engineering process. Constellation was the first major program to have HSI mandated by NASA's Human Rating document. Proper HSI is critical to the success of any project that relies on humans to function as operators, maintainers, or controllers of a system. HSI improves mission, system and human performance, significantly reduces lifecycle costs, lowers risk and minimizes re-design. Successful HSI begins with sufficient project schedule dedicated to the generation of human systems requirements, but is by no means solely a requirements management process. A top-down systems engineering process that recognizes throughout the organization, human factors as a technical discipline equal to traditional engineering disciplines with authority for the overall system. This partners with a bottoms-up mechanism for human-centered design and technical issue resolution. The Constellation Human Systems Integration Group (HSIG) was a part of the Systems Engineering and Integration (SE&I) organization within the program office, and existed alongside similar groups such as Flight Performance, Environments & Constraints, and Integrated Loads, Structures and Mechanisms. While the HSIG successfully managed, via influence leadership, a down-and-in Community of Practice to facilitate technical integration and issue resolution, it lacked parallel top-down authority to drive integrated design. This presentation will discuss how HSI was applied to Constellation, the lessons learned and best practices it revealed, and recommendations to future NASA program and project managers. This presentation will discuss how Human Systems Integration (HSI) was applied to NASA's Constellation program, the lessons learned and best practices it revealed, and recommendations to future NASA program and project managers on how to accomplish this critical function.

The brave new world of older patients: preparing general practice training for an ageing population.

PubMed

Bonney, Andrew; Phillipson, Lyn; Jones, Sandra C; Hall, Julie; Sharma, Rashmi

2015-11-01

Develop and pilot test evidence-based resources for general practice training practices to enhance older patients' (65+ years) interactions with General Practice Registrars (GPRs). In Australia, general practice trainees, referred to as GPRs, see fewer older patients and patients with chronic conditions than doctors who have completed their specialist GP training. This reduces learning opportunities for GPRs in the management of these important patient groups. Therefore, developing effective strategies to improve GPR-older patient interaction is critical to primary care training, to meet the current and future needs of an ageing population. Adopting a social marketing approach, GPR practice resources were developed to address knowledge and attitudinal barriers at the practice and patient level to improve older patient comfort, and willingness to engage, with GPR care. Two focus groups with older patients (n=18) and interviews with staff of training practices (n=12) were utilised to pre-test resources. Amended resources were pilot tested and evaluated in a naturalistic GPR training practice setting using a structured patient questionnaire (n=44). Pilot evaluation suggests improved comfort and willingness of older patients to interact with GPRs. In all, 54% of survey participants indicated they would be more likely to make an appointment with a Registrar in the future as a result of exposure to the resources. In all, 40% of patients would feel comfortable having a GPR manage a complex or chronic condition, which compares favourably with 28% of similarly aged patients in previous research. The use of tailored, engaging and informative GPR resources for older patients and practice staff may be an important contributor to addressing the growing problem of ensuring GPRs are adequately engaged in treating older patients. The adoption of a social marketing framework was instrumental in enhancing the acceptance and effectiveness of this intervention.

The present and future of opioid analgesics in small animal practice.

PubMed

Simon, B T; Steagall, P V

2017-08-01

Opioids are the cornerstone for the treatment of acute pain in small animal patients. This is primarily because of their remarkable safety profile, high efficacy, and benefit of reversibility. There have been some significant advances in our knowledge on opioid pharmacology and clinical usage in companion animal medicine. This review discusses the progression of opioid use in small animal practice providing current misconceptions and controversies in light of routes of administration. Potential targets for research and drug development and novel therapies are discussed in addition to the concepts of glial cell modulators, individual variability, and opioid tolerance and hyperalgesia. The future brings an interesting perspective with the application of pharmacogenetics and individualized pain management in canine and feline practice. © 2016 John Wiley & Sons Ltd.

Environmental geology in the United States: Present practice and future training needs

NASA Astrophysics Data System (ADS)

Lundgren, Lawrence

Environmental geology as practiced in the United States confronts issues in three large areas: Threats to human society from geologic phenomena (geologic hazards); impacts of human activities on natural systems (environmental impact), and natural-resource management. This paper illustrates present U.S. practice in environmental geology by sampling the work of 7 of the 50 state geological surveys and of the United States Geological Survey as well. Study of the work of these agencies provides a basis for identifying avenues for the training of those who will deal with environmental issues in the future. This training must deal not only with the subdisciplines of geology but with education to cope with the ethical, interdisciplinary, and public-communication aspects of the work of the environmental geologist.

Evaluation of Evidence-Based Nursing Pain Management Practice

PubMed Central

Song, Wenjia; Eaton, Linda H.; Gordon, Debra B.; Hoyle, Christine; Doorenbos, Ardith Z.

2014-01-01

Background It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. Aims This study aimed to (a) modify and test an evaluation tool for nursing cancer pain documentation, and (b) describe the frequency and quality of nursing pain documentation in one oncology unit via electronic medical system. Design and Setting A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Methods Medical records were examined for 37 adults hospitalized during April and May of 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. Results The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. Conclusions The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

Acquainting Future Office Employees with Productivity-Improvement Techniques.

ERIC Educational Resources Information Center

Quible, Zane K.

1982-01-01

Examines factors affecting productivity (government regulations, energy costs, decline in the work ethic, capital investment, number of service workers, work force characteristics, management practices, and unions), and techniques to improve productivity (employee involvement, job structure, communication, flexitime, employee upgrading, incentive…

Addressing Competencies for the Future in the Professional Curriculum

PubMed Central

Kelley, Kristi W.; Hammer, Dana P.; Haines, Stuart T.; Marlowe, Karen F.

2009-01-01

This paper reviews the literature, analyzes current and future practice, develops a list of competencies necessary for future pharmacists, and provides recommendations to pharmacy's academic enterprise regarding curricula of the future. Curricula of the future will center around 3 functional roles for pharmacists: patient-centered care, population-based care, and systems management; and must also foster the development of 5 cross-cutting abilities in student pharmacists: professionalism, self-directed learning, leadership and advocacy, interprofessional collaboration, and cultural competency. Future curricula must be developed in an evidence-based manner, focus less on information storage and retrieval, engage student pharmacists in a variety of highly interactive learning experiences, and expand experiential learning opportunities throughout all years. PMID:20221349

Understanding quit decisions in primary care: a qualitative study of older GPs

PubMed Central

Sansom, Anna; Calitri, Raff; Carter, Mary; Campbell, John

2016-01-01

Objective To investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50–60 years. Design and setting Qualitative study based on semistructured interviews with GPs in the South West region of England. Transcribed interviews were analysed thematically. Participants 23 GPs aged 50–60 years: 3 who had retired from direct patient care before age 60, and 20 who intended to quit direct patient care within the next 5 years. Results The analysis identified four key themes: early retirement is a viable option for many GPs; GPs have employment options other than undertaking direct patient care; GPs report feeling they are doing an (almost) undoable job; and GPs may have other aspirations that pull them away from practice. Findings from this study confirmed those from earlier research, with high workload, ageing and health, family and domestic life, and organisational change all influencing GPs’ decisions about when to retire/quit direct patient care. However, in addition, GPs expressed feelings of insecurity and uncertainty regarding the future of general practice, low morale, and issues regarding accountability (appraisal and revalidation) and governance. Suggestions about how to help retain GPs within the active clinical workforce were offered, covering individual, practice and organisational levels. Conclusions This research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions. Any future changes to policy or practice to help retain experienced GPs will benefit from this informed understanding of GPs’ views. Key factors to take into account include: making the GP workload more manageable; managing change sympathetically; paying attention to GPs’ own health; improving confidence in the future of general practice; and improving GP morale. PMID:26895989

Cropping practices manipulate abundance patterns of root and soil microbiome members paving the way to smart farming.

PubMed

Hartman, Kyle; van der Heijden, Marcel G A; Wittwer, Raphaël A; Banerjee, Samiran; Walser, Jean-Claude; Schlaeppi, Klaus

2018-01-16

Harnessing beneficial microbes presents a promising strategy to optimize plant growth and agricultural sustainability. Little is known to which extent and how specifically soil and plant microbiomes can be manipulated through different cropping practices. Here, we investigated soil and wheat root microbial communities in a cropping system experiment consisting of conventional and organic managements, both with different tillage intensities. While microbial richness was marginally affected, we found pronounced cropping effects on community composition, which were specific for the respective microbiomes. Soil bacterial communities were primarily structured by tillage, whereas soil fungal communities responded mainly to management type with additional effects by tillage. In roots, management type was also the driving factor for bacteria but not for fungi, which were generally determined by changes in tillage intensity. To quantify an "effect size" for microbiota manipulation, we found that about 10% of variation in microbial communities was explained by the tested cropping practices. Cropping sensitive microbes were taxonomically diverse, and they responded in guilds of taxa to the specific practices. These microbes also included frequent community members or members co-occurring with many other microbes in the community, suggesting that cropping practices may allow manipulation of influential community members. Understanding the abundance patterns of cropping sensitive microbes presents the basis towards developing microbiota management strategies for smart farming. For future targeted microbiota management-e.g., to foster certain microbes with specific agricultural practices-a next step will be to identify the functional traits of the cropping sensitive microbes.

Managed consumerism in health care.

PubMed

Robinson, James C

2005-01-01

The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.

Improving the Success of Strategic Management Using Big Data.

PubMed

Desai, Sapan S; Wilkerson, James; Roberts, Todd

2016-01-01

Strategic management involves determining organizational goals, implementing a strategic plan, and properly allocating resources. Poor access to pertinent and timely data misidentifies clinical goals, prevents effective resource allocation, and generates waste from inaccurate forecasting. Loss of operational efficiency diminishes the value stream, adversely impacts the quality of patient care, and hampers effective strategic management. We have pioneered an approach using big data to create competitive advantage by identifying trends in clinical practice, accurately anticipating future needs, and strategically allocating resources for maximum impact.

The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease.

PubMed

Martin, Louise; Leveritt, Michael D; Desbrow, Ben; Ball, Lauren E

2014-04-01

Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated. The aim of the present study was to investigate the perceptions of Australian practice nurses on the provision of nutrition care for chronic disease management, including specific nutrition-related activities. A cross-sectional online survey was completed by 181 Australian practice nurses in 2013. Descriptive analyses were conducted on each survey item. The survey sample was tested for representation of the Australian practice nurse workforce, and associations between respondents' demographic characteristics and responses to survey items were explored. Almost all practice nurses (89%) felt it was important to address diet whenever they cared for a patient. Over half of practice nurses (61%) were unsure if their practices were effective in increasing patients' compliance with nutritional recommendations. Nearly all practice nurses (98%) perceived further education on nutrition would assist them in their role. Practice nurses perceive they have an important role and favourable attitudes towards providing nutrition care; however, further training and education to enhance their self-perceived effectiveness is warranted. Future research should clarify whether an increase in nutrition-focused training results in improved effectiveness of nutrition care provided by practice nurses in terms of patient health outcomes.

A new framing approach in guideline development to manage different sources of knowledge.

PubMed

Lukersmith, Sue; Hopman, Katherine; Vine, Kristina; Krahe, Lee; McColl, Alexander

2017-02-01

Contemporary guideline methodology struggles to consider context and information from different sources of knowledge besides quantitative research. Return to work programmes involve multiple components and stakeholders. If the guideline is to be relevant and practical for a complex intervention such as return to work, it is essential to use broad sources of knowledge. This paper reports on a new method in guideline development to manage different sources of knowledge. The method used framing for the return-to-work guidance within the Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace. The development involved was a multi-disciplinary working party of experts including consumers. The researchers considered a broad range of research, expert (practice and experience) knowledge, the individual's and workplace contexts, and used framing with the International Classification of Functioning, Disability and Health. Following a systematic database search on four clinical questions, there were seven stages of knowledge management to extract, unpack, map and pack information to the ICF domains framework. Companion graded recommendations were developed. The results include practical examples, user and consumer guides, flow charts and six graded or consensus recommendations on best practice for return to work intervention. Our findings suggest using framing in guideline methodology with internationally accepted frames such as the ICF is a reliable and transparent framework to manage different sources of knowledge. Future research might examine other examples and methods for managing complexity and using different sources of knowledge in guideline development. © 2016 John Wiley & Sons, Ltd.

[How to assess clinical practice guidelines with AGREE II: The example of neonatal jaundice].

PubMed

Renesme, L; Bedu, A; Tourneux, P; Truffert, P

2016-03-01

Neonatal jaundice is a very frequent condition that occurs in approximately 50-70% of term or near-term (>35 GA) babies in the 1st week of life. In some cases, a high bilirubin blood level can lead to kernicterus. There is no consensus for the management of neonatal jaundice and few countries have published national clinical practice guidelines for the management of neonatal jaundice. The aim of this study was to assess the quality of these guidelines. We conducted a systematic review of the literature for national clinical practice guidelines for the management of neonatal jaundice in term or near-term babies. Four independent reviewers assessed the quality of each guideline using the AGREE II evaluation. For each of the clinical practice guidelines, the management modalities were analyzed (screening, treatment, follow-up, etc.). Seven national clinical practice guidelines were found (South Africa, USA AAP, UK NICE, Canada, Norway, Switzerland, and Israel). The AGREE II score showed widespread variation regarding the quality of these national guidelines. There was no major difference between the guidelines concerning the clinical management of these babies. The NICE guideline is the most valuable guideline regarding the AGREE II score. NICE showed that, despite a strong and rigorous methodology, there is no evidenced-based recommended code of practice (RCP). Comparing RCPs, we found no major differences. The NICE guideline showed the best quality. The AGREE II instrument should be used as a framework when developing clinical practice guidelines to improve the quality of the future guideline. In France, a national guideline is needed for a more standardized management of neonatal jaundice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Preventative Disease Management and Grower Decision Making: A Case Study of California Wine-Grape Growers.

PubMed

Hillis, Vicken; Lubell, Mark; Kaplan, Jonathan; Baumgartner, Kendra

2017-06-01

Preventative disease management is challenging to farmers because it requires paying immediate costs in the hopes of returning uncertain future benefits. Understanding farmer decision making about prevention has the potential to reduce disease incidence and minimize the need for more costly postinfection practices. For example, the grapevine trunk-disease complex (esca, Botryosphaeria dieback, Eutypa dieback, and Phomopsis dieback) significantly affects vineyard productivity and longevity. Given the chronic nature of the infections and inability to eradicate the fungal pathogens, the preventative practices of delayed pruning, applications of pruning-wound protectants, and double pruning (also known as prepruning) are the most effective means of management. We surveyed wine-grape growers in six regions of California on their use of these three practices. In spite of acknowledging the yield impacts of trunk diseases, a substantial number of respondents either choose not to use preventative practices or incorrectly adopted them in mature vineyards, too late in the disease cycle to be effective. Growers with more negative perceptions of cost efficacy were less likely to adopt preventative practices or were more likely to time adoption incorrectly in mature vineyards. In general, preventative management may require strong intervention in the form of policy or extension to motivate behavioral change.

Prioritizing lean management practices in public and private hospitals.

PubMed

Hussain, Matloub; Malik, Mohsin

2016-05-16

Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

Impact of SAMMPRIS on the future of intracranial atherosclerotic disease management: polling results from the ICAD symposium at the International Stroke Conference.

PubMed

Zaidat, Osama O; Castonguay, Alicia C; Nguyen, Thanh N; Becker, Kyra J; Derdeyn, Colin P; Nelson, Peter K; Amarenco, Pierre; Brott, Thomas G

2014-04-01

There are few data regarding the effect of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial results on the management of intracranial atherosclerotic disease (ICAD). We sought to understand the impact of the SAMMPRIS trial on current ICAD clinical practices and future trial design. During the ICAD symposium at the 2012 International Stroke Conference, electronic data were collected regarding attendees' clinical management of ICAD and opinions on the feasibility of future trials post-SAMMPRIS. 217 attendees from different specialties, including neurologists (57%), neurointerventionalists (9%) and neurosurgeons (5%), participated in the session. The majority of respondents (77%) indicated that the results of SAMMPRIS have impacted their consideration for intracranial stenting. Post-SAMMPRIS, 84% selected 'SAMMPRIS-style' medical management for the treatment of ICAD. For patients with ICAD who failed aggressive medical therapy, 82% would consider an alternative approach to continuing medical therapy (30% considered clinical trial enrollment, 28% suggested angioplasty and stenting and 24% angioplasty). The majority of participants (85%) were willing to randomize patients with symptomatic ICAD in future trials. For the next ICAD trial, 29% indicated that angioplasty alone should be compared with aggressive medical therapy. Our polling results suggest that the SAMMPRIS trial has had an impact on the current treatment of ICAD. Treatment of patients who failed medical therapy varied widely from aggressive medical therapy to balloon angioplasty, stenting or enrollment in future clinical trials. The willingness to continue clinical trials and randomize patients supports the need for future ICAD studies.

A first look at chorioamnionitis management practice variation among US obstetricians.

PubMed

Greenberg, Mara B; Anderson, Britta L; Schulkin, Jay; Norton, Mary E; Aziz, Natali

2012-01-01

Objective. To examine practice patterns for diagnosis and treatment of chorioamnionitis among US obstetricians. Study Design. We distributed a mail-based survey to members of the American College of Obstetricians and Gynecologists, querying demographics, practice setting, and chorioamnionitis management strategies. We performed univariable and multivariable analyses. Results. Of 500 surveys distributed, 53.8% were returned, and 212 met study criteria and were analyzed. Most respondents work in group practice (66.0%), perform >100 deliveries per year (60.0%), have been in practice >10 years (77.3%), and work in a nonuniversity setting (85.1%). Temperature plus one additional criterion (61.3%) was the most common diagnostic strategy. Over 25 different primary antibiotic regimens were reported, including use of a single agent by 30.0% of respondents. A wide range of postpartum antibiotic duration was reported from no postpartum treatment (34.5% after vaginal delivery, 11.3% after cesarean delivery) to 48 hours of postpartum treatment (24.7% after vaginal delivery, 32.1% after cesarean delivery). No practitioner characteristic was independently associated with diagnostic or therapeutic strategies in multivariable analysis. Conclusion. There is a wide variation in contemporary clinical practices for the management of chorioamnionitis. This may represent a dearth of level I evidence. Future prospective clinical trials may provide more evidence-based practice recommendations for diagnosis and treatment of chorioamnionitis.

Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice.

PubMed

Howell, D; Oliver, T K; Keller-Olaman, S; Davidson, J R; Garland, S; Samuels, C; Savard, J; Harris, C; Aubin, M; Olson, K; Sussman, J; MacFarlane, J; Taylor, C

2014-04-01

Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.

The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.

PubMed

Holley, Jessica; Chambers, Mary; Gillard, Steven

2016-08-01

Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services. To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services. Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes. Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk. In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery. A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.

Report: EPA Has Developed Guidance for Disaster Debris but Has Limited Knowledge of State Preparedness

EPA Pesticide Factsheets

Report #16-P-0219, June 29, 2016. The EPA can reduce the risk of future unsafe debris disposal practices by improving its understanding and awareness of the quality and completeness of state disaster debris management plans.

Dairy manure biochar as a phosphorus fertilizer

USDA-ARS?s Scientific Manuscript database

Future manure management practices will need to remove large amounts of organic waste as well as harness energy to generate value-added products. Manures can be processed using thermochemical conversion technologies to generate a solid product called biochar. Dairy manure biochars contain sufficient...

Landscape influence on soil carbon and nutrient levels

USDA-ARS?s Scientific Manuscript database

Past runoff, erosion, and management practices influence nutrient levels on the landscape. These starting levels affect future nutrient transport due to runoff, erosion, and leaching events. The purpose of this study was to examine closed-depression landscape effects on surface soil organic matter, ...

Water Resources and Supply Adaptation: A paradigm Shifting for Future Climate?

EPA Science Inventory

Climate change adds another layer of complexity in planning, engineering and management of water resources and urban water infrastructures. Yet our current practice is confined to the traditional approach that evaluates developmental scenarios and their sustainability mostly by a...

An analysis of computerization in primary care practices.

PubMed

Condon, James V; Smith, Sherry P

2002-12-01

To remain profitable, primary care practices, the front-line health care providers, must provide excellent patient care and reduce expenses while providing payers with accurate data. Many primary care practices have turned to computer technology to achieve these goals. This study examined the degree of computerization of primary care providers in the Augusta, Georgia, metropolitan area as well as the level of awareness of the Health Insurance Portability and Accountability Act (HIPAA) by primary care providers and its potential effect on their future computerization plans. The study's findings are presented and discussed as well as a number of recommendations for practice managers.

Implementing Evidence-Based Practices for People With Schizophrenia

PubMed Central

Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

2009-01-01

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations.

PubMed

Williams-Whitt, Kelly; Bültmann, Ute; Amick, Benjamin; Munir, Fehmidah; Tveito, Torill H; Anema, Johannes R

2016-12-01

Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.

Practice, clinical management, and financial arrangements of practicing generalists.

PubMed

Keating, Nancy L; Landon, Bruce E; Ayanian, John Z; Borbas, Catherine; Guadagnoli, Edward

2004-05-01

To describe the practice settings, financial arrangements, and management strategies experienced by generalist physicians and identify factors associated with reporting pressure to limit referrals, pressure to see more patients, and career dissatisfaction. Cross-sectional mail survey. Six hundred nineteen generalist physicians (62% response rate) caring for managed care patients in 3 Minnesota health plans during 1999. Twenty-six percent of physicians reported pressure to limit referrals. In adjusted analyses, female physicians and those who were board certified acted as gatekeepers for most of their patients, received incentives based on performance reports and quality profiles, and received direct income from capitation, and were more likely than others to report this pressure (all P <.05). Sixty-two percent reported pressure to see more patients. In adjusted analyses, this pressure was more frequent among physicians in practices owned by health systems, those using physician extenders, and among physicians paid by salary with performance adjustment or those receiving at least some capitation (all P <.05). One-quarter (24%) of physicians were dissatisfied with their career in medicine. In adjusted analyses, physicians reporting pressure to limit referrals (risk ratio, 1.12; 95% confidence interval, 1.01 to 1.19) and those reporting pressure to see more patients (risk ratio, 1.37; 95% confidence interval, 1.08 to 1.66) were more likely to be dissatisfied than other physicians. Pressures to limit referrals and to see more patients are common, particularly among physicians paid based on productivity or capitation, and they are associated with career dissatisfaction. Whether future changes in practice arrangements or compensation strategies can decrease such physician-reported pressures, and ultimately improve physician satisfaction, will be an important area for future study.

Employer Policies and Practices to Manage and Prevent Disability: Foreword to the Special Issue.

PubMed

Shaw, William S; Main, Chris J; Pransky, Glenn; Nicholas, Michael K; Anema, Johannes R; Linton, Steven J

2016-12-01

Purpose Employer policies and practices have been shown to impact workplace disability, but research in this area has waned in recent years despite an aging workforce, a growing prevalence of chronic health conditions, and a larger proportion of working-age adults on permanent work disability in many jurisdictions. The purpose of this article is to describe the background rationale and methodology for an invited conference designed to improve research of employer strategies to curtail work disability. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The overall goal was to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. Working groups were organized and draft manuscripts were prepared in advance. Conference activities included working group presentations and critiques, discussions with a panel of industry consultants and advisors, group interaction and debate, generation of final recommendations, and manuscript revision. Results/Conclusion Six principal domains were established with respect to future research: (a) further elucidation of the key workplace factors that buffer the disabling effects of injury and illness; (b) more innovative and feasible options for workplace intervention; (c) measurement of workplace-relevant disability outcomes; (d) a stronger theoretical framework for understanding the factors behind employer uptake and implementation; (e) a focus on special clinical populations and occupations where disability risk is most troubling; and (f) better representation of workers and employers that reflect the diverse and changing nature of work. Final comments and recommendations of the working groups are presented in the following six articles in this special issue of the Journal of Occupational Rehabilitation. Conference attendees recommended changes in methodology, collaboration strategies, and theoretical perspectives to improve the practical and scientific impact of future research of employer practices.

SMART DOCS: A New Patient-Centered Outcomes and Coordinated-Care Management Approach for the Future Practice of Sleep Medicine

PubMed Central

Kushida, Clete A.; Nichols, Deborah A.; Holmes, Tyson H.; Miller, Ric; Griffin, Kara; Cardell, Chia-Yu; Hyde, Pamela R.; Cohen, Elyse; Manber, Rachel; Walsh, James K.

2015-01-01

The practice of medicine is currently undergoing a transformation to become more efficient, cost-effective, and patient centered in its delivery of care. The aim of this article is to stimulate discussion within the sleep medicine community in addressing these needs by our approach as well as other approaches to sleep medicine care. The primary goals of the Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS) are: (1) to introduce a new Patient-Centered Outcomes and Coordinated-Care Management (PCCM) approach for the future practice of sleep medicine, and (2) to test the PCCM approach against a Conventional Diagnostic and Treatment Outpatient Medical Care (CONV) approach in a randomized, two-arm, single-center, long-term, comparative effectiveness trial. The PCCM approach is integrated into a novel outpatient care delivery model for patients with sleep disorders that includes the latest technology, allowing providers to obtain more accurate and rapid diagnoses and to make evidence-based treatment recommendations, while simultaneously enabling patients to have access to personalized medical information and reports regarding their diagnosis and treatment so that they can make more informed health care decisions. Additionally, the PCCM approach facilitates better communication between patients, referring primary care physicians, sleep specialists, and allied health professionals so that providers can better assist patients in achieving their preferred outcomes. A total of 1,506 patients 18 y or older will be randomized to either the PCCM or CONV approach and will be followed for at least 1 y with endpoints of improved health care performance, better health, and cost control. Clinical Trials Registration: ClinicalTrials.gov Identifier: NCT02037438. Citation: Kushida CA, Nichols DA, Holmes TH, Miller R, Griffin K, Cardell CY, Hyde PR, Cohen E, Manber R, Walsh JK. SMART DOCS: a new patient-centered outcomes and coordinated-care management approach for the future practice of sleep medicine. SLEEP 2015;38(2):315–326. PMID:25409112

Workflow technology: the new frontier. How to overcome the barriers and join the future.

PubMed

Shefter, Susan M

2006-01-01

Hospitals are catching up to the business world in the introduction of technology systems that support professional practice and workflow. The field of case management is highly complex and interrelates with diverse groups in diverse locations. The last few years have seen the introduction of Workflow Technology Tools, which can improve the quality and efficiency of discharge planning by the case manager. Despite the availability of these wonderful new programs, many case managers are hesitant to adopt the new technology and workflow. For a myriad of reasons, a computer-based workflow system can seem like a brick wall. This article discusses, from a practitioner's point of view, how professionals can gain confidence and skill to get around the brick wall and join the future.

Making sausage--effective management of enterprise-wide clinical IT projects.

PubMed

Smaltz, Detlev H; Callander, Rhonda; Turner, Melanie; Kennamer, Gretchen; Wurtz, Heidi; Bowen, Alan; Waldrum, Mike R

2005-01-01

Unlike most other industries in which company employees are, well, company employees, U.S. hospitals are typically run by both employees (nurses, technicians, and administrative staff) and independent entrepreneurs (physicians and nurse practitioners). Therefore, major enterprise-wide clinical IT projects can never simply be implemented by mandate. Project management processes in these environments must rely on methods that influence adoption rather than presume adoption will occur. "Build it and they will come" does not work in a hospital setting. This paper outlines a large academic medical center's experiences in managing an enterprise-wide project to replace its core clinical systems functionality. Best practices include developing a cogent optimal future-state vision, communications planning and execution, vendor validation against the optimal future-state vision, and benefits realization assessment.

Management of Nasopharyngeal Carcinoma: Current Practice and Future Perspective.

PubMed

Lee, Anne W M; Ma, Brigette B Y; Ng, Wai Tong; Chan, Anthony T C

2015-10-10

Nasopharyngeal carcinoma of the undifferentiated subtype is endemic to southern China, and patient prognosis has improved significantly over the past three decades because of advances in disease management, diagnostic imaging, radiotherapy technology, and broader application of systemic therapy. Despite the excellent local control with modern radiotherapy, distant failure remains a key challenge. Advances in molecular technology have helped to decipher the molecular pathogenesis of nasopharyngeal carcinoma as well as its etiologic association with the Epstein-Barr virus. This in turn has led to the discovery of novel biomarkers and drug targets, rendering this cancer site a current focus for new drug development. This article reviews and appraises the key literature on the current management of nasopharyngeal carcinoma and future directions in clinical research. © 2015 by American Society of Clinical Oncology.

Evaluation of Evidence-based Nursing Pain Management Practice.

PubMed

Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

2015-08-01

It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Modeling the influence of climate change on watershed systems: Adaptation through targeted practices

NASA Astrophysics Data System (ADS)

Dudula, John; Randhir, Timothy O.

2016-10-01

Climate change may influence hydrologic processes of watersheds (IPCC, 2013) and increased runoff may cause flooding, eroded stream banks, widening of stream channels, increased pollutant loading, and consequently impairment of aquatic life. The goal of this study was to quantify the potential impacts of climate change on watershed hydrologic processes and to evaluate scale and effectiveness of management practices for adaptation. We simulate baseline watershed conditions using the Hydrological Simulation Program Fortran (HSPF) simulation model to examine the possible effects of changing climate on watershed processes. We also simulate the effects of adaptation and mitigation through specific best management strategies for various climatic scenarios. With continuing low-flow conditions and vulnerability to climate change, the Ipswich watershed is the focus of this study. We quantify fluxes in runoff, evapotranspiration, infiltration, sediment load, and nutrient concentrations under baseline and climate change scenarios (near and far future). We model adaptation options for mitigating climate effects on watershed processes using bioretention/raingarden Best Management Practices (BMPs). It was observed that climate change has a significant impact on watershed runoff and carefully designed and maintained BMPs at subwatershed scale can be effective in mitigating some of the problems related to stormwater runoff. Policy options include implementation of BMPs through education and incentives for scale-dependent and site specific bioretention units/raingardens to increase the resilience of the watershed system to current and future climate change.

Theory and application for the promotion of wheat production in China: past, present and future.

PubMed

Xu, Zhenzhu; Yu, Zhenwen; Zhao, Junye

2013-08-15

Food security is becoming a crucial concern worldwide. In this study, we focus on wheat - a staple crop in China - as a model to review its history, status quo and future scenarios, with regard to key production technologies and management practices for wheat production and associated food security issues since the new era in China: the post-1949 era. First, the dominant technologies and management practices over the past 60 years are reviewed. Secondly, we outline several key innovative technologies and their theoretical bases over the last decade, including (i) prohibiting excessively early senescence at a later growth stage to maintain viable leaves with higher photosynthetic capacity, (ii) postponing top dressing nitrogen application to balance carbon and nitrogen nutrition, and (iii) achieving both high yield and better grain quality mainly by increasing soil productivity and balancing the ratio of nutrient elements. Finally, concerns such as water shortages and excessive application of chemical fertilizers are presented. Nevertheless, under high negative conditions, including global warming, rapid population growth, decreasing amounts of arable land, increasing competition with cash crops and severe environmental pollution, we conclude that domestic food production will be able to meet Chinese demand in the mid to long term, because increasingly innovative technologies and improved management practices have been and may continue to be applied appropriately. © 2013 Society of Chemical Industry.

Critical Essay: Building new management theories on sound data? The case of neuroscience

PubMed Central

Lindebaum, Dirk

2015-01-01

In this critical essay, I contend that accelerating demands for novel theories in management studies imply that new methodologies and data are sometimes accepted prematurely as supply of these novel theories. This point is illustrated with reference to how neuroscience can inform management research. I propose two demand forces that foster the increased focus on neuroscience in management studies, these being (i) the direction of public research funding, and (ii) publication bias as a boost for journal impact factor. Looking at the supply side, I note that (i) the statistical power of studies using functional magnetic resonance imaging (or fMRI, the ‘gold’ standard) is unacceptably low, (ii) the use of imprecise ‘motherhood’ statements, and (iii) the dismissal of ethical concerns in the formulation of management theories and practice informed by neuroscience. I then briefly outline the bad consequences of this for management theory and practice, emphasize why it is important to prevent these consequences, and offer some methodological suggestions for future research. PMID:27041766

Isohaline position as a habitat indicator for estuarine populations

USGS Publications Warehouse

Jassby, Alan D.; Kimmerer, W.J.; Monismith, Stephen G.; Armor, C.; Cloern, James E.; Powell, T.M.; Vedlinski, Timothy J.

1995-01-01

The striped bass survival data were also used to illustrate a related important point: incorporating additionalexplanatory variables may decrease the prediction error for a population or process, but it can increase theuncertainty in parameter estimates and management strategies based on these estimates. Even in cases wherethe uncertainty is currently too large to guide management decisions, an uncertainty analysis can identify themost practical direction for future data acquisition.

Communicating in a Noisy World.

DTIC Science & Technology

1983-04-18

human communication any source of message distortion from unwanted sound to distracting emotions b16 the receiver may be thought of analogically as...which discusses human communication in the future. The article runs to ten pages of offensive print. It is printed in eight-point type that is 15...the Practice of Management, 3rd ed., p. 129. 8. John Parry, The Psychology of Human Communication , p. 64. 9. Peter F. Drucker, Technology, Management

The Need to Practice What We Teach: Assessing the Preparedness of Chairs and Deans to Their Management Appointments in Mississippi's Public Universities

ERIC Educational Resources Information Center

Long, Jamye; Johnson, Cooper; Faught, Sam

2015-01-01

In the classroom, great effort is made to educate the next generation of leaders on the importance of training for them and their future employees. As educators, the natural emphasis is placed on formal education, however as employees are promoted, their success often rests with their ability to manage a larger unit. In higher education the most…

Tritium

DTIC Science & Technology

2011-11-01

fusion energy -production processes of the particular type of reactor using a lithium (Li) blanket or related alloys such as the Pb-17Li eutectic. As such, tritium breeding is intimately connected with energy production, thermal management, radioactivity management, materials properties, and mechanical structures of any plausible future large-scale fusion power reactor. JASON is asked to examine the current state of scientific knowledge and engineering practice on the physical and chemical bases for large-scale tritium

Realising their potential? Exploring interprofessional perceptions and potential of the advanced practitioner role: a qualitative analysis

PubMed Central

Powell, Tom; Watkins, Dianne; Kelly, Daniel

2015-01-01

Objectives To explore perceptions of the current practice and future potential of advanced practitioners (APs) from the perspectives of different professional groups in Wales UK. Design A qualitative study consisting of nine focus group interviews. Methods Initially verbatim transcriptions of each focus group interviews were analysed thematically before themes were merged to represent perceptions for the whole data set. Participants Data were gathered from a total of 67 stakeholders—including APs from a variety of professional groups (eg, nursing, physiotherapy, paramedics) as well as managers, workforce developers, educators and medical staff who have a role developing and supporting APs in practice. Results The results are presented in four themes: (1) demand, policy context and future priorities, (2) role clarity and standardisation, (3) agreement and understanding of the role and (4) interprofessional working. The context within which current and future AP roles were considered was influenced by inexorable demands for healthcare and the requirements to meet health policy priorities. Developing AP roles were hampered currently by a lack of shared understanding and ‘joined-up’ working between different groups such as medical practitioners, managers, commissioners and educators. Conclusions For the AP role to flourish more ‘joined-up’ thinking, support and development opportunities are required between APs, managers, senior clinicians, commissioners and educators. Working together to plan and deliver education, innovation and service delivery is of prime importance to meeting ever increasing complex health needs. This will ensure that future APs are adequately prepared and supported to reach their full potential and help deliver necessary innovations in current models of care delivery. PMID:26656024

Rice management interventions to mitigate greenhouse gas emissions: a review.

PubMed

Hussain, Saddam; Peng, Shaobing; Fahad, Shah; Khaliq, Abdul; Huang, Jianliang; Cui, Kehui; Nie, Lixiao

2015-03-01

Global warming is one of the gravest threats to crop production and environmental sustainability. Rice, the staple food of more than half of the world's population, is the most prominent cause of greenhouse gas (GHG) emissions in agriculture and gives way to global warming. The increasing demand for rice in the future has deployed tremendous concerns to reduce GHG emissions for minimizing the negative environmental impacts of rice cultivation. In this review, we presented a contemporary synthesis of existing data on how crop management practices influence emissions of GHGs in rice fields. We realized that modifications in traditional crop management regimes possess a huge potential to overcome GHG emissions. We examined and evaluated the different possible options and found that modifying tillage permutations and irrigation patterns, managing organic and fertilizer inputs, selecting suitable cultivar, and cropping regime can mitigate GHG emissions. Previously, many authors have discussed the feasibility principle and the influence of these practices on a single gas or, in particular, in the whole agricultural sector. Nonetheless, changes in management practices may influence more than one gas at the same time by different mechanisms or sometimes their effects may be antagonistic. Therefore, in the present attempt, we estimated the overall global warming potential of each approach to consider the magnitude of its effects on all gases and provided a comprehensive assessment of suitable crop management practices for reducing GHG emissions in rice culture.

Big Data Challenges for Large Radio Arrays

NASA Technical Reports Server (NTRS)

Jones, Dayton L.; Wagstaff, Kiri; Thompson, David; D'Addario, Larry; Navarro, Robert; Mattmann, Chris; Majid, Walid; Lazio, Joseph; Preston, Robert; Rebbapragada, Umaa

2012-01-01

Future large radio astronomy arrays, particularly the Square Kilometre Array (SKA), will be able to generate data at rates far higher than can be analyzed or stored affordably with current practices. This is, by definition, a "big data" problem, and requires an end-to-end solution if future radio arrays are to reach their full scientific potential. Similar data processing, transport, storage, and management challenges face next-generation facilities in many other fields.

The future of interventional and neurointerventional radiology: learning lessons from the past.

PubMed

Maingard, Julian; Kok, Hong Kuan; Ranatunga, Dinesh; Brooks, Duncan Mark; Chandra, Ronil V; Lee, Michael J; Asadi, Hamed

2017-12-01

The rapid progression of medical imaging technology and the ability to leverage knowledge from non-invasive imaging means that Interventional Radiologists (IRs) and Interventional Neuroradiologists are optimally placed to incorporate minimally invasive interventional paradigms into clinical management to advance patient care. There is ample opportunity to radically change the management options for patients with a variety of diseases through the use of minimally invasive interventional procedures. However, this will need to be accompanied by an increased clinical role of IRs to become active partners in the clinical management of patients. Unfortunately, the development of IR clinical presence has lagged behind and is reflected by declining rates of IR involvement in certain areas of practice such as vascular interventions. Current and future IRs must be willing to take on clinical responsibilities; reviewing patients in clinic to determine suitability for a procedure and potential contraindications, rounding on hospital inpatients and be willing to manage procedure related complications, which are all important parts of a successful IR practice. Increasing our clinical presence has several advantages over the procedure-driven model including enhanced patient knowledge and informed consent for IR procedures, improved rapport with patients and other clinical colleagues through active participation and engagement in patient care, visibility as a means to facilitate referrals and consistency of follow-up with opportunities for further learning. Many of the solutions to these problems are already in progress and the use of IR as a "hired gun" or "technician" is a concept that should be relegated to the past, and replaced with recognition of IRs as clinicians and partners in delivering modern high quality multidisciplinary team-based patient care. The following article will review the history of IR, the challenges facing this rapidly evolving profession and discuss recent developments occurring globally that are essential in maintaining expertise, securing future growth and improving patient outcomes in the modern multidisciplinary practice of medicine.

Creating a living document: developing the National Association of School Nurses Mission Statement for the new millennium.

PubMed

Brandt, C M

1999-12-01

The second in a series of three articles devoted to the development, maintenance, and implementation of the National Association of School Nurses 1998-2001 Strategic Plan and how it relates to the practice of school nurses. Information about the development of a mission/vision statement for the organization is given along with strategies for developing a local school district school health program strategic plan. A previous Nursing Practice Management section article discussed the development of the Association's strategic plan considering the changing health care climate, the shifting needs of school children, and the economic climate for school funding. A future Nursing Practice Management section article will discuss the implementation of the seven goal areas in the National Association of School Nurses 1998-2001 Strategic Plan.

Psychosocial treatments for schizophrenia.

PubMed

Mueser, Kim T; Deavers, Frances; Penn, David L; Cassisi, Jeffrey E

2013-01-01

The current state of the literature regarding psychosocial treatments for schizophrenia is reviewed within the frameworks of the recovery model of mental health and the expanded stress-vulnerability model. Interventions targeting specific domains of functioning, age groups, stages of illness, and human service system gaps are classified as evidence-based practices or promising practices according to the extent to which their efficacy is currently supported by meta-analyses and individual randomized controlled trials (RCTs). Evidence-based practices include assertive community treatment (ACT), cognitive behavior therapy (CBT) for psychosis, cognitive remediation, family psychoeducation, illness self-management training, social skills training, and supported employment. Promising practices include cognitive adaptive therapy, CBT for posttraumatic stress disorder, first-episode psychosis intervention, healthy lifestyle interventions, integrated treatment for co-occurring disorders, interventions targeting older individuals, peer support services, physical disease management, prodromal stage intervention, social cognition training, supported education, and supported housing. Implications and future directions are discussed.

Mild traumatic brain injury: a Midwest survey of discharge teaching practices of emergency department nurses.

PubMed

Bay, Esther; Strong, Carrie

2011-01-01

Research indicates that the assessment and discharge teaching practices for persons with traumatic brain injury are more focused on ruling out severe brain injury and informing the person about "red flags" warranting a return visit to the medical provider. Our primary purpose was to determine the extent to which discharge practices were aligned with the Centers for Disease Control and Prevention guidelines contained within the Acute Concussion Evaluation care plan. Responses from 87 nurses (25.0% response rate) to a tailored survey were analyzed to determine emergency department nurses' discharge teaching practices for adults who experienced a mild traumatic brain injury (MTBI). Results indicated that nurses in general were focused on injury-specific information and less often provided information about MTBI, symptom management, or strategies for preventing future brain damage. System improvements are justified to provide injured persons with a clearly defined diagnosis and instructions for follow-up and symptom management.

The use of a resource-based relative value scale (RBRVS) to determine practice expense costs: a novel technique of practice management for the vascular surgeon.

PubMed

Mabry, C D

2001-03-01

Vascular surgeons have had to contend with rising costs while their reimbursements have undergone steady reductions. The use of newer accounting techniques can help vascular surgeons better manage their practices, plan for future expansion, and control costs. This article reviews traditional accounting methods, together with activity-based costing (ABC) principles that have been used in the past for practice expense analysis. The main focus is on a new technique-resource-based costing (RBC)-which uses the widely available Resource-Based Relative Value Scale (RBRVS) as its basis. The RBC technique promises easier implementation as well as more flexibility in determining true costs of performing various procedures, as opposed to more traditional accounting methods. It is hoped that RBC will assist vascular surgeons in coping with decreasing reimbursement. Copyright 2001 by W.B. Saunders Company

An Overview of Practice Facilitation Programs in Canada: Current Perspectives and Future Directions

PubMed Central

Liddy, Clare; Laferriere, Dianne; Baskerville, Bruce; Dahrouge, Simone; Knox, Lyndee; Hogg, William

2013-01-01

Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field. PMID:23968627

Oil terrorism-militancy link: Mediating role of moral disengagement in emergency and crisis management.

PubMed

Mafimisebi, Oluwasoye Patrick; Thorne, Sara

2015-01-01

The controversial issues of terrorism and militancy have generated contemporary interests and different interpretations have emerged on how to combat and manage these dangerous events. This study widens understanding of moral disengagement mechanism application in the perpetuation of inhumanities within the context of oil terrorist and militant behaviors. The research findings and model are explicit on how people form moral evaluations of agents who are forced to make morally relevant decisions over times in context of crisis situations. Quite crucially, understanding the context of terrorism and militancy provides policymakers, emergency and crisis managers better analysis and response to such events. The research fundamental purpose was to investigate the mediating role of moral disengagement on delinquency of oil terrorism and militancy; and considered implications for emergency and crisis management practices. The study found that situational-induced crises such as oil terrorism and militancy were sufficient to account for an individual's misdeeds and unethical or inhumane decisions made under frustration and agitation may be perceived as less indicative of one's fundamental character. Findings suggest that more repugnant delinquencies could have been committed in the name of justice than in the name of injustice, avenues for future research. In context, the result of the moral disengagement scale shows that morality of delinquency (oil terrorism and militancy) is accomplished by cognitively redefining the morality of such acts. The main finding is that people in resistance movements are rational actors making rational choices. The authors argue that theorists, policymakers, and practitioners must give meaningful attention to understanding the multidimensional nature of emergency, crisis and disaster management for better strength of synthesis between theory and practice. The research is concluded by thorough examination of the implication and limitations for future research and practice.

Integrating natural and social sciences to manage sustainably vectors of change in the marine environment: Dogger Bank transnational case study

NASA Astrophysics Data System (ADS)

Burdon, Daryl; Boyes, Suzanne J.; Elliott, Michael; Smyth, Katie; Atkins, Jonathan P.; Barnes, Richard A.; Wurzel, Rüdiger K.

2018-02-01

The management of marine resources is a complex process driven by the dynamics of the natural system and the influence of stakeholders including policy-makers. An integration of natural and social sciences research is required by policy-makers to better understand, and manage sustainably, natural changes and anthropogenic activities within particular marine systems. Given the uncertain development of activities in the marine environment, future scenarios assessments can be used to investigate whether marine policy measures are robust and sustainable. This paper develops an interdisciplinary framework, which incorporates future scenarios assessments, and identifies four main types of evaluation needed to integrate natural and social sciences research to support the integrated management of the marine environment: environmental policy and governance assessments; ecosystem services, indicators and valuation; modelling tools for management evaluations, and risk assessment and risk management. The importance of stakeholder engagement within each evaluation method is highlighted. The paper focuses on the transnational spatial marine management of the Dogger Bank, in the central North Sea, a site which is very important ecologically, economically and politically. Current management practices are reviewed, and research tools to support future management decisions are applied and discussed in relation to two main vectors of change affecting the Dogger Bank, namely commercial fisheries and offshore wind farm developments, and in relation to the need for nature conservation. The input of local knowledge through stakeholder engagement is highlighted as a necessary requirement to produce site-specific policy recommendations for the future management of the Dogger Bank. We present wider policy recommendations to integrate natural and social sciences in a global marine context.

Improving pain management of abdominal pain in children presenting to the paediatric emergency department: a pre-post interventional study.

PubMed

Williams, Suzanne; Holzhauser, Kerri; Bonney, Donna; Burmeister, Elizabeth; Gilhotra, Yuri; Oliver, Randall; Gordon, Kerry

2012-08-01

In 2007, the Mater Children's Hospital Emergency Department participated in the Emergency Care Pain Management Initiative funded by the National Health and Medical Research Council National Institute of Clinical Studies (NHMRC-NICS). The findings of this NHMRC-NICS research across eleven paediatric emergency departments highlighted deficits in pain management of abdominal pain. Specifically pain assessment, timeliness of analgesia, and pain management guidelines were found to be lacking. In response to the NICS report local practice was reviewed and a pilot research project undertaken to develop a clinical guideline for the pain management of abdominal pain in children presenting to the emergency department. The guideline was developed by an expert panel and trialled using a pre and post intervention design. The results demonstrated improved compliance to assessment and documentation of pain scores and assimilation of the best practice principles recommended in the guideline. This project raised local awareness in the pain management of abdominal pain and provides baseline information for future improvement. The guideline has been trialled in the clinical setting of paediatric emergency and has the potential to improve pain management practices in children presenting to the emergency department with abdominal pain. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Using Assessments of Dental Students' Entrepreneurial Self-Efficacy to Aid Practice Management Education.

PubMed

Mollica, Anthony G; Cain, Kevin; Callan, Richard S

2017-06-01

In the past, the typical practice management curriculum in U.S. dental schools was found to place a heavy emphasis on customer service, whereas areas typically stressed in business entrepreneurship and management courses (e.g., long-range planning, competing strategies, and supplier relationship) received less attention. However, future dentists will likely have many points in their careers at which they must decide whether to begin a new business or to associate with a practice, and entrepreneurial and management training can help them make and implement those decisions. The aim of this exploratory study was to investigate the impact of one dental school's practice management education on students' entrepreneurial self-efficacy (ESE), a construct examined for the first time in dental education. ESE is an individual's belief that he or she is personally capable of planning for, operating, and managing a successful business. In December 2014, all students in all four classes were asked to complete a survey measuring their ESE. The response rates for each class were D1 94%, D2 91%, D3 87%, and D4 79%. The results showed that the mean scores of the fourth-year class were higher on all five examined dimensions than those of the other three classes. The same was true for the mean for each class with the exception of the competency regarding an individual's perception of his or her abilities to deploy and manage human resources, in which the first-year class had a higher score than the fourth-year class (149.07>146.06). The fourth-year class had statistically significant higher scores than the third-year class, consistent with the implementation of practice management courses in the curriculum.

Perceptions of vulnerability to a future outbreak: a study of horse managers affected by the first Australian equine influenza outbreak.

PubMed

Schemann, Kathrin; Firestone, Simon M; Taylor, Melanie R; Toribio, Jenny-Ann L M L; Ward, Michael P; Dhand, Navneet K

2013-07-31

A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated with horse managers' perceived vulnerability to a future equine influenza outbreak. Of the 200 respondents, 31.9% perceived themselves to be very vulnerable, 36.6% vulnerable and 31.4% not vulnerable to a future outbreak of equine influenza. Multivariable logistic regression modelling revealed that managers involved in horse racing and those on rural horse premises perceived themselves to have low levels of vulnerability. Managers of horse premises that experienced infection in their horses in 2007 and those seeking infection control information from specific sources reported increased levels of perceived vulnerability to a future outbreak. Different groups across the horse industry perceived differing levels of vulnerability to a future outbreak. Increased vulnerability contributes to favourable infection control behaviour and hence these findings are important for understanding uptake of recommended infection control measures. Future biosecurity communication strategies should be delivered through information sources suitable for the horse racing and rural sectors.

Land management strategies for improving water quality in biomass production under changing climate

NASA Astrophysics Data System (ADS)

Ha, Miae; Wu, May

2017-03-01

The Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. The watershed is covered primarily with annual crops (corn and soybeans). With cropland conversion to switchgrass, stover harvest, and implementation of best management practices (BMPs) (such as establishing riparian buffers and applying cover crops), significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under a historical climate scenario, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compared with current land use when a portion of the cropland is converted to switchgrass and a cover crop is in place. Climate change could cause increases of 9.7% in SS, 4.1% in N, and 7.2% in P compared to current land use. Under future climate scenarios, nutrients including SS, N, and P were reduced through land management and practices and BMPs by up to 54.0% (SS), 30.4% (N), and 7.1% (P). Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management by using long-term monitoring data from field to watershed is necessary to verify the findings and move toward watershed-specific regional programs for climate adaptation.

Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.

PubMed

Tropea, J; Slee, J; Holmes, A C N; Gorelik, A; Brand, C A

2009-02-01

Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities. A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed. Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis. A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.

Loan Stars: ILL Comes of Age.

ERIC Educational Resources Information Center

Jackson, Mary E.

1998-01-01

Assesses the changes in interlibrary loan (ILL) practices, and points the way to an ideal future. Discusses patron-initiated document request systems; library-mediated ordering systems; document delivery suppliers; accessing electronic resources; ILL management software; paying ILL invoices; new electronic delivery options; and results of a…

Performance Support in Internet Time: The State of the Practice.

ERIC Educational Resources Information Center

Gery, Gloria; Malcolm, Stan; Cichelli, Janet; Christensen, Hal; Raybould, Barry; Rosenberg, Marc J.

2000-01-01

Relates a discussion held via teleconference that addressed trends relating to performance support. Topics include computer-based training versus performance support; knowledge management; Internet and Web-based applications; dynamics and human activities; enterprise application integration; intrinsic performance support; and future possibilities.…

Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing.

PubMed

Jin, Xiaoning; Weiss, Brian A; Siegel, David; Lee, Jay

2016-01-01

The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy.

Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing

PubMed Central

Jin, Xiaoning; Weiss, Brian A.; Siegel, David; Lee, Jay

2016-01-01

The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy. PMID:28058173

Apollo experience report: Reliability and quality assurance

NASA Technical Reports Server (NTRS)

Sperber, K. P.

1973-01-01

The reliability of the Apollo spacecraft resulted from the application of proven reliability and quality techniques and from sound management, engineering, and manufacturing practices. Continual assessment of these techniques and practices was made during the program, and, when deficiencies were detected, adjustments were made and the deficiencies were effectively corrected. The most significant practices, deficiencies, adjustments, and experiences during the Apollo Program are described in this report. These experiences can be helpful in establishing an effective base on which to structure an efficient reliability and quality assurance effort for future space-flight programs.

Intracranial cavernous angioma: a practical review of clinical and biological aspects.

PubMed

Raychaudhuri, Ratul; Batjer, H Huntington; Awad, Issam A

2005-04-01

Cavernomas are an uncommon lesion seen in neurosurgical practice that can occasionally rupture. Recent developments in neurosurgical technique and microbiology have brought greater insight into the treatment and molecular pathogenesis of cavernoma. In this review, a historical overview of cavernous angioma, a current paradigm for treatment, promising new molecular biological developments, and suggestions for future directions in neurosurgical research are presented, with emphasis on practical clinical applications. A survey of the literature on cavernous angioma and consultation with the Department of Neurosurgery at Northwestern Memorial Hospital was conducted by the authors to gain greater insight regarding this lesion. Papers and consultation revealed the importance of careful evaluation of this lesion, new techniques such as functional magnetic resonance imaging and frameless stereotaxy that simplify clinical management of cavernomas, and potential mechanisms by which to tackle this lesion in the future. New basic knowledge on disease biology is summarized with practical applications in the clinical arena. There appear to be a number of controversies regarding management of this lesion. These include risk factors faced by the patient, controversy over the importance of resection, and modality through which the treatment should occur. An algorithm is presented to aid the neurosurgeon in management of these lesions. Exciting developments in neurosurgery and molecular biology will continue to have a major impact on clinical treatment of this disease. Unresolved issues regarding the importance of certain risk factors, the role for radiotherapy in treatments, and the underlying molecular abnormalities must be tackled to gain greater clarity in treatment of this lesion.

Field of Psychiatry: Current Trends and Future Directions: An Indian Perspective.

PubMed

Dave, Kishore P

2016-01-01

Attempting to predict future is dangerous. This is particularly true in medical science where change is a result of chance discoveries. Currently, practicing psychiatrists are aware of deficiencies in psychiatric practice. However, we have a number of genuine reasons for optimism and excitement. Genetics, novel treatment approaches, new investigative techniques, large-scale treatment trials, and research in general medicine and neurology will give better insights in psychiatric disorders and its management. Psychiatric services in rural India can be reached by telemedicine. There are some threat perceptions which require solving and remedying. Subspecialties in psychiatry are the need of the hour. There is also a requirement for common practice guidelines. Mental Health Care Bill, 2013, requires suitable amendments before it is passed in the Indian Parliament. Research in psychiatry is yet to be developed as adequate resources are not available.

A Fresh Look at Internet Protocol Version 6 (IPv6) for Department of Defense (DoD) Networks

DTIC Science & Technology

2010-08-01

since system administration practices (such as the use of security appliances) depend heavily on tools for network management, diagnosis and protection...are mobile ad hoc networks (MANETs) and yet there is limited practical experience with MANETs and their performance. Further, the interaction between...Systems FCS Future Combat System IETF Internet Engineering Task Force ISAT Information Science and Technology BAST Board on Army Science and

Indicators of Club Management Practices and Biological Measurements of Patrons’ Drug and Alcohol Use

PubMed Central

Byrnes, Hilary F.; Miller, Brenda A.; Johnson, Mark B.; Voas, Robert B.

2015-01-01

Background Electronic Music Dance Events in nightclubs attract patrons with heavy alcohol/drug use. Public health concerns are raised from risks related to these behaviors. Practices associated with increased risk in these club settings need to be identified. Objectives The relationship between club management practices and biological measures of patrons’ alcohol/drug use is examined. Methods Observational data from 25 events across 6 urban clubs were integrated with survey data (N=738 patrons, 42.8% female) from patrons exiting these events, 2010–2012. Five indicators of club management practices were examined using mixed model regressions: club security, bar crowding, safety signs, serving intoxicated patrons, and isolation. Results Analyses revealed that serving intoxicated patrons and safety signs were related to less substance use. Specifically, serving intoxicated patrons was related to heavy alcohol and drug use at exit, while safety signs were marginally related to less exit drug use. Conclusions/Importance Findings indicate observable measures in nightclubs provide important indicators for alcohol/drug use, suggesting practices to target. Study strengths include the use of biological measures of substance use on a relatively large scale. Limitations and future directions are discussed. PMID:24832721

Implementation of Good Clinical Laboratory Practice (GCLP) guidelines within the External Quality Assurance Program Oversight Laboratory (EQAPOL).

PubMed

Todd, Christopher A; Sanchez, Ana M; Garcia, Ambrosia; Denny, Thomas N; Sarzotti-Kelsoe, Marcella

2014-07-01

The EQAPOL contract was awarded to Duke University to develop and manage global proficiency testing programs for flow cytometry-, ELISpot-, and Luminex bead-based assays (cytokine analytes), as well as create a genetically diverse panel of HIV-1 viral cultures to be made available to National Institutes of Health (NIH) researchers. As a part of this contract, EQAPOL was required to operate under Good Clinical Laboratory Practices (GCLP) that are traditionally used for laboratories conducting endpoint assays for human clinical trials. EQAPOL adapted these guidelines to the management of proficiency testing programs while simultaneously incorporating aspects of ISO/IEC 17043 which are specifically designed for external proficiency management. Over the first two years of the contract, the EQAPOL Oversight Laboratories received training, developed standard operating procedures and quality management practices, implemented strict quality control procedures for equipment, reagents, and documentation, and received audits from the EQAPOL Central Quality Assurance Unit. GCLP programs, such as EQAPOL, strengthen a laboratory's ability to perform critical assays and provide quality assessments of future potential vaccines. © 2013.

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

PubMed Central

Pereira, José L.; Davis, Daniel H.J.; Currow, David C.; Meagher, David; Rabheru, Kiran; Wright, David; Bruera, Eduardo; Hartwick, Michael; Gagnon, Pierre R.; Gagnon, Bruno; Breitbart, William; Regnier, Laura; Lawlor, Peter G.

2014-01-01

Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. PMID:24480529

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

Wilder, Julie; Mancini, Giulio M.; Wakabi, Timothy

A survey was designed to query former Biorisk management (BRM) trainees in the East Africa region about their practices post-training and their perceived future training needs. A subset of those surveyed had been trained as BRM trainers. The survey was conducted to obtain a baseline of BRM practices that can serve as a benchmark for performance monitoring, to identify priorities for future BRM training and to gauge local BRM trainers' abilities to deliver effective training. The survey revealed that less than 50% of the respondents could identify evidence of a BRM system in their institute. Coaching and mentoring by BRMmore » experts was identified as being of highest benefit to enable success as BRM practitioners. Local trainers reached 1538 trainees in the previous year and reported that trainings positively correlated with desired BRM behavior. Acknowledgements The authors wish to sincerely thank all of the former biorisk management trainees in East Africa who agreed to participate in this survey. Their candid and honest input was extremely insightful. We also thank Lora Grainger (06826) and Ben Brodsky (Manager, 06824) for careful and critical review of the report. We are grateful for the financial support of the Defense Threat Reduction Agency, Cooperative Biological Engagement Program.« less

Geriatric Cardiology: An Emerging Discipline

PubMed Central

Dodson, John A.; Matlock, Daniel D.; Forman, Daniel E.

2017-01-01

Given changing demographics, patients with cardiovascular (CV) disease in developed countries are now older and more complex than even a decade ago. This trend is expected to continue into the foreseeable future; accordingly, cardiologists in practice are encountering patients with a greater number of comorbid illnesses as well as “geriatric conditions” such as cognitive impairment and frailty which complicate management and influence outcomes. Simultaneously, technological advances have widened the therapeutic options available for patients, including those with the most advanced CV disease. In the setting of these changes, geriatric cardiology has recently emerged as a discipline that aims to adapt principles from geriatric medicine into everyday cardiology practice. Accordingly, the tasks of a “geriatric cardiologist” may include both traditional evidence-based CV management plus comprehensive geriatric assessment, medication reduction, team-based coordination of care, and explicit incorporation of patient goals into management. Given that the field is still in its relative infancy, the training pathways and structure of clinical programs in geriatric cardiology are still being delineated. In this review we highlight the rationale behind geriatric cardiology as a discipline, several current approaches by geriatric cardiology programs, and future directions for the field. PMID:27476988

Directions for social research to underpin improved groundwater management

NASA Astrophysics Data System (ADS)

Mitchell, Michael; Curtis, Allan; Sharp, Emily; Mendham, Emily

2012-07-01

SummaryImprovements in groundwater management require strategies to change human behaviour, yet there has been limited social research in the broad arena of groundwater management. This paper provides a critical review of the small but expanding literature on that topic to identify future directions for social researchers. Comprehensive search methods identified almost three hundred potentially relevant publications, which were sorted thematically and assessed in terms of their theoretical underpinning and the evidence used to support key findings. This process enabled the authors to identify a small number of high quality publications and to identify future research opportunities. The latter includes analysing how concepts of risk and sustainable yield are constructed differently by stakeholders, especially related to divisive issues concerning coal seam gas developments and reforms that reduce irrigation allocations; how governance arrangements can be improved to achieve more effective collaborative management of groundwater, especially if managed aquifer recharge is to be more widely implemented in rural agricultural contexts; and the role that trust and social norms can play in changing groundwater use practices.

Water Resilience by Design: A water infrastructure planning framework for developing sustainable water management strategies

NASA Astrophysics Data System (ADS)

Brown, C.; Ray, P. A.; Freeman, S.

2016-12-01

Societal need for improved water management and concerns for the long-term sustainability of water resources systems are prominent around the world. The continued susceptibility of society to the harmful effects of hydrologic variability, pervasive concerns related to climate change and the emergent awareness of devastating effects of current practice on aquatic ecosystems all illustrate our limited understanding of how water ought to be managed in a dynamic world. To address these challenges, new problem solving approaches are required that acknowledge uncertainties, incorporate best available information, and link engineering design principles, typically based on determinism, with our best geoscience-based understanding of planetary change. In this presentation, we present and demonstrate a framework for developing water planning and management strategies that are resilient in the face of future uncertainties and our limited ability to anticipate the future. The approach begins with stakeholder engagement and decision framing to elicit relevant context, uncertainties, choices and connections that drive planning and serve as an entry point to exploring possible futures. The result is the development of water strategies that are informed by the best available predictive information and designed to perform well over a future of change. Examples from around the world are presented to illustrate the methodology.

End-of-life care practices of critical care nurses: A national cross-sectional survey.

PubMed

Ranse, Kristen; Yates, Patsy; Coyer, Fiona

2016-05-01

The critical care context presents important opportunities for nurses to deliver skilled, comprehensive care to patients at the end of life and their families. Limited research has identified the actual end-of-life care practices of critical care nurses. To identify the end-of-life care practices of critical care nurses. A national cross-sectional online survey. The survey was distributed to members of an Australian critical care nursing association and 392 critical care nurses (response rate 25%) completed the survey. Exploratory factor analysis using principal axis factoring with oblique rotation was undertaken on survey responses to identify the domains of end-of-life care practice. Descriptive statistics were calculated for individual survey items. Exploratory factor analysis identified six domains of end-of-life care practice: information sharing, environmental modification, emotional support, patient and family centred decision-making, symptom management and spiritual support. Descriptive statistics identified a high level of engagement in information sharing and environmental modification practices and less frequent engagement in items from the emotional support and symptom management practice areas. The findings of this study identified domains of end-of-life care practice, and critical care nurse engagement in these practices. The findings highlight future training and practice development opportunities, including the need for experiential learning targeting the emotional support practice domain. Further research is needed to enhance knowledge of symptom management practices during the provision of end-of-life care to inform and improve practice in this area. Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Good governance in national solid waste management policy (NSWMP) implementation: A case study of Malaysia

NASA Astrophysics Data System (ADS)

Wee, Seow Ta; Abas, Muhamad Azahar; Mohamed, Sulzakimin; Chen, Goh Kai; Zainal, Rozlin

2017-10-01

The National Solid Waste Management Policy (NSWMP) was introduced in 2007 under the Act 672. The execution of NSWMP involves stakeholders from various government agencies and a collaboration with the private sectors. Despite the initiatives taken by the stakeholders, the objectives of NSWMP failed to materialise. One of the major constraints is weak governance among stakeholders with regards to the NSWMP implementation. This paper will explore the good governance practices implemented by the stakeholders. Identifying the current good governance practices implemented by the stakeholders is crucial as it will serve as a guideline to improve good governance practice in the future. An exploratory research approach is applied in this study through in-depth interviews with several government agencies and concessionaires involved in the NSWMP implementation. A total of six respondents took part in this study. The findings of this study show that there are several good governance practices implemented in policy promotion, participation of stakeholders, and capacity enhancement programme for the staff. This study also proposed some points on good governance practices in the context of policy promotion and staff development. A paradigm shift by the stakeholders is imperative so as to enhance the good governance practice in NSWMP implementation towards an efficient solid waste management in Malaysia.

Visitor diversity through the recreation manager lens: comparing Forest Service Regions 8 (U S South) and 5 (California)

Treesearch

Cassandra Johnson Gaither; Nina S. Roberts; Kristin L. Hanula

2015-01-01

In response to changing demographics and cultural shifts in the U.S. population, the Forest Service, U.S. Department of Agriculture has initiated a range of “culturally transforming” management practices and priorities aimed at better reflecting both the current and future U.S. population (USDA 2011). This makeover also calls attention to the various publics served by...

Understanding the effects of fire management practices on forest health: Implications for weeds and vegetation structure (Project INT-F-04-01) [Chapter 14

Treesearch

Anne E. Black; Peter Landres

2011-01-01

Current fire policy to restore ecosystem function and resiliency and reduce buildup of hazardous fuels implies a larger future role for fire (both natural and human ignitions) (USDA and USDOI 2000). Yet some fire management (such as building fire line, spike camps, or heli-spots) potentially causes both short- and long-term impacts to forest health. In the short run,...

A resilience perspective to water risk management: case-study application of the adaptation tipping point method

NASA Astrophysics Data System (ADS)

Gersonius, Berry; Ashley, Richard; Jeuken, Ad; Nasruddin, Fauzy; Pathirana, Assela; Zevenbergen, Chris

2010-05-01

In a context of high uncertainty about hydrological variables due to climate change and other factors, the development of updated risk management approaches is as important as—if not more important than—the provision of improved data and forecasts of the future. Traditional approaches to adaptation attempt to manage future water risks to cities with the use of the predict-then-adapt method. This method uses hydrological change projections as the starting point to identify adaptive strategies, which is followed by analysing the cause-effect chain based on some sort of Pressures-State-Impact-Response (PSIR) scheme. The predict-then-adapt method presumes that it is possible to define a singular (optimal) adaptive strategy according to a most likely or average projection of future change. A key shortcoming of the method is, however, that the planning of water management structures is typically decoupled from forecast uncertainties and is, as such, inherently inflexible. This means that there is an increased risk of under- or over-adaptation, resulting in either mal-functioning or unnecessary costs. Rather than taking a traditional approach, responsible water risk management requires an alternative approach to adaptation that recognises and cultivates resiliency for change. The concept of resiliency relates to the capability of complex socio-technical systems to make aspirational levels of functioning attainable despite the occurrence of possible changes. Focusing on resiliency does not attempt to reduce uncertainty associated with future change, but rather to develop better ways of managing it. This makes it a particularly relevant perspective for adaptation to long-term hydrological change. Although resiliency is becoming more refined as a theory, the application of the concept to water risk management is still in an initial phase. Different methods are used in practice to support the implementation of a resilience-focused approach. Typically these approaches start the identification and analysis of adaptive strategies at the end of PSIR scheme: impact and examine whether, and for how long, current risk management strategies will continue to be effective under different future conditions. The most noteworthy application of this approach is the adaptation tipping point method. Adaptation tipping points (ATP) are defined as the points where the magnitude of change is such that the current risk management strategy can no longer meet its objectives. In the ATP method, policy objectives, determining aspirational functioning, are taken as the starting point. Also, the current measures to achieve these objectives are described. This is followed by a sensitivity analysis to determine the optimal and critical boundary conditions (state). Lastly, the state is related to pressures in terms of future change. It should be noted that in the ATP method the driver for adopting a new risk management strategy is not future change as such, but rather failing to meet the policy objectives. In the current paper, the ATP method is applied to the case study of an existing stormwater system in Dordrecht (the Netherlands). This application shows the potential of the ATP method to reduce the complexity of implementing a resilience-focused approach to water risk management. It is expected that this will help foster greater practical relevance of resilience as a perspective for the planning of water management structures.

A Chronic Disease Management Student-Faculty Collaborative Practice: Educating Students on Innovation in Health Care Delivery.

PubMed

Remus, Kristin E; Honigberg, Michael; Tummalapalli, Sri Lekha; Cohen, Laura P; Fazio, Sara; Weinstein, Amy R

2016-07-01

In the current transformative health care landscape, it is imperative that clinician educators inspire future clinicians to practice primary care in a dynamic environment. A focus on patient-centered, goal-oriented care for patients with chronic conditions is critical. In 2009, Harvard Medical School founded the Crimson Care Collaborative, a student-faculty collaborative practice (SFCP) network. With the aim of expanding clinical and educational opportunities for medical students and improving patient control of chronic disease (i.e., hypertension, obesity, and diabetes) in an innovative learning environment, in 2012, the authors developed a novel SFCP at their hospital-based academic primary care practice. In this SFCP, students learn to explore patient priorities, provide focused counseling and education, and assist patients with self-management goals during clinical visits. From 2012 to 2014, 250 student volunteers participated in the SFCP as clinicians, innovators, educators, and leaders, with between 80 and 95 medical students engaging each semester. Between January 2012 and March 2014, there were 476 urgent care or chronic disease management visits. Patients with chronic diseases were seen at least twice on average, and by 2014, chronic disease management visits accounted for approximately 74% of visits. Work is under way to create assessment tools to evaluate the practice's educa tional impact and student understanding of the current health care system, develop interdisciplinary care teams, expand efforts in registry management and broaden the patient recruitment scope, further emphasize patient engage ment and retention, and evaluate chronic disease management and patient satisfaction effectiveness.

New Technologies for Space Avionics, 1993

NASA Technical Reports Server (NTRS)

Aibel, David W.; Harris, David R.; Bartlett, Dave; Black, Steve; Campagna, Dave; Fernald, Nancy; Garbos, Ray

1993-01-01

The report reviews a 1993 effort that investigated issues associated with the development of requirements, with the practice of concurrent engineering and with rapid prototyping, in the development of a next-generation Reaction Jet Drive Controller. This report details lessons learned, the current status of the prototype, and suggestions for future work. The report concludes with a discussion of the vision of future avionics architectures based on the principles associated with open architectures and integrated vehicle health management.

76 FR 12888 - Registration of Intermediaries

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... enacted by Title VII of the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act... list of principals remains a meaningful reflection of the persons who actually exercise control over... the futures markets; (3) price discovery; (4) sound risk management practices; and (5) other public...

The Americanization of Florence.

ERIC Educational Resources Information Center

Wajdowicz, Elizabeth K.

1985-01-01

Provides a brief overview of the history and future of the Associate Degree Nursing (ADN) programs. Includes a statement of "Competencies of the Associate Degree Nurse on Entry into Practice." Sees ADN graduates performing interrelated roles of care provider, client teacher, communicator, manager of client care, and nursing professional. (HB)

Educators of Educators: Their Goals, Perceptions and Practices

ERIC Educational Resources Information Center

Ben-Peretz, Miriam; Kleeman, Sara; Reichenberg, Rivka; Shimoni, Sarah

2010-01-01

Teacher educators prepare future teachers, and their own professional development is essential for successful teaching and learning in schools. Our study aims at understanding teacher educators' professional development (TEPD) from the unique perspective of a group of educators who are regularly involved in planning, managing and implementing…

How Does XML Help Libraries?

ERIC Educational Resources Information Center

Banerjee, Kyle

2002-01-01

Discusses XML, how it has transformed the way information is managed and delivered, and its impact on libraries. Topics include how XML differs from other markup languages; the document object model (DOM); style sheets; practical applications for archival materials, interlibrary loans, digital collections, and MARC data; and future possibilities.…

Practice management education during surgical residency.

PubMed

Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest

2008-12-01

Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business. These needs will be present whether pursuing a career in academic medicine or the private sector. A program that focuses on the business aspect of surgery enables the residents to better navigate the future while helping to fulfill the systems-based practice competency.

Ethical issues in patient safety: Implications for nursing management.

PubMed

Kangasniemi, Mari; Vaismoradi, Mojtaba; Jasper, Melanie; Turunen, Hannele

2013-12-01

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in 'the ethical imperative' of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers' decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

Linking departmental priorities to knowledge management: the experiences of Santa Cruz County's Human Services Department.

PubMed

Lindberg, Arley

2012-01-01

Federal welfare reform, local service collaborations, and the evolution of statewide information systems inspired agency interest in evidence-informed practice and knowledge sharing systems. Four agency leaders, including the Director, Deputy Director, Director of Planning and Evaluation, and Staff Development Program Manager championed the development of a learning organization based on knowledge management throughout the agency. Internal department restructuring helped to strengthen the Planning and Evaluation, Staff Development, and Personnel units, which have become central to supporting knowledge sharing activities. The Four Pillars of Knowledge framework was designed to capture agency directions in relationship to future knowledge management goals. Featuring People, Practice, Technology and Budget, the framework links the agency's services, mission and goals to the process of becoming a learning organization. Built through an iterative process, the framework was created by observing existing activities in each department rather than being designed from the top down. Knowledge management can help the department to fulfill its mission despite reduced resources. Copyright © Taylor & Francis Group, LLC

Community-based telemonitoring for hypertension management: practical challenges and potential solutions.

PubMed

Hovey, Lauren; Kaylor, Mary Beth; Alwan, Majd; Resnick, Helaine E

2011-10-01

Older adults residing in rural areas often lack convenient, patient-centered, community-based approaches to facilitate receipt of routine care to manage common chronic conditions. Without adequate access to appropriate disease management resources, the risk of seniors' experiencing acute events related to these common conditions increases substantially. Further, poorly managed chronic conditions are costly and place seniors at increased risk of institutionalization and permanent loss of independence. Novel, telehealth-based approaches to management of common chronic conditions like hypertension may not only improve the health of older adults, but may also lead to substantial cost savings associated with acute care episodes and institutionalization. The aim of this report is to summarize practical considerations related to operations and logistics of a unique community-based telemonitoring pilot study targeting rural seniors who utilize community-based senior centers. This article reviews the technological challenges encountered during the study and proposes solutions relevant to future research and implementation of telehealth in community-based, congregate settings.

Projected Irrigation Requirement Under Climate Change in Korean Peninsula by Apply Global Hydrologic Model to Local Scale.

NASA Astrophysics Data System (ADS)

Yang, B.; Lee, D. K.

2016-12-01

Understanding spatial distribution of irrigation requirement is critically important for agricultural water management. However, many studies considering future agricultural water management in Korea assessed irrigation requirement on watershed or administrative district scale, but have not accounted the spatial distribution. Lumped hydrologic model has typically used in Korea for simulating watershed scale irrigation requirement, while distribution hydrologic model can simulate the spatial distribution grid by grid. To overcome this shortcoming, here we applied a grid base global hydrologic model (H08) into local scale to estimate spatial distribution under future irrigation requirement of Korean Peninsula. Korea is one of the world's most densely populated countries, with also high produce and demand of rice which requires higher soil moisture than other crops. Although, most of the precipitation concentrate in particular season and disagree with crop growth season. This precipitation character makes management of agricultural water which is approximately 60% of total water usage critical issue in Korea. Furthermore, under future climate change, the precipitation predicted to be more concentrated and necessary need change of future water management plan. In order to apply global hydrological model into local scale, we selected appropriate major crops under social and local climate condition in Korea to estimate cropping area and yield, and revised the cropping area map more accurately. As a result, future irrigation requirement estimation varies under each projection, however, slightly decreased in most case. The simulation reveals, evapotranspiration increase slightly while effective precipitation also increase to balance the irrigation requirement. This finding suggest practical guideline to decision makers for further agricultural water management plan including future development of water supply plan to resolve water scarcity.

Increasing the relevance of research to health care managers: hospital CEO imperatives for improving quality and lowering costs.

PubMed

Alexander, Jeffrey A; Hearld, Larry R; Jiang, H Joanna; Fraser, Irene

2007-01-01

Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice. This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals. We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges. Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality. The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.

Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit.

PubMed

Swann, Ruth; McPhail, Sean; Witt, Jana; Shand, Brian; Abel, Gary A; Hiom, Sara; Rashbass, Jem; Lyratzopoulos, Georgios; Rubin, Greg

2018-01-01

Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. Clinical audit of cancer diagnosis in general practices in England. Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15-86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0-27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer. © British Journal of General Practice 2018.

Ergonomic design for dental offices.

PubMed

Ahearn, David J; Sanders, Martha J; Turcotte, Claudia

2010-01-01

The increasing complexity of the dental office environment influences productivity and workflow for dental clinicians. Advances in technology, and with it the range of products needed to provide services, have led to sprawl in operatory setups and the potential for awkward postures for dental clinicians during the delivery of oral health services. Although ergonomics often addresses the prevention of musculoskeletal disorders for specific populations of workers, concepts of workflow and productivity are integral to improved practice in work environments. This article provides suggestions for improving workflow and productivity for dental clinicians. The article applies ergonomic principles to dental practice issues such as equipment and supply management, office design, and workflow management. Implications for improved ergonomic processes and future research are explored.

It’s about time: How do sky surveys manage uncertainty about scientific needs many years into the future

NASA Astrophysics Data System (ADS)

Darch, Peter T.; Sands, Ashley E.

2016-06-01

Sky surveys, such as the Sloan Digital Sky Survey (SDSS) and the Large Synoptic Survey Telescope (LSST), generate data on an unprecedented scale. While many scientific projects span a few years from conception to completion, sky surveys are typically on the scale of decades. This paper focuses on critical challenges arising from long timescales, and how sky surveys address these challenges.We present findings from a study of LSST, comprising interviews (n=58) and observation. Conceived in the 1990s, the LSST Corporation was formed in 2003, and construction began in 2014. LSST will commence data collection operations in 2022 for ten years.One challenge arising from this long timescale is uncertainty about future needs of the astronomers who will use these data many years hence. Sources of uncertainty include scientific questions to be posed, astronomical phenomena to be studied, and tools and practices these astronomers will have at their disposal. These uncertainties are magnified by the rapid technological and scientific developments anticipated between now and the start of LSST operations.LSST is implementing a range of strategies to address these challenges. Some strategies involve delaying resolution of uncertainty, placing this resolution in the hands of future data users. Other strategies aim to reduce uncertainty by shaping astronomers’ data analysis practices so that these practices will integrate well with LSST once operations begin.One approach that exemplifies both types of strategy is the decision to make LSST data management software open source, even now as it is being developed. This policy will enable future data users to adapt this software to evolving needs. In addition, LSST intends for astronomers to start using this software well in advance of 2022, thereby embedding LSST software and data analysis approaches in the practices of astronomers.These findings strengthen arguments for making the software supporting sky surveys available as open source. Such arguments usually focus on reuse potential of software, and enhancing replicability of analyses. In this case, however, open source software also promises to mitigate the critical challenge of anticipating the needs of future data users.

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Soil carbon management in large-scale Earth system modelling: implications for crop yields and nitrogen leaching

NASA Astrophysics Data System (ADS)

Olin, S.; Lindeskog, M.; Pugh, T. A. M.; Schurgers, G.; Wårlind, D.; Mishurov, M.; Zaehle, S.; Stocker, B. D.; Smith, B.; Arneth, A.

2015-06-01

We explore cropland management alternatives and the effect these can have on future C and N pools and fluxes using the land use-enabled dynamic vegetation model LPJ-GUESS. Simulated crop production, cropland carbon storage, carbon sequestration and nitrogen leaching from croplands are evaluated and discussed. Compared to the version of LPJ-GUESS that does not include land use dynamics, estimates of soil carbon stocks and nitrogen leaching from terrestrial to aquatic ecosystems were improved. We explore trade-offs between important ecosystem services that can be provided from agricultural fields such as crop yields, retention of nitrogen and carbon storage. These trade-offs are evaluated for current land use and climate and further explored for future conditions within the two future climate change scenarios, RCP 2.6 and 8.5. Our results show that the potential for carbon sequestration due to typical cropland management practices such as no-till and cover-crops proposed in literature is not realised, globally or over larger climatic regions. Our results highlight important considerations to be made when modelling C-N interactions in agricultural ecosystems under future environmental change, and the effects these have on terrestrial biogeochemical cycles.

Unintended consequences of carbon enhancement in agricultural soils: The N2O problem

NASA Astrophysics Data System (ADS)

Venterea, R. T.; Breuillin-Sessoms, F.; Baker, J. M.; Griffis, T. J.; Spokas, K.; Turner, P. A.

2016-12-01

The potential of agricultural soils to accumulate C as a means of removing greenhouse gases (GHGs) from the atmosphere is complicated by the inherent coupling of the C and N cycles in soil. Practices that increase soil C content can have the unintended consequence of stimulating N mineralization, nitrification and/or denitrification; which can in turn promote production of N2O as well as other forms of reactive N that can be later transformed to N2O. These effects, combined with the large global warming potential of N2O, may partially or completely offset any gains in soil C from a GHG accounting perspective. Thus, ideally, management of soil C and N must be considered together in attempts to reduce net GHG budgets. However, the knowledge base for defining practices that optimize management of soil C and N together is still quite limited. In this presentation, we will illustrate these challenges with results from several recent studies examining effects of tillage, cover crops, biochar and other practices which aim to enhance soil C. Interactions of these practices with N management, climate, and other factors and their effects on N2O will be discussed with implications for improved management and future research.

Growth and Site Relationships of Pinus caribaea Across the Caribbean Basin

Treesearch

Leon H. Liegel; [Compiler

1991-01-01

Summarizes results of growth, volume, basal area, and stand conditions for Pinus caribaea var. hondurensis in five countries. Past pine management practices are reviewed for all countries. Implications of new forestry and soils research are discussed in terms of their impact on future local reforestation and afforestation...

Corn yield under subirrigation and future climate scenarios in the Maumee river basin

USDA-ARS?s Scientific Manuscript database

Subirrigation has been proposed as a water table management practice to maintain appropriate soil water content during periods of high crop water demand on subsurface drained croplands in the Corn Belt. Subirrigation takes advantage of the subsurface drainage systems already installed on drained agr...

Review and Prospects of Educational Planning and Management in the Arab States.

ERIC Educational Resources Information Center

Gennaoui, Antoine M.

1991-01-01

Discusses educational planning and administration in the Arab countries during the last decade. Outlines future prospects as they appeared before the Gulf War. Includes structure, practice, mechanisms, and relations between planning structures and administrative authorities. Divides area by geographical contiguity, socio-cultural similarities,…

Knowledge Management in Teacher Education Progress and Future Prospects

ERIC Educational Resources Information Center

Mohan, Radha

2005-01-01

This paper develops a practical guideline for intellectual capital measuring and reporting in the context of teacher education institutions. Intellectual capital is obviously the foundation for knowledge-centric organizations like teacher training colleges. According to Bertrand Russell: "The defense of the state in all civilized countries is…

Predicting the unpredictable: potential climate change impacts on vegetation in the Pacific Northwest

Treesearch

Marie Oliver; David W. Peterson; Becky Kerns

2016-01-01

Earth's climate is changing, as evidenced by warming temperatures, increased temperature variability, fluctuating precipitation patterns, and climate-related environmental disturbances. And with considerable uncertainty about the future, Forest Service land managers are now considering climate change adaptation in their planning efforts. They want practical...

Soil water improvements with the long-term use of a winter rye cover crop

USDA-ARS?s Scientific Manuscript database

The Midwestern United States, a region that produces one-third of maize and one-quarter of soybeans globally, is projected to experience increasing rainfall variability with future climate change. One approach to mitigate climate impacts is to utilize crop and soil management practices that enhance ...

Cultural Leadership: Inside America's Community Colleges.

ERIC Educational Resources Information Center

Baker, George A., III; And Others

Contending that the relationship between leadership and the creation and management of institutional culture is critical to the future success of community colleges, this book explores theory, research, and practice associated with this perspective. The following chapters are provided: (1) "Creative Cultures: Toward a New Paradigm," by George A.…

Removing the Barriers to Effectiveness: A Practical Approach to Assistant Principal Staff Development.

ERIC Educational Resources Information Center

Richardson, M. D.; Flanigan, J. L.

The assistant principalship may not be the most productive ground for future principals. Assistant principals have traditionally been disciplinarians or building managers isolated from the realities of the principalship and the school's instructional program. Some researchers have advocated dividing the assistant principalship into two roles: one…

78 FR 12933 - Proceedings Before the Commodity Futures Trading Commission

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-26

... proceedings. These new amendments also provide that Judgment Officers may conduct sua sponte discovery in... discovery; (4) sound risk management practices; and (5) other public interest considerations. The amendments... representative capacity, it was done with full power and authority to do so; (C) To the best of his knowledge...

Best Management Practices for Beginning Farmer Support

ERIC Educational Resources Information Center

Ochterski, Jim; Frenay, Erica

2010-01-01

Many beginning farmers have little previous contact with Extension, yet they will comprise an important part of our future base of support. We present those educational activities directed toward beginning farmers that represent high impact, outcome-based Extension programming, given an educator's time limitations. This checklist of insights will…

Treatment of obesity in the primary care setting: are we there yet?

PubMed

Terre, Lisa; Hunter, Christine; Poston, Walker S Carlos; Haddock, C Keith; Stewart, Shani A

2007-01-01

Obesity is a significant public health issue in the US constituting an independent risk factor for morbidity and mortality as well as complicating the management of other medical conditions. Yet, traditionally most physicians receive little training in evidence-based obesity interventions. Previous literature suggests many physicians believe they do not have effective tools to address obesity and/or that obesity management is not within their scope of practice. Given the new emphasis from NIH and AAFP urging physicians to conceptualize and treat obesity as a chronic medical condition, we examined obesity-related knowledge and practices among military and civilian primary care physicians. Results were similar across these two physician groups in suggesting many physicians still may be ill-prepared to manage obesity in the primary care setting. Implications for patient care and future research are discussed.

Child neurology practice guidelines: past, present, and future.

PubMed

Hurwitz, Benjamin A; Hurwitz, Kathleen Bretzius; Ashwal, Stephen

2015-03-01

Practice guidelines have been developed in child neurology during the last fifteen years to address important clinical questions and provide evidence-based recommendations for patient care. This review describes the guideline development process and how it has evolved to meet the needs of child neurologists. Several current child neurology guidelines are reviewed and the advantages and disadvantages of guidelines, as well as the legal consequences of using them to determine a standard of care are discussed. The future of guidelines and of their influence on integrated support systems also is considered. Child neurology practice guidelines are a helpful resource for clinicians, families and institutions as they provide evidence-based recommendations concerning the diagnosis and management of common neurological conditions affecting children. Incorporating consensus processes has allowed expansion of clinically relevant recommendations that has increased the utility of guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

The future of capitation: the physician role in managing change in practice.

PubMed

Goodson, J D; Bierman, A S; Fein, O; Rask, K; Rich, E C; Selker, H P

2001-04-01

Capitation-based reimbursement significantly influences the practice of medicine. As physicians, we need to assure that payment models do not jeopardize the care we provide when we accept higher levels of personal financial risk. In this paper, we review the literature relevant to capitation, consider the interaction of financial incentives with physician and medical risk, and conclude that primary care physicians need to work to assure that capitated systems incorporate checks and balances which protect both patients and providers. We offer the following proposals for individuals and groups considering capitated contracts: (1) reimbursement for primary care physicians should recognize both individual patient encounters and the administrative work of patient care management; (2) reimbursement for subspecialists should recognize both access to subspecialty knowledge and expertise as well as patient care encounters, but in some situations, subspecialists may provide the majority of care to individual patients and will be reimbursed as primary care providers; (3) groups of physicians should accept financial risk for patient care only if they have the tools and resources to manage the care; (4) physicians sharing risk for patient care should meet regularly to discuss care and resource management; and (5) physicians must disclose the financial relationships they have with health plans and medical care organizations, and engage patients and communities in discussions about resource allocation. As a payment model, capitation offers opportunities for primary care physicians to influence the future of health care by improving the management of resources at a local level.

Clinical Practice Guidelines for Delirium Management: Potential Application in Palliative Care

PubMed Central

Bush, Shirley H.; Bruera, Eduardo; Lawlor, Peter G.; Kanji, Salmaan; Davis, Daniel H.J.; Agar, Meera; Wright, David; Hartwick, Michael; Currow, David C.; Gagnon, Bruno; Simon, Jessica; Pereira, José L.

2014-01-01

Context Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. Objectives This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. Methods We searched PubMed (1990–2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. Results There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from “expert opinion” for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Conclusion Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development. PMID:24766743

Laryngeal Cysts in Adults: Simplifying Classification and Management.

PubMed

Heyes, Richard; Lott, David G

2017-12-01

Objective Laryngeal cysts may occur at any mucosa-lined location within the larynx and account for 5% to 10% of nonmalignant laryngeal lesions. A number of proposed classifications for laryngeal cysts exist; however, no previously published classification aims to guide management. This review analyzes contemporary laryngeal cyst management and proposes a framework for the terminology and management of cystic lesions in the larynx. Data Sources PubMed/Medline. Review Methods A primary literature search of the entire Medline database was performed for all titles of publications pertaining to laryngeal cysts and reviewed for relevance. Full manuscripts were reviewed per the relevance of their titles and abstracts, and selection into this review was according to their clinical and scientific relevance. Conclusion Laryngeal cysts have been associated with rapid-onset epiglottitis, dyspnea, stridor, and death; therefore, they should not be considered of little significance. Symptoms are varied and nonspecific. Laryngoscopy is the primary initial diagnostic tool. Cross-sectional imaging may be required, and future use of endolaryngeal ultrasound and optical coherence tomography may revolutionize practice. Where possible, cysts should be completely excised, and there is growing evidence that a transoral approach is superior to transcervical excision for nearly all cysts. Histology provides definitive diagnosis, and oncocytic cysts require close follow-up. Implications for Practice A new classification system is proposed that increases clarity in terminology, with the aim of better preparing surgeons and authors for future advances in the understanding and management of laryngeal cysts.

Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

PubMed

Longo, Maria Cristina

2015-01-01

The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

Management of ticks and tick-borne diseases

USGS Publications Warehouse

Ginsberg, H.S.; Stafford, K.C.; Goodman, J.L.; Dennis, D.T.; Sonenshine, D .E.

2005-01-01

The mainstays of tick management and protection from tick-borne diseases have traditionally been personal precautions and the application of acaricides. These techniques maintain their value, and current innovations hold considerable promise for future improvement in effective targeting of materials for tick control. Furthermore, an explosion of research in the past few decades has resulted in the development and expansion of several novel and potentially valuable approaches to tick control, including vaccination against tick-borne pathogen transmission and against tick attachment, host management, use of natural enemies (especially entomopathogenic fungi), and pheromone-based techniques. The situations that require tick management are diverse, and occur under varied ecological conditions. Therefore, the likelihood of finding a single ?magic bullet? for tick management is low. In practical terms, the approach to tick management or to management of tick-borne disease must be tailored to the specific conditions at hand. One area that needs increased attention is the decision-making process in applying IPM to tick control. Further development of novel tick control measures, and increased efficiency in their integration and application to achieve desired goals, holds great promise for effective future management of ticks and tick-borne diseases.

Current and Future Science Plans for Restoring a Resilient Coast: Chapter 8A in Science and the storms-the USGS response to the hurricanes of 2005

USGS Publications Warehouse

2007-01-01

The overarching goal of U.S. Geological Survey (USGS) Gulf Coast science in the aftermath of the 2005 hurricane season will be to provide the scientific information, knowledge, and tools required to ensure that decisions about coastal land resource use, management practices, and future development in the coastal zone and adjacent watersheds promote restoration, increase coastal resilience, and mitigate risks associated with both human-created and natural hazards.

Editor's Choice-The role of the emergency department in the management of acute heart failure: An international perspective on education and research.

PubMed

Pang, Peter S; Collins, Sean P; Miró, Òscar; Bueno, Hector; Diercks, Deborah B; Di Somma, Salvatore; Gray, Alasdair; Harjola, Veli-Pekka; Hollander, Judd E; Lambrinou, Ekaterini; Levy, Phillip D; Papa, AnnMarie; Möckel, Martin

2017-08-01

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research.

After the revolution: the physician executive of the future.

PubMed

Goldener, J

1998-01-01

There is a revolution in health care occurring in our midst. The roots of this revolution are explored. The physician executive of the future will need a new set of skills because the health care system will change. This new, evolving set of skills includes being: Savvy about business; simultaneously employer- and customer-focused; and technologically driven. This manager must be a team builder rather than a lone ranger. These skills are learnable, just like piloting a plane or doing a surgery. None of us was born with the skill to practice medicine any more than we were born with business skills. While many physicians are depressed by the present health care climate, feeling a loss of power and a loss in spirit, the vision of the physician manager must carry them and the organizations they build forward through uncharted waters to a future which is every bit as exciting as our past.

Management of arthropod pathogen vectors in North America: Minimizing adverse effects on pollinators

USGS Publications Warehouse

Ginsberg, Howard; Bargar, Timothy A.; Hladik, Michelle L.; Lubelczyk, Charles

2017-01-01

Tick and mosquito management is important to public health protection. At the same time, growing concerns about declines of pollinator species raise the question of whether vector control practices might affect pollinator populations. We report the results of a task force of the North American Pollinator Protection Campaign (NAPPC) that examined potential effects of vector management practices on pollinators, and how these programs could be adjusted to minimize negative effects on pollinating species. The main types of vector control practices that might affect pollinators are landscape manipulation, biocontrol, and pesticide applications. Some current practices already minimize effects of vector control on pollinators (e.g., short-lived pesticides and application-targeting technologies). Nontarget effects can be further diminished by taking pollinator protection into account in the planning stages of vector management programs. Effects of vector control on pollinator species often depend on specific local conditions (e.g., proximity of locations with abundant vectors to concentrations of floral resources), so planning is most effective when it includes collaborations of local vector management professionals with local experts on pollinators. Interventions can then be designed to avoid pollinators (e.g., targeting applications to avoid blooming times and pollinator nesting habitats), while still optimizing public health protection. Research on efficient targeting of interventions, and on effects on pollinators of emerging technologies, will help mitigate potential deleterious effects on pollinators in future management programs. In particular, models that can predict effects of integrated pest management on vector-borne pathogen transmission, along with effects on pollinator populations, would be useful for collaborative decision-making.

Old Dog New Tricks: Use of Point-based Crop Models in Grid-based Regional Assessment of Crop Management Technologies Impact on Future Food Security

NASA Astrophysics Data System (ADS)

Koo, J.; Wood, S.; Cenacchi, N.; Fisher, M.; Cox, C.

2012-12-01

HarvestChoice (harvestchoice.org) generates knowledge products to guide strategic investments to improve the productivity and profitability of smallholder farming systems in sub-Saharan Africa (SSA). A keynote component of the HarvestChoice analytical framework is a grid-based overlay of SSA - a cropping simulation platform powered by process-based, crop models. Calibrated around the best available representation of cropping production systems in SSA, the simulation platform engages the DSSAT Crop Systems Model with the CENTURY Soil Organic Matter model (DSSAT-CENTURY) and provides a virtual experimentation module with which to explore the impact of a range of technological, managerial and environmental metrics on future crop productivity and profitability, as well as input use. For each of 5 (or 30) arc-minute grid cells in SSA, a stack of model input underlies it: datasets that cover soil properties and fertility, historic and future climate scenarios and farmers' management practices; all compiled from analyses of existing global and regional databases and consultations with other CGIAR centers. Running a simulation model is not always straightforward, especially when certain cropping systems or management practices are not even practiced by resource-poor farmers yet (e.g., precision agriculture) or they were never included in the existing simulation framework (e.g., water harvesting). In such cases, we used DSSAT-CENTURY as a function to iteratively estimate relative responses of cropping systems to technology-driven changes in water and nutrient balances compared to zero-adoption by farmers, while adjusting model input parameters to best mimic farmers' implementation of technologies in the field. We then fed the results of the simulation into to the economic and food trade model framework, IMPACT, to assess the potential implications on future food security. The outputs of the overall simulation analyses are packaged as a web-accessible database and published on the web with an interface that allows users to explore the simulation results in each country with user-defined baseline and what-if scenarios. The results are dynamically presented on maps, charts, and tables. This paper discusses the development of the simulation platform and its underlying data layers, a case study that assessed the role of potential crop management technology development, and the development of a web-based application that visualizes the simulation results.

Planning documents: a business planning strategy.

PubMed

Kaehrle, P A

2000-06-01

Strategic planning and business plan development are essential nursing management skills in today's competitive, fast paced, continually changing health care environment. Even in times of great uncertainty, nurse managers need to plan and forecast for the future. A well-written business plan allows nurse managers to communicate their expertise and proactively contribute to the programmatic decisions and changes occurring within their patient population or service area. This article presents the use of planning documents as a practical, strategic business planning strategy. Although the model addresses orthopedic services specifically, nurse managers can gain an understanding and working knowledge of planning concepts that can be applied to all patient populations.

Prediction of future methane emission from irrigated rice paddies in central Thailand under different water management practices.

PubMed

Minamikawa, Kazunori; Fumoto, Tamon; Iizumi, Toshichika; Cha-Un, Nittaya; Pimple, Uday; Nishimori, Motoki; Ishigooka, Yasushi; Kuwagata, Tsuneo

2016-10-01

There is concern about positive feedbacks between climate change and methane (CH4) emission from rice paddies. However, appropriate water management may mitigate the problem. We tested this hypothesis at six field sites in central Thailand, where the irrigated area is rapidly increasing. We used DNDC-Rice, a process-based biogeochemistry model adjusted based on rice growth data at each site to simulate CH4 emission from a rice-rice double cropping system from 2001 to 2060. Future climate change scenarios consisting of four representative concentration pathways (RCPs) and seven global climate models were generated by statistical downscaling. We then simulated CH4 emission in three water management practices: continuous flooding (CF), single aeration (SA), and multiple aeration (MA). The adjusted model reproduced the observed rice yield and CH4 emission well at each site. The simulated CH4 emissions in CF from 2051 to 2060 were 5.3 to 7.8%, 9.6 to 16.0%, 7.3 to 18.0%, and 13.6 to 19.0% higher than those from 2001 to 2010 in RCPs 2.6, 4.5, 6.0, and 8.5, respectively, at the six sites. Regionally, SA and MA mitigated CH4 emission by 21.9 to 22.9% and 53.5 to 55.2%, respectively, relative to CF among the four RCPs. These mitigation potentials by SA and MA were comparable to those from 2001 to 2010. Our results indicate that climate change in the next several decades will not attenuate the quantitative effect of water management practices on mitigating CH4 emission from irrigated rice paddies in central Thailand. Copyright © 2016 Elsevier B.V. All rights reserved.

Dual use of electronic nicotine delivery systems (ENDS) and smoked tobacco: a qualitative analysis.

PubMed

Robertson, Lindsay; Hoek, Janet; Blank, Mei-Ling; Richards, Rosalina; Ling, Pamela; Popova, Lucy

2018-02-01

Electronic nicotine delivery systems (ENDS) arguably pose fewer health risks than smoking, yet many smokers adopt ENDS without fully relinquishing smoking. Known as 'dual use', this practice is widespread and compromises the health benefits that ENDS may offer. To date, few studies have explored how dual use practices arise and manifest. We conducted in-depth, semi-structured interviews with 20 current ENDS users from New Zealand who reported smoking tobacco at least once a month. We explored participants' smoking history, their recent and current smoking, trial, uptake and patterns of ENDS use, and future smoking and vaping intentions. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts. Dual use practices among participants evolved in four ways. First, as an attempt to manage the 'inauthenticity' of vaping relative to smoking and to retain meaningful rituals. Second, as complex rationalisations that framed decreased tobacco use, rather than smoking cessation, as 'success'. Third, as a means of alleviating the financial burden smoking imposed and to circumvent smoke-free policies. Lastly, dual use reflected attempts to comply with social group norms and manage stigma. Dual use reflects both social and physical cues. It assisted participants to navigate smoking restrictions and allowed them to manage divergent norms. Policies that discourage smoking, particularly excise tax increases on smoked tobacco and smoke-free space restrictions, appear important in prompting ENDS use. Future research could explore whether these policies also help foster complete transition from smoking to exclusive ENDS use. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

For money or service?: a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among Ghanaian medical students.

PubMed

Johnson, Jennifer C; Nakua, Emmanuel; Dzodzomenyo, Mawuli; Agyei-Baffour, Peter; Gyakobo, Mawuli; Asabir, Kwesi; Kwansah, Janet; Kotha, S Rani; Snow, Rachel C; Kruk, Margaret E

2011-11-03

Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana. We asked fourth-year Ghanaian medical students to rank the importance of rural practice attributes including salary, infrastructure, management style, and contract length in considering future jobs. We used bivariate and multivariate ordinal logistic regression to estimate the association between attribute valuation and students' socio-demographic background, educational experience, and future career plans. Of 310 eligible fourth year medical students, complete data was available for 302 students (97%). Students considering emigration ranked salary as more important than students not considering emigration, while students with rural living experience ranked salary as less important than those with no rural experience. Students willing to work in a rural area ranked infrastructure as more important than students who were unwilling, while female students ranked infrastructure as less important than male students. Students who were willing to work in a rural area ranked management style as a more important rural practice attribute than those who were unwilling to work in a rural area. Students studying in Kumasi ranked contract length as more important than those in Accra, while international students ranked contract length as less important than Ghanaian students. Interventions to improve rural practice conditions are likely to be more persuasive than salary incentives to Ghanaian medical students who are willing to work in rural environments a priori. Policy experiments should test the impact of these interventions on actual uptake by students upon graduation.

Understanding quit decisions in primary care: a qualitative study of older GPs.

PubMed

Sansom, Anna; Calitri, Raff; Carter, Mary; Campbell, John

2016-02-19

To investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50-60 years. Qualitative study based on semistructured interviews with GPs in the South West region of England. Transcribed interviews were analysed thematically. 23 GPs aged 50-60 years: 3 who had retired from direct patient care before age 60, and 20 who intended to quit direct patient care within the next 5 years. The analysis identified four key themes: early retirement is a viable option for many GPs; GPs have employment options other than undertaking direct patient care; GPs report feeling they are doing an (almost) undoable job; and GPs may have other aspirations that pull them away from practice. Findings from this study confirmed those from earlier research, with high workload, ageing and health, family and domestic life, and organisational change all influencing GPs' decisions about when to retire/quit direct patient care. However, in addition, GPs expressed feelings of insecurity and uncertainty regarding the future of general practice, low morale, and issues regarding accountability (appraisal and revalidation) and governance. Suggestions about how to help retain GPs within the active clinical workforce were offered, covering individual, practice and organisational levels. This research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions. Any future changes to policy or practice to help retain experienced GPs will benefit from this informed understanding of GPs' views. Key factors to take into account include: making the GP workload more manageable; managing change sympathetically; paying attention to GPs' own health; improving confidence in the future of general practice; and improving GP morale. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

For money or service? a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among ghanaian medical students

PubMed Central

2011-01-01

Background Health worker shortage and maldistribution are among the biggest threats to health systems in Africa. New medical graduates are prime targets for recruitment to deprived rural areas. However, little research has been done to determine the influence of workers' background and future plans on their preference for rural practice incentives and characteristics. The purpose of this study was to identify determinants of preference for rural job characteristics among fourth year medical students in Ghana. Methods We asked fourth-year Ghanaian medical students to rank the importance of rural practice attributes including salary, infrastructure, management style, and contract length in considering future jobs. We used bivariate and multivariate ordinal logistic regression to estimate the association between attribute valuation and students' socio-demographic background, educational experience, and future career plans. Results Of 310 eligible fourth year medical students, complete data was available for 302 students (97%). Students considering emigration ranked salary as more important than students not considering emigration, while students with rural living experience ranked salary as less important than those with no rural experience. Students willing to work in a rural area ranked infrastructure as more important than students who were unwilling, while female students ranked infrastructure as less important than male students. Students who were willing to work in a rural area ranked management style as a more important rural practice attribute than those who were unwilling to work in a rural area. Students studying in Kumasi ranked contract length as more important than those in Accra, while international students ranked contract length as less important than Ghanaian students. Conclusions Interventions to improve rural practice conditions are likely to be more persuasive than salary incentives to Ghanaian medical students who are willing to work in rural environments a priori. Policy experiments should test the impact of these interventions on actual uptake by students upon graduation. PMID:22050704

Ongoing evolution of practice gaps in gastrointestinal and endoscopic surgery: 2014 report from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Continuing Education Committee.

PubMed

McLemore, Elisabeth C; Paige, John T; Bergman, Simon; Hori, Yumi; Schwarz, Erin; Farrell, Timothy M

2015-11-01

In an effort to fulfill the charge to develop and maintain a comprehensive educational program to serve the members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the SAGES Continuing Education Committee reports a summary of findings related to the evaluation of the 2014 SAGES annual meeting. All attendees to the 2014 annual meeting had the opportunity to complete an immediate post-meeting questionnaire as part of their continuing medical education (CME) certification, and identify up to two learning themes, answer questions related to potential practice change items based on these learning themes, and complete a needs assessment for relevant learning topics for future meetings. In addition, participants in the postgraduate and hands-on courses were asked to complete questions about case volume and comfort level related to procedures/topics in those courses. All respondents to this initial survey were sent a 3-month follow-up questionnaire in which they were asked how successful they had been in the implementation of the targeted practice changes and what, if any, barriers were encountered. Descriptive statistical analysis of de-identified data was undertaken. SAGES University attendees respond to a post-test and post-activity evaluation. Response rates were 43 and 31 % for CME-eligible attendees/respondents for the immediate post-meeting and 3-month follow-up questionnaires, respectively. Top learning themes for respondents were foregut, hernia, bariatric, and colorectal. Improving minimally invasive surgical (MIS) technique and managing complications related to MIS procedures were top intended practice changes. Partial implementation was common with top barriers including lack of resources and lack of time. Desired topics for future meetings included management of complications, enhanced recovery after surgery, introduction of new procedures into clinical practice, and re-operative surgery. The SAGES 2014 annual meeting analysis provides insight into the educational needs among respondents, which is meaningful information for planning future meeting educational content.

Progress Toward Future Runway Management

NASA Technical Reports Server (NTRS)

Lohr, Gary W.; Brown, Sherilyn A.; Atkins, Stephen; Eisenhawer, Stephen W.; Bott, Terrance F.; Long, Dou; Hasan, Shahab

2011-01-01

The runway is universally acknowledged as a constraining factor to capacity in the National Airspace System (NAS). It follows that investigation of the effective use of runways, both in terms of selection and assignment, is paramount to the efficiency of future NAS operations. The need to address runway management is not a new idea; however, as the complexities of factors affecting runway selection and usage increase, the need for effective research in this area correspondingly increases. Under the National Aeronautics and Space Administration s Airspace Systems Program, runway management is a key research area. To address a future NAS which promises to be a complex landscape of factors and competing interests among users and operators, effective runway management strategies and capabilities are required. This effort has evolved from an assessment of current practices, an understanding of research activities addressing surface and airspace operations, traffic flow management enhancements, among others. This work has yielded significant progress. Systems analysis work indicates that the value of System Oriented Runway Management tools is significantly increased in the metroplex environment over that of the single airport case. Algorithms have been developed to provide runway configuration recommendations for a single airport with multiple runways. A benefits analysis has been conducted that indicates the SORM benefits include supporting traffic growth, cost reduction as a result of system efficiency, NAS optimization from metroplex operations, fairness in aircraft operations, and rational decision making.

The Geoscience Paper of the Future: Best Practices for Documenting and Sharing Research from Data to Software to Provenance

NASA Astrophysics Data System (ADS)

Gil, Y.; Yu, X.; David, C. H.; Demir, I.; Essawy, B.; Fulweiler, R. W.; Goodall, J. L.; Karlstrom, L.; Lee, H.; Mills, H. J.; Pierce, S. A.; Pope, A.; Tzeng, M.; Villamizar, S. R.

2016-12-01

Geoscientists live in a world rich with digital data and methods, and their computational research cannot be fully captured in traditional publications. The Geoscience Paper of the Future (GPF) proposes best practices for GPF authors to make data, software, and methods openly accessible, citable, and well documented. Those best practices come from recommendations by both scholars and organizations concerning open science, reproducible publications, and digital scholarship. The publication of digital objects empowers scientists to manage their research products as valuable scientific assets in an open and transparent way that enables broader access by other scientists, students, decision makers, and the public. Improving documentation and dissemination of research will accelerate the pace of scientific discovery by improving the ability of others to build upon published work. This presentation summarizes these best practices, as well as the practical experiences of several GPF authors in different geosciences disciplines. It will also discuss existing challenges for authors and publishers to produce GPFs in practice, and the opportunities to develop new approaches and infrastructure to implement those best practices. The adoption of GPF recommendations requires awareness and social change in the scientific community, including clear communication of the benefits and best practices that may be new to geoscientists.

Applying the Israeli Practice of Reconstruction Following a Terrorist Attack as a Model for Cities in the United States

DTIC Science & Technology

2013-03-01

22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave blank... innovation are offered the solutions to counter decreased resources and funding. “ Foresight tells us that the future will challenge us to be even... auditing process to identify any inappropriate practices and conduct, however, they do not sustain the system in any traditional way and would serve only

On the scene: St Mary's Hospital, Madison, Wisconsin.

PubMed

Baker, Christine; Beglinger, Joan Ellis; Derosa, Jody; Griffin, Carla; Laham, Mary; Leonard, Mary Kay; Vanderkolk, Caprice

2009-01-01

In this article, we discuss Shared Governance as the foundation of our nursing professional practice model. Through the use of case examples and reflections from our management team, we demonstrate how this accountability-based practice model promotes excellence through developing, connecting, and engaging people, clarifying and communicating goals, using data to make decisions, and even shaping our organizational response to a critical incident. We close with a look to our future as our hospital embraces whole-system shared decision making.

Practice Location Characteristics of Non-Traditional Dental Practices.

PubMed

Solomon, Eric S; Jones, Daniel L

2016-04-01

Current and future dental school graduates are increasingly likely to choose a non-traditional dental practice-a group practice managed by a dental service organization or a corporate practice with employed dentists-for their initial practice experience. In addition, the growth of non-traditional practices, which are located primarily in major urban areas, could accelerate the movement of dentists to those areas and contribute to geographic disparities in the distribution of dental services. To help the profession understand the implications of these developments, the aim of this study was to compare the location characteristics of non-traditional practices and traditional dental practices. After identifying non-traditional practices across the United States, the authors located those practices and traditional dental practices geographically by zip code. Non-traditional dental practices were found to represent about 3.1% of all dental practices, but they had a greater impact on the marketplace with almost twice the average number of staff and annual revenue. Virtually all non-traditional dental practices were located in zip codes that also had a traditional dental practice. Zip codes with non-traditional practices had significant differences from zip codes with only a traditional dental practice: the populations in areas with non-traditional practices had higher income levels and higher education and were slightly younger and proportionally more Hispanic; those practices also had a much higher likelihood of being located in a major metropolitan area. Dental educators and leaders need to understand the impact of these trends in the practice environment in order to both prepare graduates for practice and make decisions about planning for the workforce of the future.

Management of climatic heat stress risk in construction: a review of practices, methodologies, and future research.

PubMed

Rowlinson, Steve; Yunyanjia, Andrea; Li, Baizhan; Chuanjingju, Carrie

2014-05-01

Climatic heat stress leads to accidents on construction sites brought about by a range of human factors emanating from heat induced illness, and fatigue leading to impaired capability, physical and mental. It is an occupational characteristic of construction work in many climates and the authors take the approach of re-engineering the whole safety management system rather than focusing on incremental improvement, which is current management practice in the construction industry. From a scientific viewpoint, climatic heat stress is determined by six key factors: (1) air temperature, (2) humidity, (3) radiant heat, and (4) wind speed indicating the environment, (5) metabolic heat generated by physical activities, and (6) "clothing effect" that moderates the heat exchange between the body and the environment. By making use of existing heat stress indices and heat stress management processes, heat stress risk on construction sites can be managed in three ways: (1) control of environmental heat stress exposure through use of an action-triggering threshold system, (2) control of continuous work time (CWT, referred by maximum allowable exposure duration) with mandatory work-rest regimens, and (3) enabling self-paced working through empowerment of employees. Existing heat stress practices and methodologies are critically reviewed and the authors propose a three-level methodology for an action-triggering, localized, simplified threshold system to facilitate effective decisions by frontline supervisors. The authors point out the need for "regional based" heat stress management practices that reflect unique climatic conditions, working practices and acclimatization propensity by local workers indifferent geographic regions. The authors set out the case for regional, rather than international, standards that account for this uniqueness and which are derived from site-based rather than laboratory-based research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Global megatrends and their implications for environmental assessment practice

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

Retief, Francois, E-mail: francois.retief@nwu.ac.za; Bond, Alan; Research Unit for Environmental Sciences and Management, North-West University

This paper addresses the future of environmental assessment (EA) practice in light of a rapidly changing world. We apply a literature review-based methodology to firstly identify key global megatrends and then reflect upon the implications for EA practice based on some known challenges. The key megatrends identified are synthesised into six categories: i) demographics, ii) urbanization, iii) technological innovation, iv) power shifts, v) resource scarcity and vi) climate change. We then discuss the implications of these megatrends for EA practice against four known EA challenges namely: dealing with i) complexity and uncertainty, ii) efficiency, iii) significance and iv) communication andmore » participation. Our analysis suggests important implications for EA practice such as: increased difficulties with accuracy of prediction; the need for facilitative adaptation; an increase in the occurrence of unexpected events; higher expectations for procedural efficiency; challenges with information and communication management; dealing with significance judgements; and mitigation amidst resource scarcity and increasing pressures on earth systems. The megatrends underscore the need for continued evolution of EA thinking and practice, especially moving away from seeking a predictable single future or outcome towards the possibility of multiple scenarios with associated adaptability and enhanced system resilience capable of responding to rapid change.« less

Risk-informed Management of Water Infrastructure in the United States: History, Development, and Best Practices

NASA Astrophysics Data System (ADS)

Wolfhope, J.

2017-12-01

This presentation will focus on the history, development, and best practices for evaluating the risks associated with the portfolio of water infrastructure in the United States. These practices have evolved from the early development of the Federal Guidelines for Dam Safety and the establishment of the National Dam Safety Program, to the most recent update of the Best Practices for Dam and Levee Risk Analysis jointly published by the U.S. Department of Interior Bureau of Reclamation and the U.S. Army Corps of Engineers. Since President Obama signed the Water Infrastructure Improvements for the Nation Act (WIIN) Act, on December 16, 2016, adding a new grant program under FEMA's National Dam Safety Program, the focus has been on establishing a risk-based priority system for use in identifying eligible high hazard potential dams for which grants may be made. Finally, the presentation provides thoughts on the future direction and priorities for managing the risk of dams and levees in the United States.

Anchoring interprofessional education in undergraduate curricula: The Heidelberg story.

PubMed

Berger, Sarah; Goetz, Katja; Leowardi-Bauer, Christina; Schultz, Jobst-Hendrik; Szecsenyi, Joachim; Mahler, Cornelia

2017-03-01

The ability of health professionals to collaborate effectively has significant potential impact on patient safety and quality-care outcomes, especially given the increasingly complex and dynamic clinical practice environments of today. Educators of the health professions are faced with an immediate challenge to adapt curricula and traditional teaching methods to ensure graduates are equipped with the necessary interprofessional competencies and (inter)professional values for their future practice. The World Health Organization's "Framework for action in interprofessional education (IPE) and collaborative practice" promotes IPE as a key strategy to enhance patient outcomes by preparing a "collaborative practice-ready health workforce." Logistical and attitudinal barriers can hinder integration of IPE into curricula. Lessons learned through the implementation of a planned change to establish four interprofessional seminars (team communication, medical error communication, healthcare English, and small business management) at Heidelberg University Medical Faculty, Germany, are described. A key factor in successfully anchoring IPE seminars in the undergraduate curricula was the structured approach drawing on change management concepts.

Trends in sustainable landfilling in Malaysia, a developing country.

PubMed

Fauziah, S H; Agamuthu, P

2012-07-01

In Malaysia, landfills are being filled up rapidly due to the current daily generation of approximately 30,000 tonnes of municipal solid waste. This situation creates the crucial need for improved landfilling practices, as sustainable landfilling technology is yet to be achieved here. The objective of this paper is to identify and evaluate the development and trends in landfilling practices in Malaysia. In 1970, the disposal sites in Malaysia were small and prevailing waste disposal practices was mere open-dumping. This network of relatively small dumps, typically located close to population centres, was considered acceptable for a relatively low population of 10 million in Malaysia. In the 1980s, a national programme was developed to manage municipal and industrial wastes more systematically and to reduce adverse environmental impacts. The early 1990s saw the privatization of waste management in many parts of Malaysia, and the establishment of the first sanitary landfills for MSW and an engineered landfill (called 'secure landfill' in Malaysia) for hazardous waste. A public uproar in 2007 due to contamination of a drinking water source from improper landfilling practices led to some significant changes in the government's policy regarding the country's waste management strategy. Parliament passed the Solid Waste and Public Cleansing Management (SWPCM) Act 2007 in August 2007. Even though the Act is yet to be implemented, the government has taken big steps to improve waste management system further. The future of the waste management in Malaysia seems somewhat brighter with a clear waste management policy in place. There is now a foundation upon which to build a sound and sustainble waste management and disposal system in Malaysia.

Nutrient Application and Algal Blooms: Farmer Decisions Regarding the Use of Best Management Practices in Lake Erie's Maumee River Watershed

NASA Astrophysics Data System (ADS)

Heeren, A.; Toman, E.; Wilson, R. S.; Martin, J.

2016-12-01

Lake Erie is the most productive of the Great Lakes. However, harmful algal blooms (HABs) caused by nutrient run-off threaten the lake. Experts have proposed numerous best management practices (BMPs) designed to reduce nutrient and sediment run-off. However, for these practices to be effective at reducing HABs, a significant portion of farmers and landowners within Lake Erie's watersheds have to first adopt and implement these practices. In order to better understand how farmers and landowners make decisions about whether or not to adopt and implement BMPs we conducted a series of focus groups and a mail survey of Lake Erie's largest watershed. We found that many farmers were supportive of adopting BMPs. For example, 60% of farmers in the watershed have already adopted using grid soil sampling while another 30% are willing to adopt the practice in the future. However, other practices were less popular, for example, only 18% of farmers had already adopted cover crops. Farmers also expressed several reservations about adopting some BMPs. For example, farmers were concerned about the costs of some BMPs, such as cover crops and drainage management systems, and how such practices might interfere with the planting of subsequent crops. Our research has several implications for reducing nutrient production by promoting BMPs. First, we identified potential concerns and limitations farmers faced in implementing specific BMPs. For example, conservationists can design future programs and communication efforts to target these specific concerns. Second, through examining the socio-psychological and cognitive characteristics that influence farmer decision-making, we identified that willingness to adopt nutrient BMPs is association with how strongly a farmer identifies with conservation and how effective they believed the BMP was at reducing run-off. Messages and information about BMPs may be more effective if they are framed in a way that aligns with identities and beliefs about BMP efficacy. Lastly, our research provides a framework of how the "wicked problem" of nutrient run-off can be addressed through the promotion of BMPs.

Developing a practice guideline for the occupational health services by using a community of practice approach: a process evaluation of the development process.

PubMed

Kwak, Lydia; Wåhlin, Charlotte; Stigmar, Kjerstin; Jensen, Irene

2017-01-18

One way to facilitate the translation of research into the occupational health service practice is through clinical practice guidelines. To increase the implementability of guidelines it is important to include the end-users in the development, for example by a community of practice approach. This paper describes the development of an occupational health practice guideline aimed at the management of non-specific low back pain (LBP) by using a community of practice approach. The paper also includes a process evaluation of the development providing insight into the feasibility of the process. A multidisciplinary community of practice group (n = 16) consisting of occupational nurses, occupational physicians, ergonomists/physical therapists, health and safety engineers, health educators, psychologists and researchers from different types of occupational health services and geographical regions within Sweden met eleven times (June 2012-December 2013) to develop the practice guideline following recommendations of guideline development handbooks. Process-outcomes recruitment, reach, context, satisfaction, feasibility and fidelity were assessed by questionnaire, observations and administrative data. Group members attended on average 7.5 out of 11 meetings. Half experienced support from their workplace for their involvement. Feasibility was rated as good, except for time-scheduling. Most group members were satisfied with the structure of the process (e.g. presentations, multidisciplinary group). Fidelity was rated as fairly high. The described development process is a feasible process for guideline development. For future guideline development expectations of the work involved should be more clearly communicated, as well as the purpose and tasks of the CoP-group. Moreover, possibilities to improve support from managers and colleagues should be explored. This paper has important implications for future guideline development; it provides valuable information on how practitioners can be included in the development process, with the aim of increasing the implementability of the developed guidelines.

The benefits of herbicide-resistant crops.

PubMed

Green, Jerry M

2012-10-01

Since 1996, genetically modified herbicide-resistant crops, primarily glyphosate-resistant soybean, corn, cotton and canola, have helped to revolutionize weed management and have become an important tool in crop production practices. Glyphosate-resistant crops have enabled the implementation of weed management practices that have improved yield and profitability while better protecting the environment. Growers have recognized their benefits and have made glyphosate-resistant crops the most rapidly adopted technology in the history of agriculture. Weed management systems with glyphosate-resistant crops have often relied on glyphosate alone, have been easy to use and have been effective, economical and more environmentally friendly than the systems they have replaced. Glyphosate has worked extremely well in controlling weeds in glyphosate-resistant crops for more than a decade, but some key weeds have evolved resistance, and using glyphosate alone has proved unsustainable. Now, growers need to renew their weed management practices and use glyphosate with other cultural, mechanical and herbicide options in integrated systems. New multiple-herbicide-resistant crops with resistance to glyphosate and other herbicides will expand the utility of existing herbicide technologies and will be an important component of future weed management systems that help to sustain the current benefits of high-efficiency and high-production agriculture. Copyright © 2012 Society of Chemical Industry.

Management of intrathecal baclofen therapy for severe acquired brain injury: consensus and recommendations for good clinical practice.

PubMed

De Tanti, Antonio; Scarponi, Federico; Bertoni, Michele; Gasperini, Giulio; Lanzillo, Bernardo; Molteni, Franco; Posteraro, Federico; Vitale, Dino Francesco; Zanpolini, Mauro

2017-08-01

Although widespread in the treatment of generalised spasticity due to severe acquired brain injury, clinical use of intrathecal baclofen administered through an implanted catheter is not yet supported by full scientific evidence. The aim of the study is to provide recommendations for good clinical practice regarding intrathecal baclofen therapy. We used a modified RAND Delphi method to develop consensus-based medical guidelines, involving clinicians who use intrathecal baclofen therapy throughout Italy. The clinicians were asked 38 questions grouped in six areas (patient selection, contraindications for implant, tests prior to implant, method of implant and management of therapy, efficacy evaluation and goal setting, and management of complications). To establish consensus, 75% agreement was required in answers to every question. Consensus was reached on the second round of the Delphi process on 27/38 questions (71%), specifically those regarding identification of objectives, efficacy evaluation, and method of implant and management of therapy, whereas management of complications and contraindications for implant remained critical areas. Despite the limits of our method, a set of recommendations was drawn up for clinical practice in this sector. The study also revealed residual critical areas and indicated future lines of research necessary to reach evidence-based consensus.

Why farmers adopt best management practice in the United States: A meta-analysis of the adoption literature

USGS Publications Warehouse

Baumgart-Getz, Adam; Stalker Prokopy, Linda; Floress, Kristin

2012-01-01

This meta-analysis of both published and unpublished studies assesses factors believed to influence adoption of agricultural Best Management Practices in the United States. Using an established statistical technique to summarize the adoption literature in the United States, we identified the following variables as having the largest impact on adoption: access to and quality of information, financial capacity, and being connected to agency or local networks of farmers or watershed groups. This study shows that various approaches to data collection affect the results and comparability of adoption studies. In particular, environmental awareness and farmer attitudes have been inconsistently used and measured across the literature. This meta-analysis concludes with suggestions regarding the future direction of adoption studies, along with guidelines for how data should be presented to enhance the adoption of conservation practices and guide research.

Nutrition management guideline for maple syrup urine disease: an evidence- and consensus-based approach.

PubMed

Frazier, Dianne M; Allgeier, Courtney; Homer, Caroline; Marriage, Barbara J; Ogata, Beth; Rohr, Frances; Splett, Patricia L; Stembridge, Adrya; Singh, Rani H

2014-07-01

In an effort to increase harmonization of care and enable outcome studies, the Genetic Metabolic Dietitians International (GMDI) and the Southeast Regional Newborn Screening and Genetics Collaborative (SERC) are partnering to develop nutrition management guidelines for inherited metabolic disorders (IMD) using a model combining both evidence- and consensus-based methodology. The first guideline to be completed is for maple syrup urine disease (MSUD). This report describes the methodology used in its development: formulation of five research questions; review, critical appraisal and abstraction of peer-reviewed studies and unpublished practice literature; and expert input through Delphi surveys and a nominal group process. This report includes the summary statements for each research question and the nutrition management recommendations they generated. Each recommendation is followed by a standardized rating based on the strength of the evidence and consensus used. The application of technology to build the infrastructure for this project allowed transparency during development of this guideline and will be a foundation for future guidelines. Online open access of the full, published guideline allows utilization by health care providers, researchers, and collaborators who advise, advocate and care for individuals with MSUD and their families. There will be future updates as warranted by developments in research and clinical practice. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: Critical review.

PubMed

Toss, M; Miligy, I; Thompson, A M; Khout, H; Green, A R; Ellis, I O; Rakha, E A

2017-10-01

The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as "low-risk" using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

Determining Competencies for Frontline Sales Managers in For-Profit Organizations

ERIC Educational Resources Information Center

Busch, Tina Killough

2012-01-01

Practice in the sales profession and current competency research indicate salesperson competence is key to organizational competitive advantage. With models of selling evolving to respond to the marketplace, there are changes in the competency requirements and roles people must play for future success, resulting in the emergence of new kinds of…

Error Tendencies in Processing Student Feedback for Instructional Decision Making.

ERIC Educational Resources Information Center

Schermerhorn, John R., Jr.; And Others

1985-01-01

Seeks to assist instructors in recognizing two basic errors that can occur in processing student evaluation data on instructional development efforts; offers a research framework for future investigations of the error tendencies and related issues; and suggests ways in which instructors can confront and manage error tendencies in practice. (MBR)

Case-Based Learning: Educating Future Human Service Managers

ERIC Educational Resources Information Center

Austin, Michael J.; Packard, Thomas

2009-01-01

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

Harnessing the Power of Technologies to Manage Collaborative e-Learning Projects in Dispersed Environments

ERIC Educational Resources Information Center

Gosper, Maree Veroncia; McNeill, Margot Anne; Woo, Karen

2010-01-01

"The impact of web-based lecture technologies on current and future practice in learning and teaching" was a collaborative project across four Australian universities, funded by the Australian Learning and Teaching Council (ALTC). The project was both exploratory and developmental in nature and according to the project's external…

Information Technology - Its Impact on Decision-Making.

ERIC Educational Resources Information Center

Hammer, Carl

Electronic systems of the future are bound to be larger, faster, and more reliable. They will furnish management with uninterrupted services in a real-time mode for practically all applications. In short, they will provide computing power as a utility company of today provides electric power. But the most spectacular advance is likely to be the…

Coastal Inlets Research Program

DTIC Science & Technology

2015-02-09

maintenance dredging of 216 million cubic yards from Federal navigation channels. Dredging costs are likely to increase in the future because of...beaches, estuaries, ecosystems and regions. Demand for regional sediment management practices and mitigation for engineering activities includes...innovative creation of nearshore berms with dredged sediment intended as a source to nourish neighboring beaches. Renewable, cost- effective placement

Engineering a future for amphibians under climate change

Treesearch

Luke P. Shoo; Deanna H. Olson; Sarah K. McMenamin; Kris A. Murray; Monique VanSluys; Maureen A. Donnelly; Danial Stratford; Juhani Terhivuo; Andres Merino-Viteri; Sarah M. Herbert; Phillip J. Bishop; Paul Stephen Corn; Liz Dovey; Richard A. Griffiths; Katrin Lowe; Michael Mahony; Hamish McCallum; Jonathan D. Shuker; Clay Simpkins; Lee F. Skerratt; Stephen E. Williams; Jean-Marc Hero

2011-01-01

Altered global climates in the 21st century pose serious threats for biological systems and practical actions are needed to mount a response for species at risk. We identify management actions from across the world and from diverse disciplines that are applicable to minimizing loss of amphibian biodiversity under climate change. Actions were...

Strategies for Multicultural Management: Communication and a Common Set of Values

ERIC Educational Resources Information Center

Castaneda, Mario E.; Bateh, Justin

2013-01-01

In the last 30 years, there has been a shift towards using multicultural strategies. The constant shifts taking place in multi-ethnic, multicultural, and multinational workforces indicate that both administrators of these organizations and higher education practices must evolve to adapt to needs for changing skill sets. In the future,…

Arbitration in one easy lesson: a review of criteria used in arbitration awards.

PubMed

Woolf, D A

1978-01-01

Some managers find awards of arbitrators "arbitrary, capricious, and discriminatory", Donald A. Woolf believes, however, that a knowledge of decisional criteria used by arbitrators can help managers to understand how they reason. Among the criteria discussed are the de minimus rule, the major/minor test, promissory estoppel, parol evidence, contract language, past practice, "clean hands", and the punishment fitting the crime (equity). Such knowledge can also help managers avoid actions that are likely to lead to grievances in addition to planning a course of action to avoid grievances going to arbitration in the future.

Physician-executives past, present, and future.

PubMed

Smallwood, K G; Wilson, C N

1992-08-01

The dramatic changes in the United States' health care system during the last decade have sparked increasing interest in physician-executives. These executives, skilled in both clinical medicine and health care management, can be found in hospitals, managed care organizations, group practices, and government institutions. This paper outlines the physician-executive's roles and the development process. The remarkable growth in the number of physician-executives is expected to continue as they demonstrate their abilities to help health care providers expand ambulatory services, facilitate provider-physician relationships and physician recruitment, and lend expertise in quality improvement and risk management issues.

Factors Affecting the Perception of Importance and Practice of Patient Safety Management among Hospital Employees in Korea.

PubMed

Kim, In-Sook; Park, MiJeong; Park, Mi-Young; Yoo, Hana; Choi, Jihea

2013-03-01

The study was undertaken to identify factors affecting perception of the importance and practice of patient safety management (PSM) among hospital employees in Korea. This study was conducted using a descriptive design and a self-report questionnaire. Two hundred and eighty employees were recruited from three hospitals using a convenience sampling method. Measures were perception of the importance, practice, and characteristics of PSM. Data were analyzed using descriptive statistics including t test, one-way analysis of variance, Pearson's correlation analysis, and multiple regression. Factors affecting perception of the importance of PSM were whether hospital employees were in contact with patients while on duty, weekly working hours, education on PSM, and perceived adequacy of PSM system construction. Factors affecting the practice of PSM were perceived adequacy of work load, perceived adequacy of PSM system construction and perception of its importance. The findings of this study indicate a need for developing strategies to improve perception of the importance and practice of PSM among all hospital employees, and provide a reference for future experimental studies. Copyright © 2013. Published by Elsevier B.V.

The Grand Challenge of Basin-Scale Groundwater Quality Management Modelling

NASA Astrophysics Data System (ADS)

Fogg, G. E.

2017-12-01

The last 50+ years of agricultural, urban and industrial land and water use practices have accelerated the degradation of groundwater quality in the upper portions of many major aquifer systems upon which much of the world relies for water supply. In the deepest and most extensive systems (e.g., sedimentary basins) that typically have the largest groundwater production rates and hold fresh groundwaters on decadal to millennial time scales, most of the groundwater is not yet contaminated. Predicting the long-term future groundwater quality in such basins is a grand scientific challenge. Moreover, determining what changes in land and water use practices would avert future, irreversible degradation of these massive freshwater stores is a grand challenge both scientifically and societally. It is naïve to think that the problem can be solved by eliminating or reducing enough of the contaminant sources, for human exploitation of land and water resources will likely always result in some contamination. The key lies in both reducing the contaminant sources and more proactively managing recharge in terms of both quantity and quality, such that the net influx of contaminants is sufficiently moderate and appropriately distributed in space and time to reverse ongoing groundwater quality degradation. Just as sustainable groundwater quantity management is greatly facilitated with groundwater flow management models, sustainable groundwater quality management will require the use of groundwater quality management models. This is a new genre of hydrologic models do not yet exist, partly because of the lack of modeling tools and the supporting research to model non-reactive as well as reactive transport on large space and time scales. It is essential that the contaminant hydrogeology community, which has heretofore focused almost entirely on point-source plume-scale problems, direct it's efforts toward the development of process-based transport modeling tools and analyses capable of appropriately upscaling advection-dispersion and reactions at the basin scale (10^2 km). A road map for research and development in groundwater quality management modeling and its application toward securing future groundwater resources will be discussed.

Radioactive and mixed waste - risk as a basis for waste classification. Symposium proceedings No. 2

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

NONE

The management of risks from radioactive and chemical materials has been a major environmental concern in the United states for the past two or three decades. Risk management of these materials encompasses the remediation of past disposal practices as well as development of appropriate strategies and controls for current and future operations. This symposium is concerned primarily with low-level radioactive wastes and mixed wastes. Individual reports were processed separately for the Department of Energy databases.

Managing the space-time-load continuum in TMDL planning: a case study for understanding groundwaer loads through advanced mapping techniques

Treesearch

Phillip Harte; Marcel Belaval; Andrea Traviglia

2016-01-01

The lag time between groundwater recharge and discharge in a watershed and the potential groundwater load to streams is an important factor in forecasting responses to future land use practices. We call this concept managing the “space-time-load continuum.” It’s understood that in any given watershed, the response function (the load at any given time) will differ for...

Role of Inspection and Condition Assessment in U.S. Army Corps of Engineers Civil Works Infrastructure Management: Current Practices and Opportunities for the Future

DTIC Science & Technology

2009-01-01

being done, in part, in response to Executive Order 13327, which mandates a pragmatic and consistent approach to Federal agency management of real...move forward. The U.S. Army Research and Development Center, Construction Engineering Research Laboratory was tasked with surveying a number of...assessment in use within USACE. (All rely on a deficiency-based approach, i.e., deviations from standards or from known benchmarks, to inspection.); (2

Benefits and Limitations of Real Options Analysis for the Practice of River Flood Risk Management

NASA Astrophysics Data System (ADS)

Kind, Jarl M.; Baayen, Jorn H.; Botzen, W. J. Wouter

2018-04-01

Decisions on long-lived flood risk management (FRM) investments are complex because the future is uncertain. Flexibility and robustness can be used to deal with future uncertainty. Real options analysis (ROA) provides a welfare-economics framework to design and evaluate robust and flexible FRM strategies under risk or uncertainty. Although its potential benefits are large, ROA is hardly used in todays' FRM practice. In this paper, we investigate benefits and limitations of a ROA, by applying it to a realistic FRM case study for an entire river branch. We illustrate how ROA identifies optimal short-term investments and values future options. We develop robust dike investment strategies and value the flexibility offered by additional room for the river measures. We benchmark the results of ROA against those of a standard cost-benefit analysis and show ROA's potential policy implications. The ROA for a realistic case requires a high level of geographical detail, a large ensemble of scenarios, and the inclusion of stakeholders' preferences. We found several limitations of applying the ROA. It is complex. In particular, relevant sources of uncertainty need to be recognized, quantified, integrated, and discretized in scenarios, requiring subjective choices and expert judgment. Decision trees have to be generated and stakeholders' preferences have to be translated into decision rules. On basis of this study, we give general recommendations to use high discharge scenarios for the design of measures with high fixed costs and few alternatives. Lower scenarios may be used when alternatives offer future flexibility.

Improvement of nuclear power plants within the perspective of applications of lean manufacturing practices

NASA Astrophysics Data System (ADS)

Malek, A. K.; Muhammad, H. I.; Rosmaini, A.; Alaa, A. S.; Falah, A. M.

2017-09-01

Development and improvement process are essential to the companies and factories of various kinds and this necessity is related aspects of cost, time and risk that can be avoided, these aspects are available at the nuclear power stations essential demands cannot be ignored. The lean management technique is one of the recent trends in the management system. Where the lean management is stated as the system increases the customer value and reduces the wastage process in an industry or in a power plants. Therefore, there is an urgent necessity to ensure the development and improvement in nuclear power plants in the pre-established in process of being established and stage of the management and production. All of these stages according to the study are closely related to the necessity operationalize and apply lean manufacturing practices that these applications are ineffective and clear contribution to reduce costs and control of production processes and the process of reducing future risks that could be exposed to the station.

Chemical hazards associated with treatment of waste electrical and electronic equipment

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

Tsydenova, Oyuna; Bengtsson, Magnus, E-mail: bengtsson@iges.or.jp

2011-01-15

This review paper summarizes the existing knowledge on the chemical hazards associated with recycling and other end-of-life treatment options of waste electrical and electronic equipment (e-waste). The hazards arise from the presence of heavy metals (e.g., mercury, cadmium, lead, etc.), flame retardants (e.g., pentabromophenol, polybrominated diphenyl ethers (PBDEs), tetrabromobisphenol-A (TBBPA), etc.) and other potentially harmful substances in e-waste. If improperly managed, the substances may pose significant human and environmental health risks. The review describes the potentially hazardous content of e-waste, examines the existing e-waste management practices and presents scientific data on human exposure to chemicals, workplace and environmental pollution associatedmore » with the three major e-waste management options, i.e., recycling, incineration and landfilling. The existing e-waste management practices and associated hazards are reviewed separately for developed and developing countries. Finally, based on this review, the paper identifies gaps in the existing knowledge and makes some recommendations for future research.« less

Predictors of nurse practitioners' autonomy: effects of organizational, ethical, and market characteristics.

PubMed

Ulrich, Connie; Soeken, Karen; Miller, Nancy

2003-07-01

To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed-care systems (e.g., HMOs). A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational characteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state. Although NPs were ethically concerned about their autonomy in a managed-care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethical concern, the lower the perceived autonomy of NPs. Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.

Use of Gaming in Self-Management of Diabetes in Teens.

PubMed

Swartwout, Ellen; El-Zein, Ashley; Deyo, Patricia; Sweenie, Rachel; Streisand, Randi

2016-07-01

With the growing prevalence of diabetes in teens and frequent concomitant problems with adherence, adolescents are a frequent target for diabetes self-management support and education. Due to widespread use of technology among teens in general, the use of serious games, games used for purposes beyond entertainment with the intention to educate and support health behavior for teens with diabetes self-management, is an emerging and promising practice. This report explores games intended for teens with diabetes, how the use of games may enhance clinical practice, and provides suggestions for future research and better utilization of these technologies. Current research on the use of gaming for promoting diabetes management in teens is fairly limited, with some initial support for improvements in both behavioral and clinical outcomes among teens. More research is clearly needed in order to further determine how gaming can best be utilized to impact health outcomes in these teens, as well as potential mechanisms of change.

Angling into the Future: Ten Commandments for Recreational Fisheries Science, Management, and Stewardship in a Good Anthropocene

NASA Astrophysics Data System (ADS)

Elmer, Laura K.; Kelly, Lisa A.; Rivest, Stephanie; Steell, S. Clay; Twardek, William M.; Danylchuk, Andy J.; Arlinghaus, Robert; Bennett, Joseph R.; Cooke, Steven J.

2017-08-01

A new geological epoch, the "Anthropocene", has been defined as the period in which humans have had substantial geological and ecological influence on the planet. A positive future for this epoch can be referred to as the "good Anthropocene" and would involve effective management strategies and changes in human behavior that promote the sustainability and restoration of ecosystems. Recreational fisheries hold significant social, cultural, and economic value and can generate many benefits when managed sustainably and thus be an integral part of a "good Anthropocene". Here, we list ten commandments to facilitate persistence and long-term sustainability of recreational fisheries in the "good Anthropocene". This list includes fostering aquatic stewardship, promoting education, using appropriate capture gear, adopting evidence-based management approaches, promoting the concept of resilience, obtaining and using effort data in management, embracing the ecosystem approach, engaging in multilevel collaboration, enhancing accessibility, and embracing optimism. When used singly, or simultaneously, these ten commandments will contribute to the harmonization of sustainable fish populations and angling practices, to create recreational fisheries' "bright spots".

Equipping future doctors: incorporating management and leadership into medical curriculums in the United Kingdom.

PubMed

Sonsale, Aniket; Bharamgoudar, Reshma

2017-04-01

Throughout their careers, doctors are likely to come across complex management and leadership scenarios that many would not have had prior training in. Expectations of doctors are rising and it is becoming increasingly necessary to be able to astutely handle a variety of situations. Medical curricula must reflect this change and adapt to include the teaching of key management and leadership skills. Despite budgeting pressures, the National Health Service continues to spend vast sums of money on external management consultants. The 2013 Francis Report stressed the need for better management skills and leadership, especially in doctors who were identified as the spearheads of change. This view is backed up by senior professionals who stress that by incorporating it into undergraduate curricula, doctors will be equipped with the skills to flourish in the future. The challenges of doing so must be highlighted, since the teaching of managerial and leadership concepts must effectively combine theoretical approaches with practical applications. Empowering students of today will enable them as tomorrow's doctors to tackle the challenges of modern medicine.

Managed care. Shifts health care from an altruistic model to a business framework.

PubMed

Kersbergen, A L

2000-01-01

The term managed care, as used throughout the scientific and lay literature, has become a generic label without a clear, universally accepted definition. The many definitions and descriptions of managed care are usually directly related to the model under discussion. Nevertheless, as nurse educators attempt to align curricula with the evolving health care environment, it is imperative that students gain an understanding of the concept of managed care and the skills needed to practice in the managed care environment. Schools of nursing must prepare students to deal with the consequences of managed care, namely, the changing base of power, conflicts, and ethical dilemmas across settings. The drive to control health care costs in the 1990s brought about unprecedented change for nurses. Regardless of the strategies implemented in the name of managing care, the evolving health care environment has changed where and how nurses practice. To aid faculty in the revision of the nursing curriculum, an attempt was made to arrive at an empirically based definition of managed care that will provide a conceptual foundation for future research and theoretical discussions. Other goals were to identify consequences of managed care across disciplines and models implemented in the name of managing care, and to identify skills needed by nurses today.

A Middle-Range Explanatory Theory of Self-Management Behavior for Collaborative Research and Practice.

PubMed

Blok, Amanda C

2017-04-01

To report an analysis of the concept of self-management behaviors. Self-management behaviors are typically associated with disease management, with frequent use by nurse researchers related to chronic illness management and by international health organizations for development of disease management interventions. A concept analysis was conducted within the context of Orem's self-care framework. Walker and Avant's eight-step concept analysis approach guided the analysis. Academic databases were searched for relevant literature including CIHAHL, Cochrane Databases of Systematic Reviews and Register of Controlled Trials, MEDLINE, PsycARTICLES and PsycINFO, and SocINDEX. Literature using the term "self-management behavior" and published between April 2001 and March 2015 was analyzed for attributes, antecedents, and consequences. A total of 189 journal articles were reviewed. Self-management behaviors are defined as proactive actions related to lifestyle, a problem, planning, collaborating, and mental support, as well as reactive actions related to a circumstantial change, to achieve a goal influenced by the antecedents of physical, psychological, socioeconomic, and cultural characteristics, as well as collaborative and received support. The theoretical definition and middle-range explanatory theory of self-management behaviors will guide future collaborative research and clinical practice for disease management. © 2016 Wiley Periodicals, Inc.

Managing Systemic Change: Future Roles for Social Learning Systems and Communities of Practice?

NASA Astrophysics Data System (ADS)

Blackmore, Chris

The Open University course that prompted this book, and for which it is part of the required reading, focuses on managing systemic change. The course is designed for people who want to develop their skills and understanding in systems thinking and practice, to be used in a range of different domains. Most of the examples in the course come from work-based settings. The idea of managing in this context is mainly about appreciating situations with others, recognising what actions are desirable and feasible and for whom, and getting organised, in order to affect or respond to change in a positive way. It has little to do with control. As Vickers (1978, p. 81) said 'I do not think it too much to hope that an understanding of systemic relations may bring us a better understanding of our limitations and even our possibilities.'

Towards an evaluation framework for information quality management (IQM) practices for health information systems--evaluation criteria for effective IQM practices.

PubMed

Mohammed, Siti Asma; Yusof, Maryati Mohd

2013-04-01

Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS. Six selected frameworks and best practices both from health informatics and information systems literature have been reviewed to identify the evaluation criteria from the perspective of human, organizational and technological factors. From the review, it was found that human and organization factors are of greater significance in influencing HIS IQ. Our review depicts that there is still shortage in finding a comprehensive IQM evaluation framework. Thus, the criteria from the frameworks reviewed can be used in combination for more comprehensive evaluation criteria. Integrated IQM evaluation criteria for HIS are then proposed in this study. Poor IQ is the result of complex interdependency within sociotechnical factors in health care organization and lack of formal and structured IQM practices. Thus, a feedback mechanism such as evaluation is needed to understand the issues in depth in the future. © 2012 Blackwell Publishing Ltd.

Financial management practices and attitudes of dental hygienists: a descriptive study.

PubMed

Russell, Katherine; Stramoski, Sandra

2011-01-01

The purpose of this study was to determine the financial management goals and practices of registered dental hygienists, their satisfaction with their current financial situations and their attitudes about savings, investments and retirement. A 40 question electronic survey was completed by 388 registered dental hygienists. The descriptive instrument assessed financial practices, attitudes, goals and beliefs, retirement mindset, savings habits, debt tendencies and demographic characteristics of respondents. Statistical analyses compared respondents' beliefs about their financial independence and security with their current financial practices. Analyses included: independent samples t-tests, chi-square analysis and ANOVA. Most dental hygienists believed themselves to be financially independent and reported satisfaction with their current financial situation. Significant relationships existed between respondents' satisfaction with their current financial situations and their financial attitudes and practices (saving regularly and having limited debt). Those who indicated they had personally saved for retirement were more likely to view these savings as their largest source of income during retirement, as opposed to Social Security benefits. A majority agreed that financial management education should be included in the dental hygiene curriculum, and that they would attend a continuing education course on the subject if offered. The results of this study suggest that hygienists have confidence in their ability to provide secure financial futures for themselves. Hygienists who practiced sound financial planning, such as adhering to monthly budgets, having wills, lowering debt and saving regularly, reported a higher level of financial security than those who did not. Most respondents expressed interest in receiving education about financial management through the dental hygiene curriculum and continuing education courses.

Complexity theory and the "puzzling" competencies: Systems-based Practice And Practice-based Learning explored.

PubMed

Gonnering, Russell S

2010-01-01

Of all the clinical competencies, the least understood are Systems-Based Practice and Practice-Based Learning and Improvement. With a shift to competency-based education and evaluation across the spectrum of surgical education and practice, a clear understanding of the power and utility of each competency is paramount. Health care operates as a complex adaptive system, with dynamics foreign to many health care professionals and educators. The adaptation and evolution of such a system is related directly to both the individual and the organizational learning of the agents within the system and knowledge management strategies. Far from being "difficult," Systems-Based Practice and Practice-Based Learning form the heart of quality improvement initiatives and future productivity advances in health care. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Possible global environmental impacts of solid waste practices

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

Davis, M.M.; Holter, G.M.; DeForest, T.J.

1994-09-01

Pollutants resulting from the management of solid waste have been shown to affect the air, land, oceans, and waterways. In addition, solid wastes have other, more indirect impacts such as reduction in feedstocks of natural resources, because useful materials are disposed of rather than recycled. The objective of this study is to evaluate solid waste management practices that have negative implications on the global environment and develop recommendations for reducing such impacts. Recommendations identifying needed changes are identified that will reduce global impacts of solid waste practices in the future. The scope of this study includes the range of non-hazardousmore » solid wastes produced within our society, including municipal solid waste (MSW) and industrial solid waste (ISW), as well as industry-specific wastes from activities such as construction, demolition, and landclearing. Most solid waste management decisions continue to be made and implemented at very local levels, predominantly with a short-term focus to respond to relatively immediate pressures of landfill shortages, funding problems, political considerations, and the like. In this rush to address immediate local problems, little consideration is being given to potential impacts, either short- or long-term, at the national or global level resulting from solid waste management practices. More and more, the cumulative impacts from local decisions concerning solid waste management are beginning to manifest themselves in broader, longer-term impacts than are being addressed by the decision-makers or, at the very least, are presenting a greater and greater potential for such impacts.« less

Cultivating Composting Culture Activities among Citizens and Its Beneficial to Prolong the Landfill Lifespan

NASA Astrophysics Data System (ADS)

Azura Zakarya, Irnis; Azri Jamial, Khairul; Mat Tanda, Norazlinda

2018-03-01

Currently, the Ministry of Housing and Local Government manage solid waste in Malaysia, with the participation of the private sector. Food waste represents almost 60% of the total municipal solid waste disposed in the landfill. Material valorisation of food waste usually conducted by biological processes such as composting. Compost, an organic amendment, is the final product of the composting process. These processes are efficient, low cost and environmentally friendly alternative for managing food waste and are used extensively worldwide. Therefore, organic solid waste management practices program for the communities in Perlis was conducted. The main objective of this program was to instilling environment awareness especially among Perlis citizens. This study was investigated the impact of food waste or kitchen waste composting to the citizens in Perlis State and the beneficial of compost fertilizer to our environment especially in plant growth. Composting method was taught to the food premises owner, individuals, teachers, and students and their responses to the composting practices were then summarized. In future, we can prolong our landfill lifespan by practicing organic waste composting and can preserving our environment.

A review of the bioretention system for sustainable storm water management in urban areas

NASA Astrophysics Data System (ADS)

Shafique, Muhammad

2016-10-01

Bioretention basins/rain garden is a very suitable low-impact development (LID) practice for storm water management around the globe. By using this practice in urban areas, flash flooding problems can be decreased and the environment of an area can be improved. The concept of bioretention was introduced a few decades ago and has been proven to be the best management practice (BMP) for storm water in urban areas. Due to urbanisation, natural surface areas are converted into hard surfaces such as roads, through which water cannot infiltrate into the ground. Due to this, infiltration decreases and surface run-off increases, which causes depletion of ground water continuously. In this study, we mainly explain the bioretention concept and its function as derived from different studies. This review includes different scientists' results for the performance of the bioretention system at different locations. A summary of the research findings by different scientists on the performance of bioretention systems is also provided, including the hydrologic and water quality performances. Finally, future work necessary to enhance the performance and widespread use of bioretention systems is also explained.

Perceptions of vulnerability to a future outbreak: a study of horse managers affected by the first Australian equine influenza outbreak

PubMed Central

2013-01-01

Background A growing body of work shows the benefits of applying social cognitive behavioural theory to investigate infection control and biosecurity practices. Protection motivation theory has been used to predict protective health behaviours. The theory outlines that a perception of a lack of vulnerability to a disease contributes to a reduced threat appraisal, which results in poorer motivation, and is linked to poorer compliance with advised health protective behaviours. This study, conducted following the first-ever outbreak of equine influenza in Australia in 2007, identified factors associated with horse managers’ perceived vulnerability to a future equine influenza outbreak. Results Of the 200 respondents, 31.9% perceived themselves to be very vulnerable, 36.6% vulnerable and 31.4% not vulnerable to a future outbreak of equine influenza. Multivariable logistic regression modelling revealed that managers involved in horse racing and those on rural horse premises perceived themselves to have low levels of vulnerability. Managers of horse premises that experienced infection in their horses in 2007 and those seeking infection control information from specific sources reported increased levels of perceived vulnerability to a future outbreak. Conclusion Different groups across the horse industry perceived differing levels of vulnerability to a future outbreak. Increased vulnerability contributes to favourable infection control behaviour and hence these findings are important for understanding uptake of recommended infection control measures. Future biosecurity communication strategies should be delivered through information sources suitable for the horse racing and rural sectors. PMID:23902718

How iSamples (Internet of Samples in the Earth Sciences) Improves Sample and Data Stewardship in the Next Generation of Geoscientists

NASA Astrophysics Data System (ADS)

Hallett, B. W.; Dere, A. L. D.; Lehnert, K.; Carter, M.

2016-12-01

Vast numbers of physical samples are routinely collected by geoscientists to probe key scientific questions related to global climate change, biogeochemical cycles, magmatic processes, mantle dynamics, etc. Despite their value as irreplaceable records of nature the majority of these samples remain undiscoverable by the broader scientific community because they lack a digital presence or are not well-documented enough to facilitate their discovery and reuse for future scientific and educational use. The NSF EarthCube iSamples Research Coordination Network seeks to develop a unified approach across all Earth Science disciplines for the registration, description, identification, and citation of physical specimens in order to take advantage of the new opportunities that cyberinfrastructure offers. Even as consensus around best practices begins to emerge, such as the use of the International Geo Sample Number (IGSN), more work is needed to communicate these practices to investigators to encourage widespread adoption. Recognizing the importance of students and early career scientists in particular to transforming data and sample management practices, the iSamples Education and Training Working Group is developing training modules for sample collection, documentation, and management workflows. These training materials are made available to educators/research supervisors online at http://earthcube.org/group/isamples and can be modularized for supervisors to create a customized research workflow. This study details the design and development of several sample management tutorials, created by early career scientists and documented in collaboration with undergraduate research students in field and lab settings. Modules under development focus on rock outcrops, rock cores, soil cores, and coral samples, with an emphasis on sample management throughout the collection, analysis and archiving process. We invite others to share their sample management/registration workflows and to develop training modules. This educational approach, with evolving digital materials, can help prepare future scientists to perform research in a way that will contribute to EarthCube data integration and discovery.

Good Data Can Be Better Data - How Data Management Maturity Can Help Repositories Improve Operations, Data Quality, And Usability, Helping Researchers

NASA Astrophysics Data System (ADS)

Stall, S.

2015-12-01

Much earth and space science data and metadata are managed and supported by an infrastructure of repositories, ranging from large agency or instrument facilities, to institutions, to smaller repositories including labs. Scientists face many challenges in this ecosystem both on storing their data and in accessing data from others for new research. Critical for all uses is ensuring the credibility and integrity of the data and conveying that and provenance information now and in the future. Accurate information is essential for future researchers to find (or discover) the data, evaluate the data for use (content, temporal, geolocation, precision) and finally select (or discard) that data as meeting a "fit-for-purpose" criteria. We also need to optimize the effort it takes in describing the data for these determinations, which means making it efficient for the researchers who collect the data. At AGU we are developing a program aimed at helping repositories, and thereby researchers, improve data quality and data usability toward these goals. AGU has partnered with the CMMI Institute to develop their Data Management Maturity (DMM) framework within the Earth and space sciences. The CMMI DMM framework guides best practices in a range of data operations, and the application of the DMM, through an assessment, reveals how repositories and institutions can best optimize efforts to improve operations and functionality throughout the data lifecycle and elevate best practices across a variety of data management operations. Supporting processes like data operations, data governance, and data architecture are included. An assessment involves identifying accomplishment, and weaknesses compared to leading practices for data management. Broad application of the DMM can help improve quality in data and operations, and consistency across the community that will facilitate interoperability, discovery, preservation, and reuse. Good data can be better data. Consistency results in sustainability.

Increasing Awareness of Sustainable Water Management for Future Civil Engineers

NASA Astrophysics Data System (ADS)

Ilic, Suzana; Karleusa, Barbara; Deluka-Tibljas, Aleksandra

2010-05-01

There are more than 1.2 billion people around the world that do not have access to drinking water. While there are plans under the United Nations Millennium Development Goals to halve this number by 2015, there are a number of regions that will be exposed to water scarcity in the coming future. Providing sufficient water for future development is a great challenge for planners and designers of water supply systems. In order to design sustainable water supplies for the future, it is important to learn how people consume water and how water consumption can be reduced. The education of future civil engineers should take into account not only technical aspects of the water supply but also the accompanying social and economical issues, and appreciated the strengths and weaknesses of traditional solutions. The Faculty of Civil Engineering, at the University of Rijeka, has begun incorporating a series of activities that engage undergraduate students and the local community to develop a mutual understanding of the future needs for sustainable management. We present one of the activities, collaboration with the Lancaster Environment Centre at Lancaster University in the UK through the field course Water and environmental management in Mediterranean context. The course, which is designed for the Lancaster University geography students, features a combination of field trips and visits to provide an understanding of the socio-economic and environmental context of water management in two counties (Istra and Primorsko-Goranska). Students from Lancaster visit the Croatian water authority and a regional water company, where they learn about current management practices and problems in managing water supplies and demand through the year. They make their own observations of current management practices in the field and learn about water consumption from the end users. One day field visit to a village in the area that is still not connected to the main water supply system is organised together with civil engineering students from the University of Rijeka. The aims of this field visit are: to learn about traditional water supply from an underground storage of rain water called cisterna; and to find out from inhabitants about their current water usage habits and expectations, and how these might change when they get water from the main water supply system. This joint activity has been beneficial for both groups of students. The engineering students become aware of the importance of the social aspects in designing the water supply system, while the geography students learn about the engineering challenges entailed. Both groups learn that water consumption increases with the provision of water through pipeline systems and that this needs to be taken into account in the design of water supply and management of water resources. Importantly, they learn the benefits of traditional sustainable water supply methods, which could be implemented as primary or additional sources of water supply in other areas.In summary, both groups of students develop their professional knowledge and skills as well as generic and transferable skills, which are very important for those who will continue to a career in the design and management of water systems.

Information technology, the internet, and the future of neurology.

PubMed

Maulden, Sarah A

2003-05-01

This review addresses the impact of information technology and the Internet on the current and future practice of neurology. Information technology is influencing medical practice in ways that could be both beneficial and harmful. Scenarios are presented to depict some of the ways in which the practice of neurology is being influenced by the growth of technology. First, the advantages and disadvantages of e-mail as a means of doctor-patient communication are presented. Some of the ethical and legal issues arising in this context are discussed.Second, the Internet is changing neurologists' relationships to other professionals in the health care industry. Geographical isolation is less problematic than in the past. Telemedicine, including remote consulting via the Web, has special implications for neurologists in several areas, including stroke management, movement disorders, and epilepsy.Third, the growing availability of large databases, powerful search engines, and online full-text journals is discussed. Skill in navigating and managing these resources will become increasingly important. New computer-assisted decision support systems will continue to be implemented. Applications exist or are being developed for use by clinicians for many specific neurologic disorders.Finally, some of the problematic issues concerning medical use of the Internet are discussed, including availability, portability, security, quality, and outcomes. Medical information systems, with their attendant advantages and limitations, will become increasingly significant in the practice of neurology. Despite overall improvement in access to information, major barriers still exist to the proper implementation and utilization of truly integrated information systems.

Nigerian medical students' opinions about the undergraduate curriculum in psychiatry.

PubMed

James, Bawo; Omoaregba, Joyce; Okogbenin, Esther; Buhari, Olubunmi; Obindo, Taiwo; Okonoda, Mayowa

2013-05-01

The number of psychiatrists in Nigeria is inadequate to meet the treatment needs for neuropsychiatric disorders. Developing mental health competency in the future Nigerian physician workforce is one approach to filling the treatment gap. The authors aimed to assess medical students' attitudes to this training and its relevance to their future practice and to assess whether they are getting adequate or relevant training. A cross-sectional, questionnaire-based survey was undertaken among a sample (N=375) of 5th- and 6th-year students across four medical schools in Nigeria. Over one-tenth (12%) chose psychiatry as a future career choice. Most expressed positive attitudes toward psychiatry and its relevance to their future careers. A majority were enthusiastic about receiving training in psychiatry in primary-care settings and welcomed a curriculum that emphasized the learning and management of common psychiatric disorders seen in general practice. Medical students surveyed would welcome an undergraduate curriculum that integrates the learning of psychiatry with other specialties and skills-training relevant for primary care. Efforts to modify the current curriculum in psychiatry in Nigerian medical schools should be encouraged.

Overcoming the momentum of anachronism: American geologic mapping in a twenty-first-century world

USGS Publications Warehouse

House, P. Kyle; Clark, Ryan; Kopera, Joe

2013-01-01

The practice of geologic mapping is undergoing conceptual and methodological transformation. Profound changes in digital technology in the past 10 yr have potential to impact all aspects of geologic mapping. The future of geologic mapping as a relevant scientific enterprise depends on widespread adoption of new technology and ideas about the collection, meaning, and utility of geologic map data. It is critical that the geologic community redefine the primary elements of the traditional paper geologic map and improve the integration of the practice of making maps in the field and office with the new ways to record, manage, share, and visualize their underlying data. A modern digital geologic mapping model will enhance scientific discovery, meet elevated expectations of modern geologic map users, and accommodate inevitable future changes in technology.

The Impact of Therapeutic Antibodies on the Management of Digestive Diseases: History, Current Practice, and Future Directions.

PubMed

Sofia, M Anthony; Rubin, David T

2017-04-01

The development of therapeutic antibodies represents a revolutionary change in medical therapy for digestive diseases. Beginning with the initial studies that confirmed the pathogenicity of cytokines in inflammatory bowel disease, the development and application of therapeutic antibodies brought challenges and insights into their potential and optimal use. Infliximab was the first biological drug approved for use in Crohn's disease and ulcerative colitis. The lessons learned from infliximab include the importance of immunogenicity and the influence of pharmacokinetics on disease response and outcomes. Building on this foundation, other therapeutic antibodies achieved approval for inflammatory bowel disease and many more are in development for several digestive diseases. In this review, we reflect on the history of therapeutic antibodies and discuss current practice and future directions for the field.

Use of care management practices in small- and medium-sized physician groups: do public reporting of physician quality and financial incentives matter?

PubMed

Alexander, Jeffrey A; Maeng, Daniel; Casalino, Lawrence P; Rittenhouse, Diane

2013-04-01

To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups. Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR. We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate. (1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone. Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting. © Health Research and Educational Trust.

The Role of Pest Control Advisers in Preventative Management of Grapevine Trunk Diseases.

PubMed

Hillis, Vicken; Lubell, Mark; Kaplan, Jonathan; Doll, David; Baumgartner, Kendra

2016-04-01

Vineyards with trunk diseases (Botryosphaeria dieback, Esca, Eutypa dieback, and Phomopsis dieback) can have negative returns in the long run. Minimizing economic impacts depends on effective management, but adopting a preventative practice after infection occurs may not improve yields. Pest control advisers may reduce grower uncertainty about the efficacy of and need for prevention, which often entails future and unobservable benefits. Here, we surveyed advisers in California to examine their influence over grower decision-making, in the context of trunk diseases, which significantly limit grape production and for which curative practices are unavailable. Our online survey revealed adviser awareness of high disease incidence, and reduced yields and vineyard lifespan. Advisers rated both preventative and postinfection practices positively. Despite higher cost estimates given to postinfection practices, advisers did not recommend preventative practices at higher rates. High recommendation rates were instead correlated with high disease incidence for both preventative and postinfection practices. Recommendation rates declined with increasing cost for preventative, but not for postinfection, practices. Our findings suggest that even when advisers acknowledge the risks of trunk diseases, they may not recommend preventative practices before infection occurs. This underscores the importance of clear outreach, emphasizing both the need for prevention and its long-term cost efficacy.

Health Information Management Leaders and the Practice of Leadership through the Lens of Bowen Theory.

PubMed

Sheridan, Patty Thierry; Watzlaf, Valerie; Fox, Leslie Ann

2016-01-01

Even though leadership is one of the most examined topics in the organizational literature, its application in the field of health information management (HIM) has not been studied extensively. This descriptive, mixed-methodology study examined HIM leadership through the lens of Bowen theory. The researchers conducted surveys of HIM directors and managers, administrators and colleagues of HIM leaders, and HIM staff using focus groups, observations of meetings, and face-to-face interviews. Results showed that HIM leaders are valued for HIM expertise in electronic health records, privacy, security, and coding; for being the center or heart of the organization; and for commonly valued leadership behaviors and skills including dependability, strategic planning, project management, listening ability, and fairness. Leadership was seen as a reciprocal process, and a team approach was preferred. Good communication, education, and training on HIM topics were also valued. However, HIM leaders believed that they spend more time on management activities than on leadership activities, although they would prefer the reverse. Future research is needed to examine how HIM leadership can be practiced more consistently in the workplace across different HIM functions.

The management of new primary care organizations: an international perspective.

PubMed

Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

2006-08-01

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

[General background and practical implementation of the health management service institution in Korea].

PubMed

Okahara, Shintaro; Lee, Byeong-Woo; Ogasawara, Takayuki; Mori, Koji

2014-09-01

The Korean Occupational Safety and Health Act requires an employer with more than 50 employees to assign a health manager or an occupational physician. However, there are many cases where it is difficult for medium-scale enterprises to perform occupational health practices autonomously because their financial base is weaker than that of large-scale enterprises. The Korean Occupational Safety and Health Act was amended in 1990 so that medium-scale enterprises could entrust a health management service institution with their health management tasks. This system is similar to the outsourcing of medical examinations, occupational physicians, or the measurement of the working environment in Japan, but its legal background and actual activities are korea-specific, and it has some different points. In particular, the quality control of health management service institutions by legal and administrative regulations, and the multidisciplinary provision of services contribute to the development of occupational health in medium-scale enterprises. This will be a good reference for occupational health services in small- and medium-scale enterprises in the future in Japan.

A comparative analysis of occupational health and safety risk prevention practices in Sweden and Spain.

PubMed

Morillas, Rosa María; Rubio-Romero, Juan Carlos; Fuertes, Alba

2013-12-01

Scandinavian countries such as Sweden implemented the occupational health and safety (OHS) measures in the European Directive 89/391/EEC earlier than other European counties, including Spain. In fact, statistics on workplace accident rates reveal that between 2004 and 2009, there were considerably fewer accidents in Sweden than in Spain. The objective of the research described in this paper was to reduce workplace accidents and to improve OHS management in Spain by exploring the OHS practices in Sweden. For this purpose, an exploratory comparative study was conducted, which focused on the effectiveness of the EU directive in both countries. The study included a cross-sectional analysis of workplace accident rates and other contextual indicators in both national contexts. A case study of 14 Swedish and Spanish companies identified 14 differences in the preventive practices implemented. These differences were then assessed with a Delphi study to evaluate their contribution to the reduction of workplace accidents and their potential for improving health and safety management in Spain. The results showed that there was agreement concerning 12 of the 14 practices. Finally, we discuss opportunities of improvement in Spanish companies so that they can make their risk management practices more effective. The findings of this comparative study on the implementation of the European Directive 89/391/EEC in both Sweden and Spain have revealed health and safety managerial practices which, if properly implemented, could contribute to improved work conditions and accident statistics of Spanish companies. In particular, the results suggest that Spanish employers, safety managers, external prevention services, safety deputies and Labour Inspectorates should consider implementing streamlined internal preventive management, promoting the integration of prevention responsibilities to the chain of command, and preventing health and safety management from becoming a mere exchange of documents. The authors also encourage future research studies to use the methodology presented to compare and assess the European Directive 89/391/EEC implementation in other European countries. © 2013.

Using a full annual cycle model to evaluate long-term population viability of the conservation-reliant Kirtland's warbler after successful recovery

USGS Publications Warehouse

Brown, Donald J.; Ribic, Christine; Donner, Deahn M.; Nelson, Mark D.; Bocetti, Carol I.; Deloria-Sheffield, Christie M.

2017-01-01

Long-term management planning for conservation-reliant migratory songbirds is particularly challenging because habitat quality in different stages and geographic locations of the annual cycle can have direct and carry-over effects that influence the population dynamics. The Neotropical migratory songbird Kirtland's warbler Setophaga kirtlandii (Baird 1852) is listed as endangered under the U.S. Endangered Species Act and Near Threatened under the IUCN Red List. This conservation-reliant species is being considered for U.S. federal delisting because the species has surpassed the designated 1000 breeding pairs recovery threshold since 2001.To help inform the delisting decision and long-term management efforts, we developed a population simulation model for the Kirtland's warbler that incorporated both breeding and wintering grounds habitat dynamics, and projected population viability based on current environmental conditions and potential future management scenarios. Future management scenarios included the continuation of current management conditions, reduced productivity and carrying capacity due to the changes in habitat suitability from the creation of experimental jack pine Pinus banksiana (Lamb.) plantations, and reduced productivity from alteration of the brown-headed cowbird Molothrus ater (Boddaert 1783) removal programme.Linking wintering grounds precipitation to productivity improved the accuracy of the model for replicating past observed population dynamics. Our future simulations indicate that the Kirtland's warbler population is stable under two potential future management scenarios: (i) continuation of current management practices and (ii) spatially restricting cowbird removal to the core breeding area, assuming that cowbirds reduce productivity in the remaining patches by ≤41%. The additional future management scenarios we assessed resulted in population declines.Synthesis and applications. Our study indicates that the Kirtland's warbler population is stable under current management conditions and that the jack pine plantation and cowbird removal programmes continue to be necessary for the long-term persistence of the species. This study represents one of the first attempts to incorporate full annual cycle dynamics into a population viability analysis for a migratory bird, and our results indicate that incorporating wintering grounds dynamics improved the model performance.

Publication ethics from the ground up.

PubMed

DeTora, Lisa; Foster, Cate; Nori, Mukund; Simcoe, Donna; Skobe, Catherine; Toroser, Dikran

2018-02-01

It is relatively easy to begin policy documents with a general assertion that ethics will be followed. Less obvious is how to ensure that day-to-day activities are consonant with ethical standards. We suggest that using day-to-day publication activities as the driver for building policies and procedures can promote ethical practices from the ground up. Although basic principles of ethical publication practice may seem straightforward to some, for others this information may require explanation, interpretation and context. Effective policy development includes big-picture items as well as more day-to-day tactical responsibilities such as those discussed below. Research questions, disciplinary practices, applications and team structures may vary. Thus, no single publication plan or policy solution is right for all teams. It is up to team members to review guidelines for best practices and find the optimal implementation for their situations. Experts in publication management, planning and writing can help large teams manage publication activities. These experts have an obligation to maintain and enhance their skills continually. A strong acumen in publication best practices will allow these publication professionals to better address any possible ethical dilemmas in the future. © 2018 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Assessment of general education teachers' Tier 1 classroom practices: contemporary science, practice, and policy.

PubMed

Reddy, Linda A; Fabiano, Gregory A; Jimerson, Shane R

2013-12-01

Progress monitoring is a type of formative assessment. Most work on progress monitoring in elementary school settings has been focused on students. However, teachers also can benefit from frequent evaluations. Research addressing teacher progress monitoring is critically important given the recent national focus on teacher evaluation and effectiveness. This special topic section of School Psychology Quarterly is the first to showcase the current research on measuring Tier 1 instructional and behavioral management practices used by prekindergarten and elementary school teachers in general education settings. The three studies included in the special section describe the development and validation efforts of several teacher observational and self-report measures of instruction and/or behavioral management. These studies provide evidence for the utility of such assessments for documenting the use of classroom practices, and these assessment results may be leveraged in innovative coaching models to promote best practice. These articles also offer insight and ideas for the next generation of teacher practice assessment for the field. Finally, the special topic is capped by a commentary synthesizing the current work and offers "big ideas" for future measurement development, policy, and professional development initiatives. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Mind the Gap: How do climate and agricultural management explain the "yield gap" of croplands around the world?

NASA Astrophysics Data System (ADS)

Licker, R.; Foley, J. A.; Johnston, M.

2007-12-01

At present, cultivated lands extend across approximately fifteen million square kilometers of the Earth's surface, making it one of the most dominant land cover types. The management practices used on these lands have become increasingly intensified, requiring large inputs of fertilizers and water, in addition to mechanization and biotechnology. These intensified practices have had implications for ecosystem goods and services ranging from water quality and availability to carbon sequestration. However, the billions of additional people that are projected to inhabit the planet in the twenty-first century will require further outputs from our global agricultural system. Given our food system's already expansive and intensive state, it is important to consider where the additional yields might come from and what additional management inputs this might require. In this study, we compare yields both within crop types and within regions of similar climate to determine where yield gaps exist. We do so using recently created, five-minute datasets of the area harvested and yield of 175 different crop types for the year 2000. We also explore the links of these yield gaps to global patterns of management. For example, we consider the ways in which management practices such as irrigation and fire are influencing yields around the world - analyses that can help critically evaluate the level of management currently employed and help imagine what management might be necessary to achieve higher yields in the future. These data will be needed in the next generation of Earth System models, in order to better represent the practices of agricultural land use in more realistic ways, thereby improving our understanding of land use / land cover change on the global carbon and water cycles, and the climate system.

Using Fluvial Geomorphology as a Physical Template in Process-Based and Recovery Enhancement Approaches to River Management

NASA Astrophysics Data System (ADS)

Fryirs, K.

2016-12-01

In an `era of river repair' fluvial geomorphology has emerged as a key science in river management practice. Geomorphologists are ideally placed to use their science in an applied manner to provide guidance on the impact of floods and droughts, landuse and climate change, and water use on river forms, processes and evolution. Increasingly, fluvial geomorphologists are also asked to make forecasts about how systems might adjust in the future, and to work with managers to implement strategies on-the-ground. Using case study material from Eastern Australia (Bega, Hunter, Wollombi and Lockyer catchments) I will focus on how process-based understanding of rivers has developed and evolved to provide a coherent physical template for effective and proactive, river management practice. I will focus on four key principles and demonstrate how geomorphology has been, and should continue to be, used in process-based, recovery enhancement approaches to river management. How understanding the difference between river behaviour and river change is used to determine how a river is `expected' to function, and how to identify anomalous processes requiring a treatment response. How understanding evolutionary trajectory is used to make future forecasts on river condition and recovery potential, and how working with processes can enhance river recovery. How geomorphic information can be used as a physical template atop which to analyse a range of biotic processes and habitat outcomes. How geomorphic information is used to effectively prioritise and plan river conservation and rehabilitation activities as part of catchment and region-scale action plans.

The effectiveness and resilience of phosphorus management practices in the Lake Simcoe watershed, Ontario, Canada

NASA Astrophysics Data System (ADS)

Crossman, J.; Futter, M. N.; Palmer, M.; Whitehead, P. G.; Baulch, H. M.; Woods, D.; Jin, L.; Oni, S. K.; Dillon, P. J.

2016-09-01

Uncertainty surrounding future climate makes it difficult to have confidence that current nutrient management strategies will remain effective. This study used monitoring and modeling to assess current effectiveness (% phosphorus reduction) and resilience (defined as continued effectiveness under a changing climate) of best management practices (BMPs) within five catchments of the Lake Simcoe watershed, Ontario. The Integrated Catchment Phosphorus model (INCA-P) was used, and monitoring data were used to calibrate and validate a series of management scenarios. To assess current BMP effectiveness, models were run over a baseline period 1985-2014 with and without management scenarios. Climate simulations were run (2070-2099), and BMP resilience was calculated as the percent change in effectiveness between the baseline and future period. Results demonstrated that livestock removal from water courses was the most effective BMP, while manure storage adjustments were the least. Effectiveness varied between catchments, influenced by the dominant hydrological and nutrient transport pathways. Resilience of individual BMPs was associated with catchment sensitivity to climate change. BMPs were most resilient in catchments with high soil water storage capacity and small projected changes in frozen-water availability and in soil moisture deficits. Conversely, BMPs were less resilient in catchments with larger changes in spring melt magnitude and in overland flow proportions. Results indicated that BMPs implemented are not always those most suited to catchment flow pathways, and a more site-specific approach would enhance prospects for maintaining P reduction targets. Furthermore, BMP resilience to climate change can be predicted from catchment physical properties and present-day hydrochemical sensitivity to climate forcing.

Clinical practice guidelines for delirium management: potential application in palliative care.

PubMed

Bush, Shirley H; Bruera, Eduardo; Lawlor, Peter G; Kanji, Salmaan; Davis, Daniel H J; Agar, Meera; Wright, David Kenneth; Hartwick, Michael; Currow, David C; Gagnon, Bruno; Simon, Jessica; Pereira, José L

2014-08-01

Delirium occurs in patients across a wide array of health care settings. The extent to which formal management guidelines exist or are adaptable to palliative care is unclear. This review aims to 1) source published delirium management guidelines with potential relevance to palliative care settings, 2) discuss the process of guideline development, 3) appraise their clinical utility, and 4) outline the processes of their implementation and evaluation and make recommendations for future guideline development. We searched PubMed (1990-2013), Scopus, U.S. National Guideline Clearinghouse, Google, and relevant reference lists to identify published guidelines for the management of delirium. This was supplemented with multidisciplinary input from delirium researchers and other relevant stakeholders at an international delirium study planning meeting. There is a paucity of high-level evidence for pharmacological and non-pharmacological interventions in the management of delirium in palliative care. However, multiple delirium guidelines for clinical practice have been developed, with recommendations derived from "expert opinion" for areas where research evidence is lacking. In addition to their potential benefits, limitations of clinical guidelines warrant consideration. Guidelines should be appraised and then adapted for use in a particular setting before implementation. Further research is needed on the evaluation of guidelines, as disseminated and implemented in a clinical setting, focusing on measurable outcomes in addition to their impact on quality of care. Delirium clinical guidelines are available but the level of evidence is limited. More robust evidence is required for future guideline development. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Strategies for preventing type 2 diabetes: an update for clinicians

PubMed Central

Amer, Halima; Ibrahim, Bashar; Brownrigg, Jack

2013-01-01

Diabetes is a major and growing public health challenge which threatens to overwhelm medical services in the future. Type 2 diabetes confers significant morbidity and mortality, most notably with target organ damage to the eyes, kidneys, nerves and heart. The magnitude of cardiovascular risk associated with diabetes is best illustrated by its position as a coronary heart disease risk equivalent. Complications related to neuropathy are also vast, often working in concert with vascular abnormalities and resulting in serious clinical consequences such as foot ulceration. Increased understanding of the natural history of this disorder has generated the potential to intervene and halt pathological progression before overt disease ensues, after which point management becomes increasingly challenging. The concept of prediabetes as a formal diagnosis has begun to be translated from the research setting to clinical practice, but with continually updated guidelines, varied nomenclature, emerging pharmacotherapies and an ever-changing evidence base, clinicians may be left uncertain of best practice in identifying and managing patients at the prediabetic stage. This review aims to summarize the epidemiological data, new concepts in disease pathogenesis and guideline recommendations in addition to lifestyle, pharmacological and surgical therapies targeted at stopping progression of prediabetes to diabetes. While antidiabetic medications, with newer anti-obesity medications and interventional bariatric procedures have shown some promising benefits, diet and therapeutic lifestyle change remains the mainstay of management to improve the metabolic profile of individuals with glucose dysregulation. New risk stratification tools to identify at-risk individuals, coupled with unselected population level intervention hold promise in future practice. PMID:23997928

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

Cassidy, Helen; Rossiter, David

The Low Level Waste Repository (LLWR) is the primary facility for disposal of Low Level Waste (LLW) in the United Kingdom (UK), serving the UK nuclear industry and a diverse range of other sectors. Management of LLW in the UK historically was dominated by disposal to the LLWR. The value of the LLWR as a national asset was recognised by the 2007 UK Governmental Policy on management of solid LLW. At this time, analysis of the projected future demand for disposal at LLWR against facility capacity was undertaken identifying a credible risk that the capacity of LLWR would be insufficientmore » to meet future demand if existing waste management practices were perpetuated. To mitigate this risk a National Strategy for the management of LLW in the UK was developed by the Nuclear Decommissioning Authority (NDA), partnered with LLW Repository Ltd. (the organisation established in 2008 to manage the LLWR on behalf of NDA). This strategy was published in 2010 and identified three mechanisms for protection of the capacity of LLWR - application of the Waste Hierarchy by waste producers; optimised use of existing assets for LLW management; and opening of new waste treatment and disposal routes to enable diversion of waste away from the LLWR. (authors)« less

Computer simulation as a teaching aid in pharmacy management--Part 1: Principles of accounting.

PubMed

Morrison, D J

1987-06-01

The need for pharmacists to develop management expertise through participation in formal courses is now widely acknowledged. Many schools of pharmacy lay the foundations for future management training by providing introductory courses as an integral or elective part of the undergraduate syllabus. The benefit of such courses may, however, be limited by the lack of opportunity for the student to apply the concepts and procedures in a practical working environment. Computer simulations provide a means to overcome this problem, particularly in the field of resource management. In this, the first of two articles, the use of a computer model to demonstrate basic accounting principles is described.

An adaptive watershed management assessment based on watershed investigation data.

PubMed

Kang, Min Goo; Park, Seung Woo

2015-05-01

The aim of this study was to assess the states of watersheds in South Korea and to formulate new measures to improve identified inadequacies. The study focused on the watersheds of the Han River basin and adopted an adaptive watershed management framework. Using data collected during watershed investigation projects, we analyzed the management context of the study basin and identified weaknesses in water use management, flood management, and environmental and ecosystems management in the watersheds. In addition, we conducted an interview survey to obtain experts' opinions on the possible management of watersheds in the future. The results of the assessment show that effective management of the Han River basin requires adaptive watershed management, which includes stakeholders' participation and social learning. Urbanization was the key variable in watershed management of the study basin. The results provide strong guidance for future watershed management and suggest that nonstructural measures are preferred to improve the states of the watersheds and that consistent implementation of the measures can lead to successful watershed management. The results also reveal that governance is essential for adaptive watershed management in the study basin. A special ordinance is necessary to establish governance and aid social learning. Based on the findings, a management process is proposed to support new watershed management practices. The results will be of use to policy makers and practitioners who can implement the measures recommended here in the early stages of adaptive watershed management in the Han River basin. The measures can also be applied to other river basins.

A 2011 survey of clinical practice patterns in the management of Graves' disease.

PubMed

Burch, Henry B; Burman, Kenneth D; Cooper, David S

2012-12-01

More than two decades have passed since members from the American Thyroid Association (ATA), European Thyroid Association, and Japan Thyroid Association were surveyed on management practices for patients with hyperthyroidism due to Graves' disease (GD). We sought to document current practices in the management of GD and compare these results both to those documented in earlier surveys and to practice recommendations made in the 2011 ATA/American Association of Clinical Endocrinologists (AACE) hyperthyroidism practice guidelines. Lastly, we sought to examine differences in GD management among international members of U.S.-based endocrine societies. Members of The Endocrine Society (TES), ATA, and AACE were invited to participate in a web-based survey dealing with testing, treatment preference, and modulating factors in patients with GD. A total of 730 respondents participated in the survey, 696 of whom completed all sections. Respondents included 641 TES members, 330 AACE members, and 157 ATA members. The preferred mode of therapy in uncomplicated GD was antithyroid drugs (ATDs) by 53.9% of respondents, radioactive iodine (RAI) therapy by 45.0%, and thyroid surgery in 0.7%. Compared with 1991, fewer U.S. (59.7 vs. 69%) and European (13.3% vs. 25%) respondents would use RAI therapy. Methimazole and carbimazole were the preferred ATDs, with only 2.7% of respondents selecting propylthiouracil. Patients with Graves' ophthalmopathy were treated with ATDs (62.9%) or surgery (18.5%) and less frequently with RAI plus corticosteroids (16.9%) or RAI alone (1.9%). Striking changes have occurred in the management of GD over the past two decades, with a shift away from RAI and toward ATDs in patients with uncomplicated GD. Apparent international differences persist but should be interpreted with caution. Current practices diverge in some areas from recently published guidelines; these differences should be assessed serially to determine the impact of the guidelines on future clinical practice.

The transformative power of social media: Considerations for practice and emerging leaders.

PubMed

Booth, Richard G; Strudwick, Gillian; Fraser, Robert

2017-05-01

Social media has transformed how people communicate both in non-healthcare and healthcare-specific settings. Due to social media's growing importance in society, it is likely that this form of communication will reshape various elements of how healthcare is conceptualized, managed, and delivered. To explore this emerging issue, this article describes the current use of social media in healthcare and examines the future digital transformation of healthcare. Finally, recommendations toward leveraging social media, and how emerging leaders can act as digital stewards to inform future healthcare environments, are also provided.

Creating an improvement culture for enhanced patient safety: service improvement learning in pre-registration education.

PubMed

Christiansen, Angela; Robson, Linda; Griffith-Evans, Christine

2010-10-01

The present study reports a descriptive survey of nursing students' experience of service improvement learning in the university and practice setting. Opportunities to develop service improvement capabilities were embedded into pre-registration programmes at a university in the Northwest of England to ensure future nurses have key skills for the workplace. A cross-sectional survey designed to capture key aspects of students' experience was completed by nursing students (n = 148) who had undertaken a service improvement project in the practice setting. Work organizations in which a service improvement project was undertaken were receptive to students' efforts. Students reported increased confidence to undertake service improvement and service improvement capabilities were perceived to be important to future career development and employment prospects. Service improvement learning in pre-registration education appears to be acceptable, effective and valued by students. Further research to identify the impact upon future professional practice and patient outcomes would enhance understanding of this developing area. Nurse Managers can play an active role in creating a service culture in which innovation and improvement can flourish to enhance patient outcomes, experience and safety. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Soil carbon management in large-scale Earth system modelling: implications for crop yields and nitrogen leaching

NASA Astrophysics Data System (ADS)

Olin, S.; Lindeskog, M.; Pugh, T. A. M.; Schurgers, G.; Wårlind, D.; Mishurov, M.; Zaehle, S.; Stocker, B. D.; Smith, B.; Arneth, A.

2015-11-01

Croplands are vital ecosystems for human well-being and provide important ecosystem services such as crop yields, retention of nitrogen and carbon storage. On large (regional to global)-scale levels, assessment of how these different services will vary in space and time, especially in response to cropland management, are scarce. We explore cropland management alternatives and the effect these can have on future C and N pools and fluxes using the land-use-enabled dynamic vegetation model LPJ-GUESS (Lund-Potsdam-Jena General Ecosystem Simulator). Simulated crop production, cropland carbon storage, carbon sequestration and nitrogen leaching from croplands are evaluated and discussed. Compared to the version of LPJ-GUESS that does not include land-use dynamics, estimates of soil carbon stocks and nitrogen leaching from terrestrial to aquatic ecosystems were improved. Our model experiments allow us to investigate trade-offs between these ecosystem services that can be provided from agricultural fields. These trade-offs are evaluated for current land use and climate and further explored for future conditions within the two future climate change scenarios, RCP (Representative Concentration Pathway) 2.6 and 8.5. Our results show that the potential for carbon sequestration due to typical cropland management practices such as no-till management and cover crops proposed in previous studies is not realised, globally or over larger climatic regions. Our results highlight important considerations to be made when modelling C-N interactions in agricultural ecosystems under future environmental change and the effects these have on terrestrial biogeochemical cycles.

Partnering to change the world for people with haemophilia: 7th Haemophilia Global Summit, Madrid, Spain 22-24 September 2016.

PubMed

Dolan, Gerry

2017-10-01

The 7th Haemophilia Global Summit was held in Madrid, Spain, in September 2016. With a programme designed, for the 6th consecutive year, by a Scientific Steering Committee of haemophilia experts, the aim of the summit was to share optimal management strategies for haemophilia at all life stages and to provide an opportunity for specialists from across the haemophilia multidisciplinary care team to engage in discussion and debate with leading international experts on current and future areas of research. Topics covered ranged from the optimisation of haemophilia management, emerging issues in clinical care, practical approaches and future perspectives, in addition to patient engagement and empowerment in modern haemophilia care. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Embryo futures and stem cell research: the management of informed uncertainty

PubMed Central

Ehrich, Kathryn; Williams, Clare; Farsides, Bobbie; Scott, Rosamund

2012-01-01

In the social worlds of assisted conception and stem cell science, uncertainties proliferate and particular framings of the future may be highly strategic. In this article we explore meanings and articulations of the future using data from our study of ethical and social issues implicated by the donation of embryos to human embryonic stem cell research in three linked assisted conception units and stem cell laboratories in the UK. Framings of the future in this field inform the professional management of uncertainty and we explore some of the tensions this involves in practice. The bifurcation of choices for donating embryos into accepting informed uncertainty or not donating at all was identified through the research process of interviews and ethics discussion groups. Professional staff accounts in this study contained moral orientations that valued ideas such as engendering patient trust by offering full information, the sense of collective ownership of the National Heath Service and publicly funded science and ideas for how donors might be able to give restricted consent as a third option. PMID:21812792

The public hospital of the future.

PubMed

Zajac, Jeffrey D

2003-09-01

Public hospitals designed for the past are not changing rapidly enough to meet the needs of the future. Changing work practices, increased pressure on bed occupancy, and greater numbers of patients with complex diseases and comorbidities will determine the functions of future hospitals. To maximise the use of resources, hospital "down times" on weekends and public holidays will be a distant memory. Elective surgery will increase in the traditionally "quiet times", such as summer, and decrease in the busy winter period. The patient will be the focus of an efficient information flow, streamlining patient care in hospital and enhancing communication between hospitals and community-based health providers. General and specialty units will need to work more efficiently together, as general physicians take on the role of patient case managers for an increasing proportion of patients. Funding needs to be adequate, and system management should involve clinicians. Safety will be enshrined in hospital systems and procedures, as well as in the minds of hospital staff. If these changes are not implemented successfully, public hospitals will not survive in the future.

Diagnosis and management of temperature abnormality in ICUs: a EUROBACT investigators' survey.

PubMed

Niven, Daniel J; Laupland, Kevin B; Tabah, Alexis; Vesin, Aurélien; Rello, Jordi; Koulenti, Despoina; Dimopoulos, George; de Waele, Jan; Timsit, Jean-Francois

2013-12-10

Although fever and hypothermia are common abnormal physical signs observed in patients admitted to intensive care units (ICU), little data exist on their optimal management. The objective of this study was to describe contemporary practices and determinants of management of temperature abnormalities among patients admitted to ICUs. Site leaders of the multi-national EUROBACT study were surveyed regarding diagnosis and management of temperature abnormalities among patients admitted to their ICUs. Of the 162 ICUs originally included in EUROBACT, responses were received from 139 (86%) centers in 23 countries in Europe (117), South America (8), Asia (5), North America (4), Australia (3) and Africa (2). A total of 117 (84%) respondents reported use of a specific temperature threshold in their ICU to define fever. A total of 14 different discrete levels were reported with a median of 38.2°C (inter-quartile range, IQR, 38.0°C to 38.5°C). The use of thermometers was protocolized in 91 (65%) ICUs and a wide range of methods were reportedly used, with axillary, tympanic and urinary bladder sites as the most common as primary modalities. Only 31 (22%) of respondents indicated that there was a formal written protocol for temperature control among febrile patients in their ICUs. In most or all cases practice was to control temperature, to use acetaminophen, and to perform a full septic workup in febrile patients and that this was usually directed by physician order. While reported practice was to treat nearly all patients with neurological impairment and most patients with acute coronary syndromes and infections, severe sepsis and septic shock, this was not the case for most patients with liver failure and fever. A wide range of definitions and management practices were reported regarding temperature abnormalities in the critically ill. Documenting temperature abnormality management practices, including variability in clinical care, is important to inform planning of future studies designed to optimize infection and temperature management strategies in the critically ill.

Health care marketing: doctors to patients and hospitals to doctors.

PubMed

Paul, D P; Honeycutt, E D

1996-01-01

The adoption and usage of formal marketing practices by hospitals and physicians have increased exponentially over the past twenty-five years. This article examines marketing developments within the doctor-patient and hospital-patient associations, as well as the impact of managed care on these two relationships. Conclusions are drawn and suggestions for future research are provided.

Growing trees where trees grow best: short-term research sheds light on long-term productivity.

Treesearch

Jonathan Thompson

2008-01-01

In 1999, the Fall River Long-Term Site Productivity study began in coastal Washington to investigate how intensive management practices affect soil processes and forest productivity. By comparing conventional harvests to more intensive wood removal treatments, researchers are answering long-standing questions about how residual organic matter influences future growth....

The Professional Socialization of Students in Today's Russian Institution of Higher Learning. A Sociological Analysis

ERIC Educational Resources Information Center

Tikhonova, E. V.

2013-01-01

Research on students studying business management shows that there is a series of changes they go through during their education, during which students become more concerned with the practical application of what they are learning and how it will fit into their future careers. (Contains 7 tables, 2 figures, and 4 notes.)

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

ERIC Educational Resources Information Center

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

2009-01-01

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

Invasive species and disturbances: Current and future roles of Forest Service Research and Development

Treesearch

Jim Slavicek; Allen M. Solomon

2010-01-01

The success of an invasive species is in large part due to favorable conditions resulting from the complex interactions among natural and anthropogenic factors such as native and nonnative pests, fires, droughts, hurricanes, wind storms, ice storms, climate warming, management practices, human travel, and trade. Reducing the negative effects of invasive species and...

Retooling for the future.

PubMed

Andrews, D

1999-04-01

Several trends will accelerate changes in the industry initiated by Medicare's change in payment methodology, including explosive growth fueled by changing demographics, patient preferences, and technological advances; altered customer buying incentives created by managed care organization-provider partnerships; and accelerated consolidation. Home care agencies should "take inventory" of current practices and systems to determine capability gaps for competing in the new environment.

University of Missouri-St. Louis: Data-Driven Online Course Design and Effective Practices

ERIC Educational Resources Information Center

Grant, Mary Rose

2012-01-01

Analytics has a significant place in the future of higher education by guiding reform and system change. As this case study has shown, analytics can do more than evaluate what students have done and predict what they will do. Learning analytics can be transformative, altering existing pedagogical processes, research, data management, and…

Proceedings of the symposium on fire and watershed management

Treesearch

Neil H. Berg

1989-01-01

Wildfires have affected the landscape since the dawn of time and will continue to do so for the foreseeable future. Policies and practices in response to fire have varied, however, contingent upon a complex mix of values and attitudes overlaid by the technical acumen available to both "fight" the fire and reclaim the land afterwards.

Discussion of the Design and Implementation of the Lauder Content-Based Curriculum: Practical and Theoretical Considerations.

ERIC Educational Resources Information Center

Cowles, Maria Antonia

The dual-degree MBA/MA program of the University of Pennsylvania is described. The program is designed to provide future business leaders with superior international management education and prepare them to operate effectively and comfortably in the global economy through social and professional language skills and knowledge of diverse cultural…

Worldwide Practice Patterns in Lynch Syndrome Diagnosis and Management, Based on Data From the International Mismatch Repair Consortium.

PubMed

Pan, Jennifer Y; Haile, Robert W; Templeton, Allyson; Macrae, Finlay; Qin, FeiFei; Sundaram, Vandana; Ladabaum, Uri

2018-04-24

Families with a history of Lynch syndrome often do not adhere to guidelines for genetic testing and screening. We investigated practice patterns related to Lynch syndrome worldwide, to ascertain potential targets for research and public policy efforts. We collected data from the International Mismatch Repair Consortium (IMRC), which comprises major research and clinical groups engaged in the care of families with Lynch syndrome worldwide. IMRC institutions were invited to complete a questionnaire to characterize diagnoses of Lynch syndrome and management practice patterns. Fifty-five providers, representing 63 of 128 member institutions (49%) in 21 countries, completed the questionnaire. For case finding, 55% of respondents reported participating in routine widespread population tumor testing among persons with newly diagnosed Lynch syndrome-associated cancers, whereas 27% reported relying on clinical criteria with selective tumor and/or germline analyses. Most respondents (64%) reported using multigene panels for germline analysis, and only 28% reported testing tumors for biallelic mutations for cases in which suspected pathogenic mutations were not confirmed by germline analysis. Respondents reported relying on passive dissemination of information to at-risk family members, and there was variation in follow through of genetic testing recommendations. Reported risk management practices varied-nearly all programs (98%) recommended colonoscopy every 1 to 2 years, but only 35% recommended chemoprevention with aspirin. There is widespread heterogeneity in management practices for Lynch syndrome worldwide among IMRC member institutions. This may reflect the rapid pace of emerging technology, regional differences in resources, and the lack of definitive data for many clinical questions. Future efforts should focus on the large numbers of high-risk patients without access to state-of-the-art Lynch syndrome management. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

State Wildlife Action Plans as Tools for Adapting to a Continuously Changing Climate

NASA Astrophysics Data System (ADS)

Metivier, D. W.; Yocum, H.; Ray, A. J.

2015-12-01

Public land management plans are potentially powerful policies for building sustainability and adaptive capacity. Land managers are recognizing the need to respond to numerous climate change impacts on natural and human systems. For the first time, in 2015, the federal government required each state to incorporate climate change into their State Wildlife Action Plans (SWAP) as a condition for funding. As important land management tools, SWAPs have the potential to guide state agencies in shaping and implementing practices for climate change adaptation. Intended to be revised every ten years, SWAPs can change as conditions and understanding of climate change evolves. This study asks what practices are states using to integrate climate change, and how does this vary between states? To answer this question, we conducted a broad analysis among seven states (CO, MT, NE, ND, SD, UT, WY) and a more in-depth analysis of four states (CO, ND, SD, WY). We use seven key factors that represent best practices for incorporating climate change identified in the literature. These best practices are species prioritization, key habitats, threats, monitoring, partnerships and participation, identification of management options, and implementation of management options. The in-depth analysis focuses on how states are using climate change information for specific habitats addressed in the plans. We find that states are integrating climate change in many different ways, showing varying degrees of sophistication and preparedness. We summarize different practices and highlight opportunities to improve the effectiveness of plans through: communication tools across state lines and stakeholders, explicit targeting of key habitats, enforcement and monitoring progress and success, and conducting vulnerability analyses that incorporate topics beyond climate and include other drivers, trajectories, and implications of historic and future land-use change.

Physiotherapists' experiences of the management of anterior cruciate ligament injuries.

PubMed

von Aesch, Arlene V; Perry, Meredith; Sole, Gisela

2016-05-01

While extensive research has been reported for management of anterior cruciate ligament (ACL) injuries, variation in treatment by physiotherapists is evident. To explore physiotherapists' experiences regarding ACL injury rehabilitation and factors that influenced physiotherapists' decision making for ACL rehabilitation, and to elicit what research physiotherapists perceived would support their management of these patients. Qualitative study. Fifteen physiotherapists from six private clinics in New Zealand participated in semi-structured interviews. The interviews were recorded, transcribed verbatim and the general inductive approach was used to develop key themes. Participant's management strengths were evident by their intent and commitment to provide expert rehabilitation, using a biopsychosocial approach and evidence-informed practice. The lengthy management process (including prolonged rehabilitation and referral processes) and interprofessional disconnect concerned participants. Translational research was needed for clear directions for exercise prescription and milestones for return to sports and occupation following ACL injury. Participants provided a biopsychosocial and evidence-based approach to ACL injury management. Potential areas of improvement include simplifying the referral process and enhancing communication between physiotherapists and other health professionals. Future research should focus on clarifying areas of ACL rehabilitation uncertainty, or collating results in an accessible and usable format for clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Back to the Future for Clinical Oncology.

PubMed

Chabner

1996-01-01

Dear Colleague: I remember, but just barely, what it was like to practice medicine in the first half of this century. My Dad was a general practitioner in a very small farming community in central Illinois, with a hospital of six beds and a trusting clientele. His patients thought he knew how to do everything: deliver babies, set broken bones and take out an appendix. He was an advocate for his patients, not for an HMO or an insurance company. He derived great satisfaction from his practice and was comfortable in this role, up to a point, but knew that he frequently needed the help of specialists from Decatur, St. Louis, and the Mayo Clinic. As his experience and practice evolved, and as medicine itself changed, referrals became a sign of good practice and not an indication of weakness or inadequacy. Some doctors in our town continued to do more than they should have and resisted the trend, and their patients, many with blind faith in their doctor, suffered for it. Clearly, there were economic as well as emotional factors that contributed to this reluctance to ask for help. Clinical oncology is facing much the same situation today. Scientific and economic forces are revolutionizing medicine, but not always in compatible directions. Practice and research have evolved to the point where old patterns of practice are no longer optimal. Few cancer patients can be managed without the input, advice, and even direct involvement of specialists from sister disciplines. Thus, multimodality management of cancer patients is now the norm rather than the exception. At the same time, strong economic forces are dictating a movement in the opposite direction, undermining the strength of traditional academic centers and limiting choices, streamlining patient evaluation, and creating "pathways" to standardize patient management. Who should be setting the course for the cancer patient? We agree that it should not be a clerk at the other end of the phone at the HMO, a computerized practice manual, or even the gatekeeper, who watches his or her capitated bottom line with great nervousness. It should be the physician(s) best able to evaluate the alternatives and communicate these choices to the patient and family. Often it is not possible for a solo physician to make these choices in isolation, particularly when the decisions involve multiple specialties and multimodality therapies. At presentation, many primary cancers now require an integration of the opinion of more than one specialist, and increasingly this integration occurs before surgery. Breast, lung, and prostate cancer, three of our most common diseases, illustrate this point with growing clarity. While less convenient for the doctor, and perhaps less efficient than the "old style" of practice, multimodatity disease center clinics offer significant advantages both to the patient and to the research effort, and are here to stay. Certainly for the payer it is faster and cheaper to have one doctor do it all, but I doubt that the results will be as good. Obviously not all patients need this cooperative approach. It would waste good physicians' time to require that all patients be seen by a radiotherapist, surgeon, and medical oncologist or pediatric oncologist. The specific circumstances may clearly dictate a simple approach and an uncomplicated decision, particularly in dealing with metastatic solid tumors, or at the other extreme, in managing easily resectable, low-risk tumors. However, even here, optimal management of local disease or of potentially resectable metastases may require consideration of an expanded series of options. Thus, all cancer specialists need to be aware of the potential of their colleagues to contribute to disease management. ellipsisWhich brings us to the reason for this journal. The editorial board members of The Oncologist hold the belief that the various subspecialists in oncology should share the same information base and read from the same journal. We believe that cancer specialists should resist the trend to capitulate our responsibilities in disease management to payers, gatekeepers, and hospital administrators. It is up to us to defend the patient's turf and to assure that the patient has an advocate. In order to do so, we will have to be united and fully informed. In this journal, we hope to put the best and latest information on cancer management before our readership, to prepare them for the future, and to do their best as a team for every patient. To this end, we hope to challenge the reader to understand what is new and better, and to let you glimpse the future, not only in terms of research, but also in terms of new team approaches to disease management. We hope to explore how cancer medicine could be and will be practiced as we pass through the economic revolution and return to the future.

Marsh management plans in practice: Do they work in coastal Louisiana, USA?

NASA Astrophysics Data System (ADS)

Cowan, James H.; Turner, R. Eugene; Cahoon, Donald R.

1988-01-01

Louisiana's coastal wetlands represent about 41% of the nation's total and are extensively managed for fish, fur, and waterfowl. Marsh management plans (MMPs) are currently used to avoid potential user conflicts and are believed to be a best management practice for specific management goals. In this article, we define MMPs and examine their variety, history, impacts, and future. A MMP is an organized written plan submitted to state and federal permitting agencies for approval and whose purpose is to regulate wetland habitat quantity and quality (control land loss and enhance productivity). MMPs are usually implemented by making structural modifications in the marsh, primarily by using a variety of water control structures in levees to impound or semi-impound managed areas. It appears that MMPs using impoundments are only marginally successful in achieving and often contradict management goals. Although 20% of coastal Louisiana may be in MMPs by the year 2000, conflict resolution of public and private goals is compromised by a surfeit of opinion and dearth of data and experience. Based on interpretation of these results, we believe the next phase of management should include scientific studies of actual impacts, utilization of post-construction monitoring data, inventory of existing MMPs, development of new techniques, and determination of cumulative impacts.

Care for a Patient With Cancer As a Project: Management of Complex Task Interdependence in Cancer Care Delivery.

PubMed

Trosman, Julia R; Carlos, Ruth C; Simon, Melissa A; Madden, Debra L; Gradishar, William J; Benson, Al B; Rapkin, Bruce D; Weiss, Elisa S; Gareen, Ilana F; Wagner, Lynne I; Khan, Seema A; Bunce, Mikele M; Small, Art; Weldon, Christine B

2016-11-01

Cancer care is highly complex and suffers from fragmentation and lack of coordination across provider specialties and clinical domains. As a result, patients often find that they must coordinate care on their own. Coordinated delivery teams may address these challenges and improve quality of cancer care. Task interdependence is a core principle of rigorous teamwork and is essential to addressing the complexity of cancer care, which is highly interdependent across specialties and modalities. We examined challenges faced by a patient with early-stage breast cancer that resulted from difficulties in understanding and managing task interdependence across clinical domains involved in this patient's care. We used team science supported by the project management discipline to discuss how various task interdependence aspects can be recognized, deliberately designed, and systematically managed to prevent care breakdowns. This case highlights how effective task interdependence management facilitated by project management methods could markedly improve the course of a patient's care. This work informs efforts of cancer centers and practices to redesign cancer care delivery through innovative, practical, and patient-centered approaches to management of task interdependence in cancer care. Future patient-reported outcomes research will help to determine optimal ways to engage patients, including those who are medically underserved, in managing task interdependence in their own care.

Practical Side of the Bibliographic Information Retrieval System in the National Museum of Ethnology

NASA Astrophysics Data System (ADS)

Kondo, Katsuichi

The information retrieval system of the National Museum of Ethnology made its debut in 1979 and now enables us to search the books not only in the Museum but in the country and abroad by means of JAPAN MARC & LC MARC. The author presents the outline and the development of the information managing system including the above briefly and secondly the practical case of using our retrieval system in particular. The problems to be solved in the course of the future plan are also mentioned.

Discursive construction of polyphony in healthcare management.

PubMed

Hujala, Anneli; Rissanen, Sari

2012-01-01

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

Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

PubMed

Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

2017-11-01

While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

Weight management practices associated with PCOS and their relationships with diet and physical activity.

PubMed

Moran, L J; Brown, W J; McNaughton, S A; Joham, A E; Teede, H J

2017-03-01

Do weight management practices differ in women with and without PCOS? Women in the general population with self-reported PCOS are more likely to be using healthy weight management practices and alternative non-lifestyle measures for weight management than women without PCOS. Lifestyle management is the first-line treatment in PCOS. However, the specific weight management practices used by women with PCOS and their effect on diet and physical activity are unclear. The study was a population-based observational cross-sectional study involving women in the 1973-1978 cohort (n = 7767 total; n = 556 with PCOS, n = 7211 without PCOS). Women with and without self-reported PCOS were included. Self-reported outcome measures included healthy lifestyle-related or alternative non-lifestyle-related (e.g. laxatives or smoking) weight management practices, dietary intake and physical activity. Women with PCOS were more likely to be following both healthy [reducing meal or snack size (odds ratio (OR) 1.50, 95% CI 1.14, 1.96, P = 0.004) and reducing fat or sugar intake (OR 1.32, 95% CI 1.03, 1.69, P = 0.027) or following a low glycaemic index diet (OR 2.88, 95% CI 2.30, 3.59, P < 0.001)] and alternative [smoking (OR 1.60, 95% CI 1.02, 2.52, P = 0.043) or use of laxative, diet pills, fasting or diuretics (OR 1.45, 95% CI 1.07, 1.97, P = 0.017)] weight management practices than women without PCOS. In PCOS, the use of a range of healthy weight management practices was associated with increases in physical activity (P < 0.001), diet quality (P < 0.001), percentage protein intake (P < 0.001) and decreases in glycaemic index (P < 0.001), and percentages of fat (P = 0.001), saturated fat (P < 0.001) or fibre (P = 0.003). Use of alternative weight management practices was associated with decreases in diet quality. Limitations include the use of self-reported data for PCOS, height, weight, diet, physical activity and weight management behaviours. In PCOS, we should focus on improving healthy weight practices across both diet quality and quantity, and on assessing alternative weight practices and their potential adverse effect on dietary intake. L.M. is supported by a South Australian Cardiovascular Research Development Program Fellowship (ID AC11S374); a program collaboratively funded by the National Heart Foundation, the South Australian Department of Health and the South Australian Health and Medical Research Institute. H.T. is supported by the NHMRC. S.A.M. is supported by an NHMRC Career Development Fellowship Level 2, ID1104636 and was previously supported by an ARC Future Fellowship (2011-2015, FT100100581). The authors declare no conflict of interest. Not applicable. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study.

PubMed

Rafferty, Rae; Fairbrother, Greg

2015-06-01

To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. A grounded theory study design. Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs. © 2015 John Wiley & Sons Ltd.

Scenarios reveal pathways to sustain future ecosystem services in an agricultural landscape.

PubMed

Qiu, Jiangxiao; Carpenter, Stephen R; Booth, Eric G; Motew, Melissa; Zipper, Samuel C; Kucharik, Christopher J; Chen, Xi; Loheide, Steven P; Seifert, Jenny; Turner, Monica G

2018-01-01

Sustaining food production, water quality, soil retention, flood, and climate regulation in agricultural landscapes is a pressing global challenge given accelerating environmental changes. Scenarios are stories about plausible futures, and scenarios can be integrated with biophysical simulation models to explore quantitatively how the future might unfold. However, few studies have incorporated a wide range of drivers (e.g., climate, land-use, management, population, human diet) in spatially explicit, process-based models to investigate spatial-temporal dynamics and relationships of a portfolio of ecosystem services. Here, we simulated nine ecosystem services (three provisioning and six regulating services) at 220 × 220 m from 2010 to 2070 under four contrasting scenarios in the 1,345-km 2 Yahara Watershed (Wisconsin, USA) using Agro-IBIS, a dynamic model of terrestrial ecosystem processes, biogeochemistry, water, and energy balance. We asked (1) How does ecosystem service supply vary among alternative future scenarios? (2) Where on the landscape is the provision of ecosystem services most susceptible to future social-ecological changes? (3) Among alternative future scenarios, are relationships (i.e., trade-offs, synergies) among food production, water, and biogeochemical services consistent over time? Our results showed that food production varied substantially with future land-use choices and management, and its trade-offs with water quality and soil retention persisted under most scenarios. However, pathways to mitigate or even reverse such trade-offs through technological advances and sustainable agricultural practices were apparent. Consistent relationships among regulating services were identified across scenarios (e.g., trade-offs of freshwater supply vs. flood and climate regulation, and synergies among water quality, soil retention, and climate regulation), suggesting opportunities and challenges to sustaining these services. In particular, proactive land-use changes and management may buffer water quality against undesirable future climate changes, but changing climate may overwhelm management efforts to sustain freshwater supply and flood regulation. Spatially, changes in ecosystem services were heterogeneous across the landscape, underscoring the power of local actions and fine-scale management. Our research highlights the value of embracing spatial and temporal perspectives in managing ecosystem services and their complex interactions, and provides a system-level understanding for achieving sustainability of the food-water-climate nexus in agricultural landscapes. © 2017 by the Ecological Society of America.

Influences shaping nurses' use of distraction for children's procedural pain.

PubMed

Olmstead, Deborah L; Scott, Shannon D; Mayan, Maria; Koop, Priscilla M; Reid, Kathy

2014-04-01

This study explored pediatric nurses' choices to use distraction for managing painful procedures. Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain. Nurses' distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses' accounts of performing painful procedures on children mirrored children's descriptions of pain from the literature. Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain. © 2014, Wiley Periodicals, Inc.

Countertransference. Its continued importance in psychiatric education

PubMed Central

Rao, Nyapati R.; Meinzer, Arthur E.; Berman, Sheldon S.

1997-01-01

Psychotherapy is likely to play a minor or nonexistent role in the future general psychiatrist's training and practice. However, the component skills of recognition and management of the countertransference will remain important. Because psychotherapy training and supervision have been the venues for countertransference learning, the field is in danger of losing its teaching laboratory and hence losing these skills. The authors examine the concept of countertransference and discuss its importance in four increasingly significant areas: managed care, psychopharmacological treatment, emergency intervention, and the management of professional boundaries regarding sexual misconduct. Methods are discussed for enhancing residents' countertransference skills through supervision, training groups, and the resident's personal psychotherapy. PMID:9058556

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.

Training future surgeons for management roles: the resident-surgeon-manager conference.

PubMed

Hanna, Waël C; Mulder, David S; Fried, Gerald M; Elhilali, Mostafa; Khwaja, Kosar A

2012-10-01

OBJECTIVE To demonstrate that senior surgical residents would benefit from focused training by professionals with management expertise. Although managerial skills are recognized as necessary for the successful establishment of a surgical practice, they are not often emphasized in traditional surgical residency curricula. DESIGN Senior residents from all surgical subspecialties at McGill University were invited to participate in a 1-day management seminar. Precourse questionnaires aimed at evaluating the residents' perceptions of their own managerial knowledge and preparedness were circulated. The seminar was then given in the form of interactive lectures and case-based discussions. The questionnaires were readministered at the end of the course, along with an evaluation form. Precourse and postcourse data were compared using the Freeman-Halton extension of the Fisher exact test to determine statistical significance (P < .05). SETTING McGill University Health Centre in Montreal, Quebec, Canada. PARTICIPANTS A total of 43 senior residents. RESULTS Before the course, the majority of residents (27 of 43 [63%]) thought that management instruction only happened "from time to time" in their respective programs. After the course, 15 residents (35%) felt that management topics were "well addressed," and 19 (44%) felt that management topics have been "very well addressed" (P < .01). Residents noted a significant improvement in their ability to perform the following skills after the course: giving feedback, delegating duties, coping with stress, effective learning, and effective teaching. On the ensemble of all managerial skills combined, 26 residents (60%) rated their performance as "good" or "excellent" after the course vs only 21 (49%) before the course (P = .02). Residents also noted a statistically significant improvement in their ability to perform the managerial duties necessary for the establishment of a surgical practice. CONCLUSIONS Surgical residency programs have the responsibility of preparing their residents for leadership and managerial roles in their future careers. An annual seminar serves as a starting point that could be built on for incorporating formal management training in surgical residency curricula.

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme

NASA Astrophysics Data System (ADS)

Smith, David; Grand-Clement, Emile; Brazier, Richard

2014-05-01

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme Smith, D., Grand-Clement, E., Anderson, K., Luscombe, D., G, N., Bratis, Brazier, R.E Peatlands in the South West of the British Isles have been extensively drained for agricultural reclamation and peat cutting. The improvement in food production resulting from this management practice has never clearly been observed. Instead, we are now faced with several detrimental consequences on a whole suite of ecosystem services, such as the delivery of water, water quality, biodiversity and carbon storage. Alongside the direct environmental implications, poor water quality is increasing water treatment costs and will drive significant future investment. As a result, water companies now need to find appropriate solutions to varying water levels and decreasing water quality through catchment management. The Mires Project, the catchment management programme used by South West Water (SWW) is working with a wide range of stakeholders to restore the hydrological functioning of peatlands, and the ecosystem services they provide. This programme is driven by overarching legal requirements (i.e. the water framework directive, Natura 2000), future climate change predictions, corporate responsibility and commercial needs. Post-restoration scientific monitoring is at the heart of the project improving of our understanding of the eco-hydrological and chemical process driving changes in management practice. The challenges faced from the involvement of a wide range of stakeholders will be explored, focusing on the benefits from stakeholder involvement in catchment management and hydrological research, but also considering the difficulties to be overcome. SWW is working with private land-owners, government agencies, local and national park Authorities, community and single interest groups and research institutions to achieve its catchment management objectives. To achieve this it has replaced the traditional water company approach of hard engineering solutions with a mixture of softer natural and social engineering.

Effects of Management on Soil Carbon Pools in California Rangeland Ecosystems

NASA Astrophysics Data System (ADS)

Silver, W. L.; Ryals, R.; Lewis, D. J.; Creque, J.; Wacker, M.; Larson, S.

2008-12-01

Rangeland ecosystems managed for livestock production represent the largest land-use footprint globally, covering more than one-quarter of the world's land surface (Asner et al. 2004). In California, rangelands cover an estimated 17 million hectares or approximately 40% of the land area (FRAP 2003). These ecosystems have considerable potential to sequester carbon (C) in soil and offset greenhouse gas emissions through changes in land management practices. Climate policies and C markets may provide incentives for rangeland managers to pursue strategies that optimize soil C storage, yet we lack a thorough understanding of the effects of management on soil C pools in rangelands over time and space. We sampled soil C pools on rangelands in a 260 km2 region of Marin and Sonoma counties to determine if patterns in soil C storage exist with management. Replicate soil samples were collected from 35 fields that spanned the dominant soil orders, plant communities, and management practices in the region while controlling for slope and bioclimatic zone (n = 1050). Management practices included organic amendments, intensive (dairy) and extensive (other) grazing practices, and subsoiling. Soil C pools ranged from approximately 50 to 140 Mg C ha-1 to 1 m depth, with a mean of 99 ± 22 (sd) Mg C ha-1. Differences among sites were due primarily to C concentrations, which exhibited a much larger coefficient of variation than bulk density at all depths. There were no statistically significant differences among the dominant soil orders. Subsoiling appeared to significantly increase soil C content in the top 50 cm, even though subsoiling had only occurred for the first time the previous Nov. Organic amendments also appeared to greatly increase soil C pools, and was the dominant factor that distinguished soil C pools in intensive and extensive land uses. Our results indicate that management has the potential to significantly increase soil C pools. Future research will determine the location of sequestered C within the soil matrix and its turnover time.

Climate warming alters effects of management on population viability of threatened species: results from a 30-year experimental study on a rare orchid.

PubMed

Sletvold, Nina; Dahlgren, Johan P; Oien, Dag-Inge; Moen, Asbjørn; Ehrlén, Johan

2013-09-01

Climate change is expected to influence the viability of populations both directly and indirectly, via species interactions. The effects of large-scale climate change are also likely to interact with local habitat conditions. Management actions designed to preserve threatened species therefore need to adapt both to the prevailing climate and local conditions. Yet, few studies have separated the direct and indirect effects of climatic variables on the viability of local populations and discussed the implications for optimal management. We used 30 years of demographic data to estimate the simultaneous effects of management practice and among-year variation in four climatic variables on individual survival, growth and fecundity in one coastal and one inland population of the perennial orchid Dactylorhiza lapponica in Norway. Current management, mowing, is expected to reduce competitive interactions. Statistical models of how climate and management practice influenced vital rates were incorporated into matrix population models to quantify effects on population growth rate. Effects of climate differed between mown and control plots in both populations. In particular, population growth rate increased more strongly with summer temperature in mown plots than in control plots. Population growth rate declined with spring temperature in the inland population, and with precipitation in the coastal population, and the decline was stronger in control plots in both populations. These results illustrate that both direct and indirect effects of climate change are important for population viability and that net effects depend both on local abiotic conditions and on biotic conditions in terms of management practice and intensity of competition. The results also show that effects of management practices influencing competitive interactions can strongly depend on climatic factors. We conclude that interactions between climate and management should be considered to reliably predict future population viability and optimize conservation actions. © 2013 John Wiley & Sons Ltd.

Management practices associated with pain in cattle on western Canadian cow-calf operations: A mixed methods study.

PubMed

Moggy, M A; Pajor, E A; Thurston, W E; Parker, S; Greter, A M; Schwartzkopf-Genswein, K S; Campbell, J R; Windeyer, M C

2017-02-01

The implementation of on-farm pain mitigation strategies is dependent on feasibility and importance to producers. Currently, there is a lack of information regarding adoption of management practices associated with pain in cattle within the Canadian beef industry. The objective of this mixed methods study was to describe pain-associated practices implemented on farm and producer perceptions toward pain mitigation strategies. A questionnaire about calving management and calf processing was delivered to 109 cow-calf producers in western Canada. In addition, 15 respondents were purposively selected based on questionnaire responses to participate in individual semistructured, on-farm interviews. The prevalence of pain mitigation strategies used for dystocia and cesarean section by respondents were 46 and 100%, respectively. The majority of operations reported castrating and dehorning calves before 3 mo of age (95 and 89%, respectively). The majority of operations did not use pain mitigation strategies for castration and dehorning (90 and 85%, respectively). Branding was practiced by 57% of respondents, 4% of which used pain mitigation. Thematic content analysis revealed that producers' perception of pain were influenced by what they referred to as "common sense," relatability to cattle, visual evidence of pain, and age of the animal. Factors that influenced participant rationale for the implementation of pain mitigation practices included access to information and resources, age of the animal, benefit to the operation, cost and logistics, market demands, and personal conscience. Overall, management practices were generally in compliance with published Canadian guidelines. Results of this study may provide direction for future policy making, research, and extension efforts to encourage the adoption of pain mitigation strategies.

Omics databases on kidney disease: where they can be found and how to benefit from them.

PubMed

Papadopoulos, Theofilos; Krochmal, Magdalena; Cisek, Katryna; Fernandes, Marco; Husi, Holger; Stevens, Robert; Bascands, Jean-Loup; Schanstra, Joost P; Klein, Julie

2016-06-01

In the recent decades, the evolution of omics technologies has led to advances in all biological fields, creating a demand for effective storage, management and exchange of rapidly generated data and research discoveries. To address this need, the development of databases of experimental outputs has become a common part of scientific practice in order to serve as knowledge sources and data-sharing platforms, providing information about genes, transcripts, proteins or metabolites. In this review, we present omics databases available currently, with a special focus on their application in kidney research and possibly in clinical practice. Databases are divided into two categories: general databases with a broad information scope and kidney-specific databases distinctively concentrated on kidney pathologies. In research, databases can be used as a rich source of information about pathophysiological mechanisms and molecular targets. In the future, databases will support clinicians with their decisions, providing better and faster diagnoses and setting the direction towards more preventive, personalized medicine. We also provide a test case demonstrating the potential of biological databases in comparing multi-omics datasets and generating new hypotheses to answer a critical and common diagnostic problem in nephrology practice. In the future, employment of databases combined with data integration and data mining should provide powerful insights into unlocking the mysteries of kidney disease, leading to a potential impact on pharmacological intervention and therapeutic disease management.

From the Canadian Dietetic Association. Concept of dietetic practice and framework for undergraduate education for the 21st century.

PubMed

McDonald, B E; Evers, S; Simard-Mavrikakis, S; Mendelson, R; Schweitzer, J; Smyth, L; Beaudry, M

1993-01-01

Rapid change and marked diversity are expected to characterize the 21st century. If dietitians are to serve as change facilitators in this environment they will have to demonstrate greater flexibility and creativity, practise critical analysis and problem solving and employ creative thinking. Although provision of quality nutrition care will remain the unique contribution of dietitians, practitioners in the future will require a greater understanding of the impact of social, economic and political systems on food availability and food consumption and, in turn, health and well-being. Critical to the future practice of dietetics will be a greater understanding of research methodology, computer technology, quality improvement processes and risk management, principles governing learning and behaviour, personnel management and organizational behaviour, family and group dynamics, interpersonal communication and their application to dietetic practice. The Canadian Dietetic Association recently adopted a framework for the development of baccalaureate programs in dietetics designed to enable the dietetic practitioner to continue to make a unique contribution in the 21st century. The framework allows individual institutions the freedom and flexibility to plan programs that are compatible with their philosophy and organizational structure. In addition, it is predicted on the principle that a career in dietetics entails a lifetime commitment to education, of which the baccalaureate program is only the beginning.

Effects of Climate Change on Extreme Streamflow Risks in the Olympic National Park

NASA Astrophysics Data System (ADS)

Tohver, I. M.; Lee, S.; Hamlet, A.

2011-12-01

Conventionally, natural resource management practices are designed within the framework that past conditions serve as a baseline for future conditions. However, the warmer future climate projected for the Pacific Northwest will alter the region's flood and low flow risks, posing considerable challenges to resource managers in the Olympic National Forest (ONF) and Olympic National Park (ONP). Shifts in extreme streamflow will influence two key management objectives in the ONF and ONP: the protection of wildlife and the maintenance of road infrastructure. The ONF is charged with managing habitat for species listed under the Endangered Species Act (ESA), and with maintaining the network of forest roads and culverts. Climate-induced increases in flood severity will introduce additional challenges in road and culvert design. Furthermore, the aging road infrastructure and more extreme summer low flows will compromise aquatic habitats, intrinsic to the health of threatened and endangered fish species listed under the ESA. Current practice uses estimates of Q100 (or the peak flow with an estimated 100 year return frequency) as the standard metric for stream crossing design. Simple regression models relating annual precipitation and basin area to Q100 are used in the design process. Low flow estimates are based on historical streamflow data to calculate the 7-day consecutive lowest flow with a 10-year return interval, or 7Q10. Under the projections a changing climate, these methods for estimating extreme flows are ill equipped to capture the complex and spatially varying effects of seasonal changes in temperature, precipitation, and snowpack on extreme flow risk. As an alternative approach, this study applies a physically-based hydrologic model to estimate historical and future flood risk at 1/16th degree (latitude/longitude) resolution (about 32 km2). We downscaled climate data derived from 10 global climate models to use as input for the Variable Infiltration Capacity (VIC) model, a macro-scale hydrologic model, which simulates various hydrologic variables at a daily time step. Using the VIC estimates for baseflow and run-off, we calculated Q100 and 7Q10 for the historical period and under two emission scenarios, A1B and B1, at three future time intervals: the 2020s, the 2040s and the 2080s. We also calculated Q100 and 7Q10 at the spatial scale of the 12-digit hydrologic unit codes (HUCs) as delineated by the United States Geologic Survey. The results demonstrate the sensitivity of snowpack at mid-elevation basins to a warmer climate, resulting in more severe winter flooding and lower streamflows in the summertime. These ensemble estimates of extreme streamflows will serve as a tool for management practices by providing high-resolution maps of changing risk over the ONF and ONP.

Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit

PubMed Central

Swann, Ruth; McPhail, Sean; Witt, Jana; Shand, Brian; Abel, Gary A; Hiom, Sara; Rashbass, Jem; Lyratzopoulos, Georgios; Rubin, Greg

2018-01-01

Background Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. Aim To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. Design and setting Clinical audit of cancer diagnosis in general practices in England. Method Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. Results Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15–86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0–27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. Conclusion The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer. PMID:29255111

Land management strategies for improving water quality in biomass production under changing climate

DOE PAGES

Ha, Miae; Wu, May

2017-03-07

Here, the Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. In much of the nation, agricultural nutrients are a primary cause of water quality degradation. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. Thirty-six projections from select Regional Climate Models (RCM) for Representative Concentration Pathways (RCP) 2.5, 4.5,more » and 8.5 were used to develop climate change scenarios for the SFIR watershed and incorporated into the Soil and Water Assessment Tool (SWAT). The watershed is covered primarily with annual crops (corn and soybeans). Three scenarios of land use change and conservation practices were further developed to examine their impacts on water quality under historical and modeled future climate. With cropland conversion to switchgrass, stover harvest, and best management practices (BMPs) (such as establishing riparian buffers and applying cover crops) significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under historical climate, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compare with current land use when a portion of the cropland is converted to switchgrass and cover crop is in place. Climate change could cause an increase in 12.0% (SS), 4.7% (N), and 7.7% (P) from current land use. This increase could be mitigated through land management and practices by 53.6% (SS), 27.8 (N), and 7.0% (P). Climate change reduced crop yield. Nutrient and sediments loadings distributed heterogeneously across the watershed. Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management using long-term field to watershed water monitoring data is necessary to verify the findings and moving towards watershed specific regional programs for climate adaptation.« less

ORGANIC VS CONVENTIONAL: SOIL NEMATODE COMMUNITY STRUCTURE AND FUNCTION.

PubMed

Kapp, C; Storey, S G; Malan, A P

2014-01-01

Global increases in human population are creating an ever-greater need for food production. Poor soil management practices have degraded soil to such an extent that rapidly improved management practices is the only way to ensure future food demands. In South Africa, deciduous fruit producers are realising the need for soil health, and for an increased understanding of the benefits of soil ecology, to ensure sustainable fruit production. This depends heavily on improved orchard management. Conventional farming relies on the addition of artificial fertilizers, and the application of chemicals, to prevent or minimise, the effects of the soil stages of pest insects, and of plant-parasitic nematodes. Currently, there is resistance toward conventional farming practices, which, it is believed, diminishes biodiversity within the soil. The study aimed to establish the soil nematode community structure and function in organically, and conventionally, managed deciduous fruit orchards. This was done by determining the abundance, the diversity, and the functionality of the naturally occurring free-living, and plant-parasitic, nematodes in deciduous fruit orchards in the Western Cape province of South Africa. The objective of the study was to form the basis for the use of nematodes as future indicators of soil health in deciduous fruit orchards. Orchards from neighbouring organic, and conventional, apricot farms, and from an organic apple orchard, were studied. All the nematodes were quantified, and identified, to family level. The five nematode-classified trophic groups were found at each site, while 14 families were identified in each orchard, respectively. Herbivores were dominant in all the orchards surveyed. Organic apples had the fewest herbivores and fungivores, with the highest number of carnivores. When comparing organic with conventional apricot orchards, higher numbers of plant-parasitic nematodes were found in the organic apricot orchards. The Maturity Index (MI) indicated that all orchard soils had values below 1.5, indicating disturbed conditions. The conventionally managed apricot orchard had the highest MI value, of 1.48. The Plant Parasitic Index (PPI) value was highest in the organically managed apricot orchard. In order to determine the existing enrichment, structural, and basal conditions, the nematode faunal analysis was applied to each site. All the sites indicated enriched and structured conditions. Regarding the diversity, the richness, and the evenness of the distribution, soil from the conventional apricot orchard had the highest species richness, whereas the organic apple orchard soil had the most even distribution of families. Different management practices in fruit orchards did not show marked differences in terms of community composition and structure.

Land management strategies for improving water quality in biomass production under changing climate

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

Ha, Miae; Wu, May

Here, the Corn Belt states are the largest corn-production areas in the United States because of their fertile land and ideal climate. This attribute is particularly important as the region also plays a key role in the production of bioenergy feedstock. In much of the nation, agricultural nutrients are a primary cause of water quality degradation. This study focuses on potential change in streamflow, sediment, nitrogen, and phosphorus due to climate change and land management practices in the South Fork Iowa River (SFIR) watershed, Iowa. Thirty-six projections from select Regional Climate Models (RCM) for Representative Concentration Pathways (RCP) 2.5, 4.5,more » and 8.5 were used to develop climate change scenarios for the SFIR watershed and incorporated into the Soil and Water Assessment Tool (SWAT). The watershed is covered primarily with annual crops (corn and soybeans). Three scenarios of land use change and conservation practices were further developed to examine their impacts on water quality under historical and modeled future climate. With cropland conversion to switchgrass, stover harvest, and best management practices (BMPs) (such as establishing riparian buffers and applying cover crops) significant reductions in nutrients were observed in the SFIR watershed under historical climate and future climate scenarios. Under historical climate, suspended sediment (SS), total nitrogen (N), and phosphorus (P) at the outlet point of the SFIR watershed could decrease by up to 56.7%, 32.0%, and 16.5%, respectively, compare with current land use when a portion of the cropland is converted to switchgrass and cover crop is in place. Climate change could cause an increase in 12.0% (SS), 4.7% (N), and 7.7% (P) from current land use. This increase could be mitigated through land management and practices by 53.6% (SS), 27.8 (N), and 7.0% (P). Climate change reduced crop yield. Nutrient and sediments loadings distributed heterogeneously across the watershed. Water footprint analysis further revealed changes in green water that are highly dependent on land management scenarios. The study highlights the versatile approaches in landscape management that are available to address climate change adaptation and acknowledged the complex nature of different perspectives in water sustainability. Further study involving implementing landscape design and management using long-term field to watershed water monitoring data is necessary to verify the findings and moving towards watershed specific regional programs for climate adaptation.« less

Drug-nutrient interaction in clinical nutrition.

PubMed

Chan, Lingtak-Neander

2002-05-01

Drug-nutrient interactions have been recognized for decades. It is known that improper management of some of these interactions may lead to therapeutic failure or cause serious adverse effects to the patients. While most of the known drug-nutrient interactions involve changes in oral bioavailabilities and absorption of the offending compounds, recent investigations suggest that different mechanisms also exist. A mechanism-derived classification system for drug-nutrient interactions has only recently been developed. This system should facilitate the future research and development of practice guidelines in the identification and management of important interactions.

An ecosystem service approach to support integrated pond management: a case study using Bayesian belief networks--highlighting opportunities and risks.

PubMed

Landuyt, Dries; Lemmens, Pieter; D'hondt, Rob; Broekx, Steven; Liekens, Inge; De Bie, Tom; Declerck, Steven A J; De Meester, Luc; Goethals, Peter L M

2014-12-01

Freshwater ponds deliver a broad range of ecosystem services (ESS). Taking into account this broad range of services to attain cost-effective ESS delivery is an important challenge facing integrated pond management. To assess the strengths and weaknesses of an ESS approach to support decisions in integrated pond management, we applied it on a small case study in Flanders, Belgium. A Bayesian belief network model was developed to assess ESS delivery under three alternative pond management scenarios: intensive fish farming (IFF), extensive fish farming (EFF) and nature conservation management (NCM). A probabilistic cost-benefit analysis was performed that includes both costs associated with pond management practices and benefits associated with ESS delivery. Whether or not a particular ESS is included in the analysis affects the identification of the most preferable management scenario by the model. Assessing the delivery of a more complete set of ecosystem services tends to shift the results away from intensive management to more biodiversity-oriented management scenarios. The proposed methodology illustrates the potential of Bayesian belief networks. BBNs facilitate knowledge integration and their modular nature encourages future model expansion to more encompassing sets of services. Yet, we also illustrate the key weaknesses of such exercises, being that the choice whether or not to include a particular ecosystem service may determine the suggested optimal management practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Translating National Level Forest Service Goals to Local Level Land Management: Carbon Sequestration

NASA Astrophysics Data System (ADS)

McNulty, S.; Treasure, E.

2017-12-01

The USDA Forest Service has many national level policies related to multiple use management. However, translating national policy to stand level forest management can be difficult. As an example of how a national policy can be put into action, we examined three case studies in which a desired future condition is evaluated at the national, region and local scale. We chose to use carbon sequestration as the desired future condition because climate change has become a major area of concern during the last decade. Several studies have determined that the 193 million acres of US national forest land currently sequester 11% to 15% of the total carbon emitted as a nation. This paper provides a framework by which national scale strategies for maintaining or enhancing forest carbon sequestration is translated through regional considerations and local constraints in adaptive management practices. Although this framework used the carbon sequestration as a case study, this framework could be used with other national level priorities such as the National Environmental Protection Act (NEPA) or the Endangered Species Act (ESA).

PREP-T1 (Preteen Re-Education With Parents-Type 1 Diabetes) Feasibility Intervention Results.

PubMed

Sullivan-Bolyai, Susan; Crawford, Sybil; Johnson, Kim; Ramchandani, Neesha; Quinn, Diane; D'Alesandro, Bianca; Stern, Kailyn; Lipman, Terry; Melkus, Gail; Streisand, Randi

2016-11-01

There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the "driver's seat." The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens (n = 22) and parents (n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents. Concurrently, mothers met with a parent mentor and psychologist to discuss growth and development, and collaborative shared management. Comparison dyads discussed hypoglycemia management with a nurse. Preteens slightly improved in diabetes knowledge; the experimental arm had higher problem-solving scores. Parents in the experimental arm had higher self-efficacy scores. Findings will inform future research. © The Author(s) 2016.

Remote Monitoring of Cardiac Implantable Electronic Devices (CIED)

PubMed Central

Zeitler, Emily P.; Piccini, Jonathan P.

2016-01-01

With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow up continues to rise. In parallel, the technology available for managing these devices has advanced considerably. In this setting, remote monitoring (RM) has emerged as a complement to routine in-office care. Rigorous studies, randomized and otherwise, have demonstrated advantages to CIED patient management systems which incorporates RM resulting in authoritative guidelines from relevant professional societies recommending RM for all eligible patients. In addition to clinical benefits, CIED management programs that include RM have been shown to be cost effective and associated with high patient satisfaction. Finally, RM programs hold promise for the future of CIED research in light of the massive data collected through RM databases converging with unprecedented computational capability. This review outlines the available data associated with clinical outcomes in patients managed with RM with an emphasis on randomized trials; the impact of RM on patient satisfaction, cost-effectiveness and healthcare utilization; and possible future directions for the use of RM in clinical practice and research. PMID:27134007

Management of dredge material in the Republic of Ireland - A review.

PubMed

Sheehan, C; Harrington, J

2012-05-01

As an island nation the Republic of Ireland's ports and harbours are key to the economic wellbeing of the country as they are the primary transport link to the United Kingdom, mainland Europe and beyond. This paper examines the main aspects of the Irish dredging industry with comparison to international practice and standards, including the source of the dredge material and volumes generated annually, the dredging plant employed and the management processes currently practised. Relevant European and Irish legislation governing dredging, disposal at sea and waste licensing are presented. The potential impacts of disposal at sea are discussed with the implications for the Irish dredging industry of recently introduced European Directives assessed. Beneficial use rates for dredge material and the techniques implemented in Ireland are examined and compared with international practice. Recent notable beneficial use projects for dredge material and proposed innovative dredge material management techniques for specific dredging projects in Ireland are presented. Proposals to encourage greater beneficial use of dredge material and minimise disposal at sea for Ireland are presented including the introduction of environmental credits, tax breaks and a grant system for pilot schemes. An alternative disposal at sea charge fee structure is also recommended to encourage alternative dredge material management practices. Ireland's management of contaminated sediment is also presented with recent projects described highlighting the current practice of primarily exporting contaminated sediment to mainland Europe. Alternative methods of treatment of contaminated sediment are assessed in an Irish context. Future issues and challenges facing the Irish dredging industry are assessed and a critical analysis of the current approaches to dredge material management is presented. Copyright © 2011 Elsevier Ltd. All rights reserved.

Judging the Neonatal Abstinence Syndrome Assessment Tools to Guide Future Tool Development: The use of Clinimetrics as Opposed to Psychometrics.

PubMed

Westgate, Philip M; Gomez-Pomar, Enrique

2017-01-01

In the face of the current Neonatal Abstinence Syndrome (NAS) epidemic, there is considerable variability in the assessment and management of infants with NAS. In this manuscript, we particularly focus on NAS assessment, with special attention given to the popular Finnegan Neonatal Abstinence Score (FNAS). A major instigator of the problem of variable practices is that multiple modified versions of the FNAS exist and continue to be proposed, including shortened versions. Furthermore, the validity of such assessment tools has been questioned, and as a result, the need for better tools has been suggested. The ultimate purpose of this manuscript, therefore, is to increase researchers' and clinicians' understanding on how to judge the usefulness of NAS assessment tools in order to guide future tool development and to reduce variable practices. In short, we suggest that judgment of NAS assessment tools should be made on a clinimetrics viewpoint as opposed to psychometrically. We provide examples, address multiple issues that must be considered, and discuss future tool development. Furthermore, we urge researchers and clinicians to come together, utilizing their knowledge and experience, to assess the utility and practicality of existing assessment tools and to determine if one or more new or modified tools are needed with the goal of increased agreement on the assessment of NAS in practice.

Enhancing assertiveness in district nurse specialist practice.

PubMed

Green, Julie

2016-08-02

District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.

Toward the Geoscience Paper of the Future: Best practices for documenting and sharing research from data to software to provenance

NASA Astrophysics Data System (ADS)

Gil, Yolanda; David, Cédric H.; Demir, Ibrahim; Essawy, Bakinam T.; Fulweiler, Robinson W.; Goodall, Jonathan L.; Karlstrom, Leif; Lee, Huikyo; Mills, Heath J.; Oh, Ji-Hyun; Pierce, Suzanne A.; Pope, Allen; Tzeng, Mimi W.; Villamizar, Sandra R.; Yu, Xuan

2016-10-01

Geoscientists now live in a world rich with digital data and methods, and their computational research cannot be fully captured in traditional publications. The Geoscience Paper of the Future (GPF) presents an approach to fully document, share, and cite all their research products including data, software, and computational provenance. This article proposes best practices for GPF authors to make data, software, and methods openly accessible, citable, and well documented. The publication of digital objects empowers scientists to manage their research products as valuable scientific assets in an open and transparent way that enables broader access by other scientists, students, decision makers, and the public. Improving documentation and dissemination of research will accelerate the pace of scientific discovery by improving the ability of others to build upon published work.

An analysis of UK waste minimization clubs: key requirements for future cost effective developments.

PubMed

Phillips, P S; Pratt, R M; Pike, K

2001-01-01

The UK waste strategy is based upon use of the best practicable environmental option (BPEO), by those making waste management decisions. BPEO is supported by the use of the waste hierarchy, with its range of preferable options for dealing with waste, and the proximity principle, where waste is treated/disposed of as close to its point of origin as possible. The national waste strategy emphasizes the key role of waste minimization and encourages industry, commerce and the public to move towards sustainable waste management practice for economic and environmental reasons. Waste minimization clubs have been used, since the early 1990s, to demonstrate to industry/commerce that reducing waste production can lead to significant financial savings. There have been around 75 such clubs in the UK and they receive support from a wide range of agencies, including the Environmental Technology Best Practice Program. The early Demonstration Clubs had significant savings to cost ratios, e.g. Aire and Calder at 8.4, but had very high costs, e.g. Aire and Calder at 400,000 pounds. It is acknowledged that the number of clubs will have to be approximately doubled in the next few years so as to have an adequate coverage of the UK. There are at present, marked regional variations in club development and cognizance needs to be taken, by facilitators, of the need for extensive coverage of the UK. Future clubs will probably have to operate in a financially constrained climate and they need to be designed to deliver significant savings and waste reduction at low cost. To aid future club design, final reports of all projects should report in a standard manner so that cost benefit analysis can be used to inform facilitators about the most effective club type. rights reserved.

Projecting technology change to improve space technology planning and systems management

NASA Astrophysics Data System (ADS)

Walk, Steven Robert

2011-04-01

Projecting technology performance evolution has been improving over the years. Reliable quantitative forecasting methods have been developed that project the growth, diffusion, and performance of technology in time, including projecting technology substitutions, saturation levels, and performance improvements. These forecasts can be applied at the early stages of space technology planning to better predict available future technology performance, assure the successful selection of technology, and improve technology systems management strategy. Often what is published as a technology forecast is simply scenario planning, usually made by extrapolating current trends into the future, with perhaps some subjective insight added. Typically, the accuracy of such predictions falls rapidly with distance in time. Quantitative technology forecasting (QTF), on the other hand, includes the study of historic data to identify one of or a combination of several recognized universal technology diffusion or substitution patterns. In the same manner that quantitative models of physical phenomena provide excellent predictions of system behavior, so do QTF models provide reliable technological performance trajectories. In practice, a quantitative technology forecast is completed to ascertain with confidence when the projected performance of a technology or system of technologies will occur. Such projections provide reliable time-referenced information when considering cost and performance trade-offs in maintaining, replacing, or migrating a technology, component, or system. This paper introduces various quantitative technology forecasting techniques and illustrates their practical application in space technology and technology systems management.

Identifying an Education Gap in Wound Care Training in United States Dermatology.

PubMed

Ruiz, Emily Stamell; Ingram, Amber; Landriscina, Angelo; Tian, Jiaying; Kirsner, Robert S; Friedman, Adam

2015-07-01

As restoration of the integument is paramount to wound healing, dermatologists should be central to managing wounds; yet this is often not the case. If a training gap exists during residency training, this may account for the observed discrepancy. To identify United States (US) dermatology residents' impressions regarding their preparedness to care for wounds, and to assess the amount and type of training devoted to wound care during residency. An online survey among current US dermatology residents enrolled in a residency training program. The primary goal was to determine whether dermatology residents believe more wound care education is needed, evaluate preparedness to care for wounds, and identify future plans to manage wounds. Responses were received from 175 of 517 (33.8%) US Dermatology residents contacted. The majority of residents did not feel prepared to manage acute (78.3%) and chronic (84.6%) wounds. Over three quarters (77.1%) felt that more education is needed. Fewer than half (49.1% and 35.4%) of residents planned to care for acute and chronic wounds, respectively, when in practice. There is a gap in wound care education in US dermatology residency training. This translates to a low percentage of dermatology residents planning to care for wounds in future practice. Dermatology residents need to receive focused wound care training in order to translate the underpinnings of wound healing biology and ultimately better serve patients.

Childhood fever in well-child clinics: a focus group study among doctors and nurses.

PubMed

Peetoom, Kirsten K B; Ploum, Luc J L; Smits, Jacqueline J M; Halbach, Nicky S J; Dinant, Geert-Jan; Cals, Jochen W L

2016-07-08

Fever is common in children aged 0-4 years old and often leads to parental worries and in turn, high use of healthcare services. Educating parents may have beneficial effects on their sense of coping and fever management. Most parents receive information when their child is ill but it might be more desirable to educate parents in the setting of well-child clinics prior to their child becoming ill, in order to prepare parents for future illness management. This study aims to explore experiences of well-child clinic professionals when dealing with childhood fever and current practices of fever information provision to identify starting points for future interventions. We held four focus group discussions based on naturalistic enquiry among 22 well-child clinic professionals. Data was analysed using the constant comparative technique. Well-child clinic professionals regularly received questions from parents about childhood fever and felt that parental worries were the major driving factor behind these contacts. These worries were assumed to be driven by: (1) lack of knowledge (2) experiences with fever (3) educational level and size social network (4) inconsistencies in paracetamol administration advice among healthcare professionals. Well-child clinic professionals perceive current information provision as limited and stated a need for improvement. For example, information should be consistent, easy to find and understand. Fever-related questions are common in well-child care and professionals perceive that most of the workload is driven by parental worries. The focus group discussions revealed a desire to optimise the current limited information provision for childhood fever. Future interventions aimed at improving information provision for fever in well-child clinics should consider parental level of knowledge, experience, educational level and social network and inconsistencies among healthcare providers. Future fever information provision should focus on improving fever management and practical skills.

A review study of maintenance and management issues in Malaysian commercial building towards sustainable future practice

NASA Astrophysics Data System (ADS)

Nawi, Mohd Nasrun Mohd; Baharum, Faizal; Ibrahim, Siti Halipah; Riazi, Salman Riazi Mehdi

2017-10-01

Good management of the building will be able to influence the quality of the buildings that remain long, safe and beautiful without any damage and problems. This research paper aims to explore the issue of maintenance and management that appear in managing the commercial building in Malaysian construction and property industry. The data in this research has been gathered through the reviewing process of secondary data such as journals, proceeding, thesis etc. in the area that related to maintenance and management issue in commercial building. As highlighted by previous study, building a good management can ensure that the facilities available in the building are well and meet the standard. Thus, exposure to the problems and needs in the management of the building would be able to improve the quality of building management systems to be more effective and fulfil the client needs and features.

Future preparation of occupational health nurse managers.

PubMed

Scalzi, C C; Wilson, D L; Ebert, R

1991-03-01

This article presents the results of a national survey of job activities of corporate level occupational health nurse managers. The survey was designed to identify the relative amount of time spent and importance attributed to specific areas of their current job. In general this sample tended to have more management experience and educational preparation than previously cited studies: over 50% had completed a graduate degree. The scores for importance and time spent were highly correlated. That is, occupational health corporate nurse managers seemed to allocate their time to job responsibilities they considered most important. Management activities related to policy, practice standards, quality assurance, staff development, and systems for client care delivery appear to represent the core responsibilities of occupational health nursing management. Curriculum recommendations for management positions in occupational health include: health policy, program planning, and evaluation; business strategy; applications of management information systems; quality assurance; and marketing.

Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care.

PubMed

Bourgault, Annette M; Upvall, Michele J; Graham, Alison

2018-06-01

Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba , derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. To explore the use of gemba boards and gemba huddles to facilitate practice change. Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted. ©2018 American Association of Critical-Care Nurses.

A System Dynamics Modeling of Water Supply and Demand in Las Vegas Valley

NASA Astrophysics Data System (ADS)

Parajuli, R.; Kalra, A.; Mastino, L.; Velotta, M.; Ahmad, S.

2017-12-01

The rise in population and change in climate have posed the uncertainties in the balance between supply and demand of water. The current study deals with the water management issues in Las Vegas Valley (LVV) using Stella, a system dynamics modeling software, to model the feedback based relationship between supply and demand parameters. Population parameters were obtained from Center for Business and Economic Research while historical water demand and conservation practices were modeled as per the information provided by local authorities. The water surface elevation of Lake Mead, which is the prime source of water supply to the region, was modeled as the supply side whereas the water demand in LVV was modeled as the demand side. The study was done from the period of 1989 to 2049 with 1989 to 2012 as the historical one and the period from 2013 to 2049 as the future period. This study utilizes Coupled Model Intercomparison Project data sets (2013-2049) (CMIP3&5) to model different future climatic scenarios. The model simulates the past dynamics of supply and demand, and then forecasts the future water budget for the forecasted future population and future climatic conditions. The results can be utilized by the water authorities in understanding the future water status and hence plan suitable conservation policies to allocate future water budget and achieve sustainable water management.

Multiple stressors threatening the future of the Baltic Sea-Kattegat marine ecosystem: implications for policy and management actions.

PubMed

Jutterström, S; Andersson, H C; Omstedt, A; Malmaeus, J M

2014-09-15

The paper discusses the combined effects of ocean acidification, eutrophication and climate change on the Baltic Sea and the implications for current management strategies. The scientific basis is built on results gathered in the BONUS+ projects Baltic-C and ECOSUPPORT. Model results indicate that the Baltic Sea is likely to be warmer, more hypoxic and more acidic in the future. At present management strategies are not taking into account temporal trends and potential ecosystem change due to warming and/or acidification, and therefore fulfilling the obligations specified within the Marine Strategy Framework Directive, OSPAR and HELCOM conventions and national environmental objectives may become significantly more difficult. The paper aims to provide a basis for a discussion on the effectiveness of current policy instruments and possible strategies for setting practical environmental objectives in a changing climate and with multiple stressors. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Financial rating optimization in pressure ulcers management: yes, but at what price?].

PubMed

Crouzet, C; Chaput, B; Grolleau, J-L

2013-06-01

The surgical management of pressure ulcers remains very expensive even if preventive measures and improved care pathways allowed to reduce spending in this domain in recent years. Since 2004, the funding of French hospitals by "fee-for-service" and the needs of saving health spending necessarily compels us to interest ourselves in these purely economic considerations and sometimes modify our requirements for hospital stay to optimize a "patient' valorisation group". In the future, this may lead the surgeon to bias the real needs of the patient for the benefit of hospital establishment. Through a medico-economic analysis of our practices conducted in the plastic surgery department of the University hospital of Toulouse, we tried to identify how to optimize the surgical management of pressure ulcers in terms of valorisation of hospital stay. The aim is still to remain critical about the aberrations that this could introduce in the future for our clinical activity. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Modelling raw water quality: development of a drinking water management tool.

PubMed

Kübeck, Ch; van Berk, W; Bergmann, A

2009-01-01

Ensuring future drinking water supply requires a tough management of groundwater resources. However, recent practices of economic resource control often does not involve aspects of the hydrogeochemical and geohydraulical groundwater system. In respect of analysing the available quantity and quality of future raw water, an effective resource management requires a full understanding of the hydrogeochemical and geohydraulical processes within the aquifer. For example, the knowledge of raw water quality development within the time helps to work out strategies of water treatment as well as planning finance resources. On the other hand, the effectiveness of planed measurements reducing the infiltration of harmful substances such as nitrate can be checked and optimized by using hydrogeochemical modelling. Thus, within the framework of the InnoNet program funded by Federal Ministry of Economics and Technology, a network of research institutes and water suppliers work in close cooperation developing a planning and management tool particularly oriented on water management problems. The tool involves an innovative material flux model that calculates the hydrogeochemical processes under consideration of the dynamics in agricultural land use. The program integrated graphical data evaluation is aligned on the needs of water suppliers.

Local Institutional Development and Organizational Change for Advancing Sustainable Urban Water Futures

NASA Astrophysics Data System (ADS)

Brown, Rebekah R.

2008-02-01

This paper presents the local institutional and organizational development insights from a five-year ongoing interdisciplinary research project focused on advancing the implementation of sustainable urban water management. While it is broadly acknowledged that the inertia associated with administrative systems is possibly the most significant obstacle to advancing sustainable urban water management, contemporary research still largely prioritizes investigations at the technological level. This research is explicitly concerned with critically informing the design of methodologies for mobilizing and overcoming the administrative inertia of traditional urban water management practice. The results of fourteen in-depth case studies of local government organizations across Metropolitan Sydney primarily reveal that (i) the political institutionalization of environmental concern and (ii) the commitment to local leadership and organizational learning are key corporate attributes for enabling sustainable management. A typology of five organizational development phases has been proposed as both a heuristic and capacity benchmarking tool for urban water strategists, policy makers, and decision makers that are focused on improving the level of local implementation of sustainable urban water management activity. While this investigation has focused on local government, these findings do provide guideposts for assessing the development needs of future capacity building programs across a range of different institutional contexts.

Local institutional development and organizational change for advancing sustainable urban water futures.

PubMed

Brown, Rebekah R

2008-02-01

This paper presents the local institutional and organizational development insights from a five-year ongoing interdisciplinary research project focused on advancing the implementation of sustainable urban water management. While it is broadly acknowledged that the inertia associated with administrative systems is possibly the most significant obstacle to advancing sustainable urban water management, contemporary research still largely prioritizes investigations at the technological level. This research is explicitly concerned with critically informing the design of methodologies for mobilizing and overcoming the administrative inertia of traditional urban water management practice. The results of fourteen in-depth case studies of local government organizations across Metropolitan Sydney primarily reveal that (i) the political institutionalization of environmental concern and (ii) the commitment to local leadership and organizational learning are key corporate attributes for enabling sustainable management. A typology of five organizational development phases has been proposed as both a heuristic and capacity benchmarking tool for urban water strategists, policy makers, and decision makers that are focused on improving the level of local implementation of sustainable urban water management activity. While this investigation has focused on local government, these findings do provide guideposts for assessing the development needs of future capacity building programs across a range of different institutional contexts.

Exploring drivers and challenges in implementation of health promotion in community mental health services: a qualitative multi-site case study using Normalization Process Theory.

PubMed

Burau, Viola; Carstensen, Kathrine; Fredens, Mia; Kousgaard, Marius Brostrøm

2018-01-24

There is an increased interest in improving the physical health of people with mental illness. Little is known about implementing health promotion interventions in adult mental health organisations where many users also have physical health problems. The literature suggests that contextual factors are important for implementation in community settings. This study focused on the change process and analysed the implementation of a structural health promotion intervention in community mental health organisations in different contexts in Denmark. The study was based on a qualitative multiple-case design and included two municipal and two regional provider organisations. Data were various written sources and 13 semi-structured interviews with 22 key managers and frontline staff. The analysis was organised around the four main constructs of Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring. Coherence: Most respondents found the intervention to be meaningful in that the intervention fitted well into existing goals, practices and treatment approaches. Cognitive Participation: Management engagement varied across providers and low engagement impeded implementation. Engaging all staff was a general problem although some of the initial resistance was apparently overcome. Collective Action: Daily enactment depended on staff being attentive and flexible enough to manage the complex needs and varying capacities of users. Reflexive Monitoring: During implementation, staff evaluations of the progress and impact of the intervention were mostly informal and ad hoc and staff used these to make on-going adjustments to activities. Overall, characteristics of context common to all providers (work force and user groups) seemed to be more important for implementation than differences in the external political-administrative context. In terms of research, future studies should adopt a more bottom-up, grounded description of context and pay closer attention to the interplay between different dimensions of implementation. In terms of practice, future interventions need to better facilitate the translation of the initial sense of general meaning into daily practice by active local management support that occurs throughout the implementation process and that systematically connects the intervention to existing practices.

A Multi-Institutional Project to Develop Discipline-Specific Data Literacy Instruction for Graduate Students

NASA Astrophysics Data System (ADS)

Wright, S. J.; Fosmire, M.; Jeffryes, J.; Stowell Bracke, M.; Westra, B.

2012-12-01

What data stewardship skills are needed by future scientists to fulfill their professional responsibilities and take advantage of opportunities in e-science? How can academic librarians contribute their expertise in information organization, dissemination and preservation to better serve modern science? With support from the Institute of Museum and Library Services (IMLS), four research libraries have formed a partnership to address these questions. The aims of the partnership are to identify the data stewardship skills, including data management and curation, needed by graduate students at the research discipline level, to identify trends that extend across the Science, Technology, Engineering, and Mathematics (STEM) disciplines, and to collaborate with faculty to develop and implement "data information literacy" (DIL) curricula to address those needs. Over the course of the first year, the authors have been working closely with faculty in hydrology, civil engineering, ecology/environmental science, and natural resources. At the outset, we performed structured interviews with faculty and graduate students using a modified version of the Data Curation Profiles Toolkit (http://datacurationprofiles.org) to gather detailed information about the practices, limitations, needs, and opportunities for improving data management and curation practices in each group. Project teams also conducted discipline-based literature reviews and environmental scans of the available resources pertaining to data management and curation issues to identify how (or if) these topics are currently addressed by the discipline. The results were used to develop and implement specific instructional interventions attuned to the needs of each research group. We will share the results of our interviews and information-gathering, summarizing similarities and differences in the data stewardship needs expressed by the graduate students and faculty from different STEM disciplines. We will also discuss some of the educational and support practices undertaken by the teams. The authors' approaches ranged from offering a one-credit special topics class, "Managing data to facilitate your research," to closely integrating resources and training with research projects and practices. A range of strategies will likely need to be employed to educate future scientists in the fundamentals of data stewardship; our strategies are intended to give attendees a starting point for how they can approach the issue at their own institution.

The influence of the structure and culture of medical group practices on prescription drug errors.

PubMed

Kralewski, John E; Dowd, Bryan E; Heaton, Alan; Kaissi, Amer

2005-08-01

This project was designed to identify the magnitude of prescription drug errors in medical group practices and to explore the influence of the practice structure and culture on those error rates. Seventy-eight practices serving an upper Midwest managed care (Care Plus) plan during 2001 were included in the study. Using Care Plus claims data, prescription drug error rates were calculated at the enrollee level and then were aggregated to the group practice that each enrollee selected to provide and manage their care. Practice structure and culture data were obtained from surveys of the practices. Data were analyzed using multivariate regression. Both the culture and the structure of these group practices appear to influence prescription drug error rates. Seeing more patients per clinic hour, more prescriptions per patient, and being cared for in a rural clinic were all strongly associated with more errors. Conversely, having a case manager program is strongly related to fewer errors in all of our analyses. The culture of the practices clearly influences error rates, but the findings are mixed. Practices with cohesive cultures have lower error rates but, contrary to our hypothesis, cultures that value physician autonomy and individuality also have lower error rates than those with a more organizational orientation. Our study supports the contention that there are a substantial number of prescription drug errors in the ambulatory care sector. Even by the strictest definition, there were about 13 errors per 100 prescriptions for Care Plus patients in these group practices during 2001. Our study demonstrates that the structure of medical group practices influences prescription drug error rates. In some cases, this appears to be a direct relationship, such as the effects of having a case manager program on fewer drug errors, but in other cases the effect appears to be indirect through the improvement of drug prescribing practices. An important aspect of this study is that it provides insights into the relationships of the structure and culture of medical group practices and prescription drug errors and provides direction for future research. Research focused on the factors influencing the high error rates in rural areas and how the interaction of practice structural and cultural attributes influence error rates would add important insights into our findings. For medical practice directors, our data show that they should focus on patient care coordination to reduce errors.

Paradoxes and Dilemmas in Managing E-Learning in Higher Education. Research & Occasional Paper Series. CSHE.7.03

ERIC Educational Resources Information Center

Guri-Rosenblit, Sarah

2003-01-01

The new information and communication technologies (ICT) affect currently most spheres of life, including all educational levels. Their effects are most likely to grow in the future. However, many predictions in the last few years as to the sweeping impact of the ICT on restructuring the teaching/learning practices at universities and their high…

7 CFR 14.6 - Criteria for determining the pri- mary purpose of payments with respect to potential exclusion...

Code of Federal Regulations, 2010 CFR

2010-01-01

... conservation includes actions that, for a given level of water supply, reduce the demand for or use of water by... reuse of water, thereby making existing supplies available for other current or future uses; or (iv) Improving land management practices for the purpose of reducing water use, loss, waste, increasing the...

Sites for retrospective studies: opportunities for research in western Washington and Oregon

Treesearch

Ted B. Thomas; John F. Lehmkuhl; Martin G. Raphael; Dean S. DeBell

1993-01-01

Sites were identified on publicly managed and privately owned lands in western Oregon and Washington where research or demonstration of new forestry practices could be conducted by using a retrospective approach. One hundred and seventy-six stands were selected for this catalog to represent examples of the future condition that could be expected from new forestry...

Italian National Forest Inventory: methods, state of the project, and future developments

Treesearch

Giovanni Tabacchi; Flora De Natale; Antonio Floris; Caterina Gagliano; Patrizia Gasparini; Gianfranco Scrinzi; Vittorio Tosi

2007-01-01

A primary objective of the Italian National Forest Inventory (NFI) is to provide information required by the Kyoto Protocol and the Ministerial Conference on the Protection of Forests in Europe in relation to sustainable forest management practices. For this reason, the second Italian NFI was aimed at providing data in a way that is consistent with the international...

Vegetation monitoring to detect and predict vegetation change: Connecting historical and future shrub/steppe data in Yellowstone National Park

Treesearch

Geneva Chong; David Barnett; Benjamin Chemel; Roy Renkin; Pamela Sikkink

2011-01-01

A 2002 National Research Council (NRC) evaluation of ungulate management practices in Yellowstone specifically concluded that previous (1957 to present) vegetation monitoring efforts were insufficient to determine whether climate or ungulates were more influential on shrub/steppe dynamics on the northern ungulate winter range. The NRC further recommended that the...

The Fire and Fire Surrogates Study: Providing guidelines for fire in future forest watershed management decisions

Treesearch

Carleton B. Edminster; C. Phillip Weatherspoon; Daniel G. Neary

2000-01-01

As part of the 1998 Joint USDA/USDI Fire Science Program, the Fire and Fire Surrogates Study was proposed to establish and evaluate cross-comparisons of fuels treatment practices and techniques to reduce wildfire risk. This study evaluates prescribed fire, thinning, and various mechanical treatment methods for treating, removing, or using woody biomass. Site-specific...

The Private Military Firms: Historical Evolution and Industry Analysis

DTIC Science & Technology

2007-06-01

Company, Private Military Firm, Supply Push, Demand Pull, Future Projections, Blackwater, DynCorp, Entrepreneurship 16. PRICE CODE 17. SECURITY...Business Administration, University of California, 1995. Baumol, W. J. Entrepreneurship , Management, and the Structure of Payoffs. Cambridge, MA: The MIT...P. F. Innovation and Entrepreneurship : Practice and Principles. Toronto: Fitzhenry & Whiteside Limited, 1985. Duffy, M. When Private Armies Take to

Contemporary disease management in Quebec.

PubMed

Gogovor, Amédé; Savoie, Michelle; Moride, Yola; Krelenbaum, Marilyn; Montague, Terrence

2008-01-01

Health or disease management (DM) has emerged as a promising solution to improve the quality of healthcare and patient outcomes in a cost-efficient way. This solution is particularly relevant in the care of our increasing, and aging, patient populations with multiple chronic diseases. This article reviews the recent history and current status of DM in the province of Quebec and summarizes its evolving perspectives and future prospects. Most DM projects in Quebec have developed from a public-private partnership, and they have addressed several disease states. The results of completed programs confirmed the presence of care gaps--the differences between best and usual care in several disease states. They also identified process changes leading to improved practices and enhanced professional satisfaction among stakeholders. Priorities identified for further research include increased knowledge of the underlying causes of care gaps and greater concentration on the measurement of clinical, humanistic and fiscal outcomes and their causal links to DM structures and processes. Although still embryonic in Quebec and Canada, the available evidence suggests that DM partnerships are practical and functional vehicles to expedite knowledge creation and transfer in the care of whole populations of patients. Future projects offer the promise of updated knowledge and continuously improved care and outcomes.

Climate impacts on European agriculture and water management in the context of adaptation and mitigation--the importance of an integrated approach.

PubMed

Falloon, Pete; Betts, Richard

2010-11-01

We review and qualitatively assess the importance of interactions and feedbacks in assessing climate change impacts on water and agriculture in Europe. We focus particularly on the impact of future hydrological changes on agricultural greenhouse gas (GHG) mitigation and adaptation options. Future projected trends in European agriculture include northward movement of crop suitability zones and increasing crop productivity in Northern Europe, but declining productivity and suitability in Southern Europe. This may be accompanied by a widening of water resource differences between the North and South, and an increase in extreme rainfall events and droughts. Changes in future hydrology and water management practices will influence agricultural adaptation measures and alter the effectiveness of agricultural mitigation strategies. These interactions are often highly complex and influenced by a number of factors which are themselves influenced by climate. Mainly positive impacts may be anticipated for Northern Europe, where agricultural adaptation may be shaped by reduced vulnerability of production, increased water supply and reduced water demand. However, increasing flood hazards may present challenges for agriculture, and summer irrigation shortages may result from earlier spring runoff peaks in some regions. Conversely, the need for effective adaptation will be greatest in Southern Europe as a result of increased production vulnerability, reduced water supply and increased demands for irrigation. Increasing flood and drought risks will further contribute to the need for robust management practices. The impacts of future hydrological changes on agricultural mitigation in Europe will depend on the balance between changes in productivity and rates of decomposition and GHG emission, both of which depend on climatic, land and management factors. Small increases in European soil organic carbon (SOC) stocks per unit land area are anticipated considering changes in climate, management and land use, although an overall reduction in the total stock may result from a smaller agricultural land area. Adaptation in the water sector could potentially provide additional benefits to agricultural production such as reduced flood risk and increased drought resilience. The two main sources of uncertainty in climate impacts on European agriculture and water management are projections of future climate and their resulting impacts on water and agriculture. Since changes in climate, agricultural ecosystems and hydrometeorology depend on complex interactions between the atmosphere, biosphere and hydrological cycle there is a need for more integrated approaches to climate impacts assessments. Methods for assessing options which "moderate" the impact of agriculture in the wider sense will also need to consider cross-sectoral impacts and socio-economic aspects. Crown Copyright © 2009. Published by Elsevier B.V. All rights reserved.

Building capacity for community disaster preparedness: a call for collaboration between public environmental health and emergency preparedness and response programs.

PubMed

Gamboa-Maldonado, Thelma; Marshak, Helen Hopp; Sinclair, Ryan; Montgomery, Susanne; Dyjack, David T

2012-09-01

Partnerships among local public environmental health (EH), emergency preparedness and response (EPR) programs, and the communities they serve have great potential to build community environmental health emergency preparedness (EHEP) capacity. In the study described in this article, the beliefs and organizational practices pertaining to community EHEP outreach and capacity were explored through key informant (KI) interviews (N = 14) with a sample of governmental EH and EPR administrators and top-level managers from Riverside and San Bernardino counties in Southern California. The results indicate that KIs were highly confident in their workforces' efficacy, ability, willingness, and motivation to directly engage local communities in EHEP. Best practices to combat organizational and systematic barriers to community EHEP outreach were identified. Based on the authors' results, training in participatory methods is needed to bridge technical knowledge in emergency management to daily practice. The lessons learned will form the basis of future interventions aimed to prepare EH and EPR professions to implement community-focused emergency preparedness strategies.

Iron and clinical outcomes in dialysis and non-dialysis-dependent chronic kidney disease patients.

PubMed

Kovesdy, Csaba P

2009-03-01

Abnormal iron homeostasis plays an important role in the anemia of chronic kidney disease (CKD). Although iron overload was the main complication seen in the pre-erythropoiesis-stimulating agent era, relative iron deficiency is much more common today in patients with CKD. Maintaining certain "desirable" levels of commonly used markers of iron stores (such as transferrin saturation ratio and serum ferritin) have become the goal of iron management in clinical practice, yet it is unclear whether achievement and maintenance of these "desirable" levels translates into improved clinical outcomes. This review examines issues related to iron and long-term clinical outcomes from an epidemiologic perspective, with the goal to determine what an ideal therapeutic approach should be in clinical practice and what future research is required to clarify important practical questions. Particular attention is devoted to patients with non-dialysis-dependent CKD because the management of iron homeostasis in this group of patients poses additional intriguing questions.

Aging and orthopedics: how a lifespan development model can inform practice and research.

PubMed

Gautreau, Sylvia; Gould, Odette N; Forsythe, Michael E

2016-08-01

Orthopedic surgical care, like all health care today, is in flux owing to an aging population and to chronic medical conditions leading to an increased number of people with illnesses that need to be managed over the lifespan. The result is an ongoing shift from curing acute illnesses to the management and care of chronic illness and conditions. Theoretical models that provide a useful and feasible vision for the future of health care and health care research are needed. This review discusses how the lifespan development model used in some disciplines within the behavioural sciences can be seen as an extension of the biopsychosocial model. We posit that the lifespan development model provides useful perspectives for both orthopedic care and research. We present key concepts and recommendations, and we discuss how the lifespan development model can contribute to new and evolving perspectives on orthopedic outcomes and to new directions for research. We also offer practical guidelines on how to implement the model in orthopedic practice.

Good Practice Chaplaincy: An Exploratory Study Identifying the Appropriate Skills, Attitudes and Practices for the Selection, Training and Utilisation of Chaplains.

PubMed

Carey, Lindsay B; Rumbold, Bruce

2015-08-01

This article presents an overview of exploratory research regarding the skills, knowledge, attitudes and practices considered necessary for chaplains to be highly competent in providing holistic care to clients and staff. Utilising a qualitative methodology, two focus groups comprising Salvation Army chaplains and their managers provided data about their expectations of chaplaincy personnel and about the pastoral care interventions undertaken by chaplains. The results indicated that while there were some differences in opinion, nevertheless, in overall terms, there was general agreement between chaplains and their managers about particular personal and professional qualities necessary for chaplains to be considered appropriate and proficient. Evidence was also obtained indicating a need for change with regard to the organisational attitude and culture of The Salvation Army towards chaplaincy. Recommendations are presented concerning (1) the selection criteria for chaplaincy, (2) training and utilisation of chaplains plus (3) issues relating to organizational cultural change necessary to develop a future-ready chaplaincy more suitable for the twenty-first century.

Best Practices in Mentoring in NOAA Scholarship Programs

NASA Astrophysics Data System (ADS)

Kaplan, M.; Sarvis, S.; Dancy, V.

2015-12-01

Through established scholarship programs, NOAA hosts 125 - 175 undergraduate students each summer to participate in internship opportunities at agency facilities. In order to host a scholar, NOAA labs and offices must designate a mentor who develops a project and oversees activities of the student throughout the summer. NOAA implements best practices in mentoring in the following ways: mentor and intern responsibilities are clearly defined in a manual; mentors are required to take an online mentor training class; mentors and scholars are matched through an online system and scholars conduct a site visit prior to beginning the internship; proposed internship projects are reviewed by scholarship program managers to assure they are sufficiently analytical and will advance the student in their future academic and career goals; and mentors are surveyed at the midpoint, allowing scholarship program managers to identify problems and intervene if possible. These practices have resulted in strong results. Students identify the mentor relationship, hands-on experience and networking with professionals as the three most important outcomes of the internship experience.

Key strategies to improve systems for managing patient complaints within health facilities - what can we learn from the existing literature?

PubMed

Mirzoev, Tolib; Kane, Sumit

2018-01-01

Information from patient complaints - a widely accepted measure of patient satisfaction with services - can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients' awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.

How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.

PubMed

Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

2017-06-02

Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

PubMed Central

2018-01-01

ABSTRACT Background: Information from patient complaints – a widely accepted measure of patient satisfaction with services – can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems. Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research. Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands. Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients’ awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context. Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints. PMID:29658393