A Multiple Period Problem in Distributed Energy Management Systems Considering CO2 Emissions

NASA Astrophysics Data System (ADS)

Muroda, Yuki; Miyamoto, Toshiyuki; Mori, Kazuyuki; Kitamura, Shoichi; Yamamoto, Takaya

Consider a special district (group) which is composed of multiple companies (agents), and where each agent responds to an energy demand and has a CO2 emission allowance imposed. A distributed energy management system (DEMS) optimizes energy consumption of a group through energy trading in the group. In this paper, we extended the energy distribution decision and optimal planning problem in DEMSs from a single period problem to a multiple periods one. The extension enabled us to consider more realistic constraints such as demand patterns, the start-up cost, and minimum running/outage times of equipment. At first, we extended the market-oriented programming (MOP) method for deciding energy distribution to the multiple periods problem. The bidding strategy of each agent is formulated by a 0-1 mixed non-linear programming problem. Secondly, we proposed decomposing the problem into a set of single period problems in order to solve it faster. In order to decompose the problem, we proposed a CO2 emission allowance distribution method, called an EP method. We confirmed that the proposed method was able to produce solutions whose group costs were close to lower-bound group costs by computational experiments. In addition, we verified that reduction in computational time was achieved without losing the quality of solutions by using the EP method.

Flight Test Evaluation of an Unmanned Aircraft System Traffic Management (UTM) Concept for Multiple Beyond-Visual-Line-of-Sight (BVLOS) Operations

NASA Technical Reports Server (NTRS)

Johnson, Marcus; Jung, Jaewoo; Rios, Joseph; Mercer, Joey; Homola, Jeffrey; Prevot, Thomas; Mulfinger, Daniel; Kopardekar, Parimal

2017-01-01

This study evaluates a traffic management concept designed to enable simultaneous operations of multiple small unmanned aircraft systems (UAS) in the national airspace system (NAS). A five-day flight-test activity is described that examined the feasibility of operating multiple UAS beyond visual line of sight (BVLOS) of their respective operators in the same airspace. Over the five-day campaign, three groups of five flight crews operated a total of eleven different aircraft. Each group participated in four flight scenarios involving five simultaneous missions. Each vehicle was operated BVLOS up to 1.5 miles from the pilot in command. Findings and recommendations are presented to support the feasibility and safety of routine BVLOS operations for small UAS.

Flight Test Evaluation of an Unmanned Aircraft System Traffic Management (UTM) Concept for Multiple Beyond-Visual-Line-of-Sight Operations

NASA Technical Reports Server (NTRS)

Johnson, Marcus; Jung, Jaewoo; Rios, Joseph; Mercer, Joey; Homola, Jeffrey; Prevot, Thomas; Mulfinger, Daniel; Kopardekar, Parimal

2017-01-01

This study evaluates a traffic management concept designed to enable simultaneous operations of multiple small unmanned aircraft systems (UAS) in the national airspace system (NAS). A five-day flight-test activity is described that examined the feasibility of operating multiple UAS beyond visual line of sight (BVLOS) of their respective operators in the same airspace. Over the five-day campaign, three groups of five flight crews operated a total of eleven different aircraft. Each group participated in four flight scenarios involving five simultaneous missions. Each vehicle was operated BVLOS up to 1.5 miles from the pilot in command. Findings and recommendations are presented to support the feasibility and safety of routine BVLOS operations for small UAS.

Web-based self-management for patients with multiple sclerosis: a practical, randomized trial.

PubMed

Miller, Deborah M; Moore, Shirley M; Fox, Robert J; Atreja, Ashish; Fu, Alex Z; Lee, Jar-Chi; Saupe, Welf; Stadtler, Maria; Chakraborty, Swati; Harris, C M; Rudick, Richard A

2011-01-01

No studies have addressed the use of electronic personal health records (e-PHRs) for self-management in complex neurological disorders. We assessed and tested an Internet-based self-management system that utilized the e-PHR and determined its impact on self-assessed well-being, clinician-assessed well-being, and healthcare utilization in patients with multiple sclerosis (MS). Subjects were randomized to usual care (a secure Web-based messaging system) or active intervention, which included secure messaging, self-monitoring, self-management of MS symptoms, and communication about upcoming clinic visits. Computers and Internet access were provided. Subjects were included if they had MS, lived within the county or region surrounding our MS center, had at least two appointments at our center in the previous 12 months, and demonstrated basic typing and computer skills. Study duration was 12 months. Of 220 subjects completing informed consent, 206 met the inclusion criteria. At the study's end, 83 subjects remained in the usual care group and 84 in the enhanced care group. Both groups used the available system components. The groups did not significantly differ on the primary endpoints or healthcare utilization. Self-management support is an emerging aspect of chronic care management. We established the feasibility of conducting a randomized, controlled trial using e-PHRs for patient self-management. We did not find that e-PHR-enabled self-management augmented multidisciplinary MS center-based care, possibly because the differences between interventions were not great enough.

Randomized controlled pilot study of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis.

PubMed

Plow, Matthew; Bethoux, Francois; McDaniel, Corey; McGlynn, Mark; Marcus, Bess

2014-02-01

Investigate the feasibility and potential efficacy of a customized print-based intervention to promote physical activity and symptom self-management in women with multiple sclerosis. A randomly allocated two-group repeated measures design, with a delayed-treatment contact group serving as the control. Participants were randomized to receive the intervention immediately (n =14) or receive it at week 12 (n =16). Outcome measures were administered at weeks 1, 12, and 24. Community-based in metropolitan area. Thirty women with multiple sclerosis. Prescribing a home-exercise program and following up with customized pamphlets, which are matched to participants' stage of readiness to change physical activity behavior and physical activity barriers (e.g. encouraging self-management of symptoms). Physical Activity and Disability Survey-revised, Godin Leisure-Time Exercise Questionnaire, SF-12, Symptoms of Multiple Sclerosis Scale, and 6-minute walk test. Intent-to-treat analyses using mixed multivariate analysis of variance (MANOVA) were conducted on (1) physical activity levels and (2) health and function outcomes. The mixed MANOVAs for physical activity levels and health and function outcomes indicated significant improvements in the immediate group compared with the delayed group (i.e. condition by time interaction was significant, Wilks' λ = 0.59, F(2, 27) = 9.31, P = 0.001 and Wilks' λ = 0.70, F(4, 25) = 2.72, P = 0.052, respectively). The intervention had moderate to large effect sizes in improving physical activity levels (d = 0.63 to 0.89), perceptions of physical function (d = 0.63), and 6-minute walk test (d=0.86). This pilot study indicates that a customized print-based intervention shows promise in improving physical activity levels and health and function in women with multiple sclerosis.

Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

PubMed

Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

2016-12-01

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

Immediate vs. Delayed Feedback in a Computer-Managed Test: Effects on Long-Term Retention. Technical Report, March 1976-August 1976.

ERIC Educational Resources Information Center

Sturges, Persis T.

This experiment was designed to test the effect of immediate and delayed feedback on retention of learning in an educational situation. Four groups of college undergraduates took a multiple-choice computer-managed test. Three of these groups received informative feedback (the entire item with the correct answer identified) either: (1) immediately…

Managing wildfire events: risk-based decision making among a group of federal fire managers

Treesearch

Robyn S. Wilson; Patricia L. Winter; Lynn A. Maguire; Timothy Ascher

2011-01-01

Managing wildfire events to achieve multiple management objectives involves a high degree of decision complexity and uncertainty, increasing the likelihood that decisions will be informed by experience-based heuristics triggered by available cues at the time of the decision. The research reported here tests the prevalence of three risk-based biases among 206...

Effective user management with high strength crypto -key in dynamic group environment in cloud

NASA Astrophysics Data System (ADS)

Kumar, P. J.; Suganya, P.; Karthik, G.

2017-11-01

Cloud Clusters consists of various collections of files which are being accessed by multiple users of Cloud. The users are managed as a group and the association of the user to a particular group is dynamic in nature. Every group has a manager who handles the membership of a user to a particular group by issuing keys for encryption and decryption. Due to the dynamic nature of a user he/she may leave the group very frequently. But an attempt can be made by the user who has recently left the group to access a file maintained by that group. Key distribution becomes a critical issue while the behavior of the user is dynamic. Existing techniques to manage the users of group in terms of security and key distribution has been investigated so that to arrive at an objective to identify the scopes to increase security and key management scheme in cloud. The usage of various key combinations to measure the strength of security and efficiency of user management in dynamic cloud environment has been investigated.

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

PubMed

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

2017-01-01

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

The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma

PubMed Central

Hong, Zhi-Jie; Chen, Cheng-Jueng; Yu, Jyh-Cherng; Chan, De-Chuan; Chou, Yu-Ching; Liang, Chia-Ming; Hsu, Sheng-Der

2016-01-01

Abstract We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT. Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome. Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients’ time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06–0.75, P = 0.016). Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma. PMID:27631215

The evolution of computed tomography from organ-selective to whole-body scanning in managing unconscious patients with multiple trauma: A retrospective cohort study.

PubMed

Hong, Zhi-Jie; Chen, Cheng-Jueng; Yu, Jyh-Cherng; Chan, De-Chuan; Chou, Yu-Ching; Liang, Chia-Ming; Hsu, Sheng-Der

2016-09-01

We aimed to evaluate the benefit of whole-body computed tomography (WBCT) scanning for unconscious adult patients suffering from high-energy multiple trauma compared with the conventional stepwise approach of organ-selective CT.Totally, 144 unconscious patients with high-energy multiple trauma from single level I trauma center in North Taiwan were enrolled from January 2009 to December 2013. All patients were managed by a well-trained trauma team and were suitable for CT examination. The enrolled patients are all transferred directly from the scene of an accident, not from other medical institutions with a definitive diagnosis. The scanning regions of WBCT include head, neck, chest, abdomen, and pelvis. We analyzed differences between non-WBCT and WBCT groups, including gender, age, hospital stay, Injury Severity Score, Glasgow Coma Scale, Revised Trauma Score, time in emergency department (ED), medical cost, and survival outcome.Fifty-five patients received the conventional approach for treating trauma, and 89 patients received immediate WBCT scanning after an initial examination. Patients' time in ED was significantly shorter in the WBCT group in comparison with the non-WBCT group (158.62 ± 80.13 vs 216.56 ± 168.32 min, P = 0.02). After adjusting for all possible confounding factors, we also found that survival outcome of the WBCT group was better than that of the non-WBCT group (odds ratio: 0.21, 95% confidence interval: 0.06-0.75, P = 0.016).Early performing WBCT during initial trauma management is a better approach for treating unconscious patients with high-energy multiple trauma.

The effectiveness of transdermal opioid in the management multiple rib fractures: randomized clinical trial.

PubMed

Solak, Okan; Oz, Gürhan; Kokulu, Serdar; Solak, Ozlem; Doğan, Gökçen; Esme, Hıdır; Ocalan, Kubilay; Baki, Elif Doğan

2013-09-01

The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain. Prospective randomized clinical trial. In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4×40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 μg/mL continuous intravenous fentanyl and was 50 μg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VASl) and mobilisation (VASm) was detected. There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p<0.05). The mean VASl and VASm scores measured on the 1(st), 2(nd), 3(rd), 4(th) and 5(th) days were found to be higher in Group IMO than in Groups IVPCA and TTS; however, these differences were not statistically significant (p>0.05). In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.

THINEX - an expert system for estimating forest harvesting productivity and cost

Treesearch

C. B. LeDoux; B. Gopalakrishnan; R. S. Pabba

1998-01-01

As the emphasis of forest stand management shifts towards implementing ecosystem management, managers are examining alternative methods to harvesting stands in order to accomplish multiple objectives by using techniques such as shelterwood harvests, thinnings, and group selection methods, thus leaving more residual trees to improve the visual quality of the harvested...

Group Therapy for Abused and Neglected Youth: Therapeutic and Child Advocacy Challenges

ERIC Educational Resources Information Center

Wanlass, Janine; Moreno, J. Kelly; Thomson, Hannah M.

2006-01-01

Although group therapy for abused and neglected youth is a viable and efficacious treatment option, facilitation is challenging. Group leaders must contain intense affect, manage multiple transferences, and advocate for their clients within the larger social welfare system. Using a case study of a group for sexually abused girls, this paper…

Multiple Goals and Homework Involvement in Elementary School Students.

PubMed

Valle, Antonio; Pan, Irene; Núñez, José C; Rodríguez, Susana; Rosário, Pedro; Regueiro, Bibiana

2015-10-27

This work arises from the need to investigate the role of motivational variables in homework involvement and academic achievement of elementary school students. The aims of this study are twofold: identifying the different combinations of student academic goals and analyzing the differences in homework involvement and academic achievement. The sample was composed of 535 fourth-, fifth- and sixth-grade elementary school students, between the ages of 9 and 13 years old. Findings showed three groups with different motivational profiles: a group of students with high multiple goals, another group with a learning goal orientation and a third group defined by a low multiple goals profile. Focusing on the differences between groups, it was observed that the amount of time doing homework was not associated with any motivational profile. Nevertheless, the differences were statistically significant between the motivational groups in the amount of homework (F(2, 530) = 42.59; p < .001; ηp 2 = .138), in the management of time spent on homework (F(2, 530) = 33.08; p < .001; ηp 2 = .111), and in academic achievement (F(2, 530) = 33.99; p < .001; ηp 2 = .114). The effect size was large for the amount of homework performed and was also relatively large in the case of management of time and academic achievement.

Applying voting theory in natural resource management: a case of multiple-criteria group decision support.

PubMed

Laukkanen, Sanna; Kangas, Annika; Kangas, Jyrki

2002-02-01

Voting theory has a lot in common with utility theory, and especially with group decision-making. An expected-utility-maximising strategy exists in voting situations, as well as in decision-making situations. Therefore, it is natural to utilise the achievements of voting theory also in group decision-making. Most voting systems are based on a single criterion or holistic preference information on decision alternatives. However, a voting scheme called multicriteria approval is specially developed for decision-making situations with multiple criteria. This study considers the voting theory from the group decision support point of view and compares it with some other methods applied to similar purposes in natural resource management. A case study is presented, where the approval voting approach is introduced to natural resources planning and tested in a forestry group decision-making process. Applying multicriteria approval method was found to be a potential approach for handling some challenges typical for forestry group decision support. These challenges include (i) utilising ordinal information in the evaluation of decision alternatives, (ii) being readily understandable for and treating equally all the stakeholders in possession of different levels of knowledge on the subject considered, (iii) fast and cheap acquisition of preference information from several stakeholders, and (iv) dealing with multiple criteria.

Life Lessons from Women with HIV: Mutuality, Self-Awareness, and Self-Efficacy

PubMed Central

Jack, Dana C.; Bruck-Segal, Dana L.; Ruffing, Elizabeth G.; Firpo-Perretti, Yudelki M.; Dale, Sannisha K.; Weber, Kathleen M.; Cohen, Mardge H.

2016-01-01

Abstract Women with HIV in the United States cope with multiple traumas that influence adherence to antiretroviral therapy (ART) and well-being. Narrative themes from three life turning points and a projective story task were compared for two groups of women with HIV (HIV well-managed vs. HIV not well-managed, matched on demographics and narrative word count) to understand predictors of successful outcomes. The well-managed group (n = 10) was virally suppressed and reported ≥95% ART adherence; the not well-managed group (n = 10) had detectable viral load and reported <95% ART adherence. Women were predominantly African American with low socioeconomic status and averaged 46.51 years. A three-stage coding process (with coders blind to group status in stages 1 and 2) involved (1) line by line thematic analyses that generated 155 subthemes reflecting six content areas (interpersonal relationships; culture and community; sense of self; relationship to past, present, and future experiences; self-care; and motivators for change); (2) absence/presence of the 155 subthemes was compared for the two groups; the frequency of 37 subthemes was found to significantly differ; and (3) the 37 differentiating subthemes were conceptually integrated, revealing that the well-managed group's narratives more frequently reflected (a) mutuality (growth-fostering relationships involving reciprocal care and empathy); (b) self-awareness (recognition of personal strengths and weaknesses and multiple factors contributing to life choices and trajectories); and (c) self-efficacy (active coping, self-advocacy, and utilizing resources). Implications for treatment and interconnections among themes are discussed, emphasizing the factors that enable women to care for themselves and others. PMID:27214648

A three-level atomicity model for decentralized workflow management systems

NASA Astrophysics Data System (ADS)

Ben-Shaul, Israel Z.; Heineman, George T.

1996-12-01

A workflow management system (WFMS) employs a workflow manager (WM) to execute and automate the various activities within a workflow. To protect the consistency of data, the WM encapsulates each activity with a transaction; a transaction manager (TM) then guarantees the atomicity of activities. Since workflows often group several activities together, the TM is responsible for guaranteeing the atomicity of these units. There are scalability issues, however, with centralized WFMSs. Decentralized WFMSs provide an architecture for multiple autonomous WFMSs to interoperate, thus accommodating multiple workflows and geographically-dispersed teams. When atomic units are composed of activities spread across multiple WFMSs, however, there is a conflict between global atomicity and local autonomy of each WFMS. This paper describes a decentralized atomicity model that enables workflow administrators to specify the scope of multi-site atomicity based upon the desired semantics of multi-site tasks in the decentralized WFMS. We describe an architecture that realizes our model and execution paradigm.

Consensus in the Management of Multiple Myeloma in India at Myeloma State of the Art 2016 Conference.

PubMed

Yanamandra, Uday; Khattry, Navin; Kumar, Shaji; Raje, Noopur; Jain, Arihant; Jagannath, Sundar; Menon, Hari; Kumar, Lalit; Varma, Neelam; Varma, Subhash; Saikia, Tapan; Malhotra, Pankaj

2017-03-01

The science of multiple myeloma (MM) and related plasma cell disorders is rapidly evolving with increased understanding of the disease biology and recent approval of the newer drugs widening the therapeutic armamentarium. Despite multiple international guidelines regarding the management of this disease, the practice of managing MM is not uniform amongst Indian physicians. There are challenges in management which are unique to the Indian patients. This review discusses these challenges and the consensus of the nation-wide experts in dealing with the same. We also briefly highlighted the perspective of international experts as discussed in the Myeloma State of the Art conference held in September 2016 at PGI, Chandigarh. An I ndian M yeloma A cademic G roup e (IMAGe) group was formed to strengthen the research, create awareness about myeloma and related disorders and form consensus guidelines/ recommendations that can be adapted to the Indian Scenario.

Efficacy of Self-Hypnosis in Pain Management in Female Patients with Multiple Sclerosis.

PubMed

Hosseinzadegan, Fariba; Radfar, Moloud; Shafiee-Kandjani, Ali Reza; Sheikh, Naser

2017-01-01

Pain is common in patients with multiple sclerosis. This study evaluated self-hypnosis for pain control in that population. A randomized clinical trial was conducted on 60 patients, who were assigned to either a control group or to a self-hypnosis group, in which patients performed self-hypnosis at least 10 times a day. All patients were trained to score the perceived pain twice daily on a numerical rating scale and also reported the quality of pain with the McGill Pain questionnaire. Repeated-measures analysis showed a significant difference between the groups; pain was lower in the self-hypnosis group but was not maintained after 4 weeks. Self-hypnosis could effectively decrease the intensity and could modify quality of pain in female patients with multiple sclerosis.

Management of non-traumatic avascular necrosis of the femoral head-a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting.

PubMed

Mohanty, S P; Singh, K A; Kundangar, R; Shankar, V

2017-04-01

The purpose of this study was to compare the clinical and radiological outcomes of multiple small diameter drilling and core decompression with fibular strut grafting in the management of non-traumatic avascular necrosis (AVN) of the femoral head. Outcomes of patients with AVN treated by multiple small diameter drilling (group 1) were compared retrospectively with patients treated by core decompression and fibular grafting (group 2). Harris hip score (HHS) was used to assess the clinical status pre- and postoperatively. Modified Ficat and Arlet classification was used to assess the radiological stage pre- and postoperatively. Forty-six patients (68 hips) were included in this study. Group 1 consisted of 33 hips, and group 2 consisted of 35 hips. In stages I and IIB, there was no statistically significant difference in the final HHS between the two groups. However, in stages IIA and III, hips in group 2 had a better final HHS (P < 0.05). In terms of radiographic progression, there was no statistical difference between hips in stages I, IIA and stage IIB. However, in stage III, hips belonging to group 2 had better results (P < 0.05). Kaplan-Meier survivorship analysis showed better outcome in group 2 in stage III (P < 0.05). Hips with AVN in the precollapse stage can be salvaged by core decompression with or without fibular grafting. Multiple small diameter drilling is relatively simple and carries less morbidity and hence preferred in stages I and II. However, in stage III disease, core decompression with fibular strut grafting gives better results.

Multipoint Multimedia Conferencing System with Group Awareness Support and Remote Management

ERIC Educational Resources Information Center

Osawa, Noritaka; Asai, Kikuo

2008-01-01

A multipoint, multimedia conferencing system called FocusShare is described that uses IPv6/IPv4 multicasting for real-time collaboration, enabling video, audio, and group awareness information to be shared. Multiple telepointers provide group awareness information and make it easy to share attention and intention. In addition to pointing with the…

An Examination of the Introductory MIS Course

ERIC Educational Resources Information Center

Wang, Shouhong

2007-01-01

The introductory management information systems (MIS) course is a core course for all business majors at almost every business school. It is common for this course to have multiple sections taught by a mixed group of instructors each semester. Hence, consistent pedagogy and assessment are needed for multiple sections of this course. This paper…

Beyond Leadership and Management: The Boundary-Spanning Role of the Pro-Vice Chancellor

ERIC Educational Resources Information Center

Pilbeam, Colin; Jamieson, Ian

2010-01-01

With the global increase in networked forms of organizations come new challenges for the conceptualization and practice of management and leadership. Universities have a networked organizational form being composed internally of multiple groups with both complementary and conflicting characteristics and expectations, and interfacing externally…

Making time for learning-oriented leadership in multidisciplinary hospital management groups.

PubMed

Singer, Sara J; Hayes, Jennifer E; Gray, Garry C; Kiang, Mathew V

2015-01-01

Although the clinical requirements of health care delivery imply the need for interdisciplinary management teams to work together to promote frontline learning, such interdisciplinary, learning-oriented leadership is atypical. We designed this study to identify behaviors enabling groups of diverse managers to perform as learning-oriented leadership teams on behalf of quality and safety. We randomly selected 12 of 24 intact groups of hospital managers from one hospital to participate in a Safety Leadership Team Training program. We collected primary data from March 2008 to February 2010 including pre- and post-staff surveys, multiple interviews, observations, and archival data from management groups. We examined the level and trend in frontline perceptions of managers' learning-oriented leadership following the intervention and ability of management groups to achieve objectives on targeted improvement projects. Among the 12 intervention groups, we identified higher- and lower-performing intervention groups and behaviors that enabled higher performers to work together more successfully. Management groups that achieved more of their performance goals and whose staff perceived more and greater improvement in their learning-oriented leadership after participation in Safety Leadership Team Training invested in structures that created learning capacity and conscientiously practiced prescribed learning-oriented management and problem-solving behaviors. They made the time to do these things because they envisioned the benefits of learning, valued the opportunity to learn, and maintained an environment of mutual respect and psychological safety within their group. Learning in management groups requires vision of what learning can accomplish; will to explore, practice, and build learning capacity; and mutual respect that sustains a learning environment.

Balancing multiple roles among a group of urban midlife American Indian working women.

PubMed

Napholz, L

2000-06-01

Presented are the results of a secondary analysis of group data from a study of a six-week role conflict reduction intervention among a group of urban American Indian women (n = 8). The specific aim of this researcher was to understand the process of balancing multiple roles as expressed in the participants' daily lived experiences as mothers, wives, and workers. A construction of the process of balancing multiple roles was accomplished through the use of narratives. Balancing multiple roles represented a major current attempt on the part of the participants to integrate and balance traditional and contemporary feminine strengths in a positive, culturally consistent manner. The study themes included: traditional sex role expectation conflicts, family guilt, guilt management, transitioning inner conflict and stress, breaking the silence-learning to say no, and healing the spirit to reclaim the self. Further support for retraditionalization of roles for this group of Indian women was maintained as an effective means of balancing roles and achieving Indian self-determination.

Frequent consulting and multiple morbidity: a qualitative comparison of ‘high’ and ‘low’ consulters of GPs

PubMed Central

Wyke, Sally; Hunt, Kate

2008-01-01

Background. Frequent consulting is associated with multiple and complex social and health conditions. It is not known how the impact of multiple conditions, the ability to self-manage and patient perception of the GP consultation combines to influence consulting frequency. Objective. To investigate reasons for frequent consultation among people with multiple morbidity but contrasting consulting rates. Methods. Qualitative study with in-depth interviews in the west of Scotland. Participants were 23 men and women aged about 50 years with four or more chronic illnesses; 11 reported consulting seven or more times in the last year [the frequent consulters (FCs)] and 12, three or fewer times [the less frequent consulters (LFCs)]. The main outcome measures were the participants’ accounts of their symptoms, self-management strategies and reasons for consulting a GP. Results. All participants used multiple self-management strategies. FCs described: more disruptive symptoms, which were resistant to self-management strategies; less access to fewer treatments and resources and more medical monitoring, for unstable conditions and drug regimens. The LFCs reported: less severe and more containable symptoms; accessing more efficacious self-management strategies and infrequent GP monitoring for stable conditions and routine drug regimens. All participants conveyed consulting as a ‘last resort’. However, the GP was seen as ‘ally’, for the FCs, and as ‘innocent bystander’, for the LFCs. Conclusions. This qualitative investigation into the combined significance of multiple morbidities and self-management on the GP consultation suggests that current models of self-management might have limited potential to reduce utilization rates among this vulnerable group. Severity of symptoms, stability of condition and complexity of drug regimens combine to influence the availability of effective resources and influence frequency of GP consultations. PMID:18448858

Multidrug-resistant bacteria infection and nursing quality management application in the department of physical examination.

PubMed

Xu, Li; Luo, Qiang; Chen, Liangzhen; Jiao, Lingmei

2017-09-01

The main problem of clinical prevention and control of multi drug resistant bacteria infection is to strengthen the monitoring of pathogenic bacteria spectrum, this study research on the multi drug-resistant bacteria infection and nursing quality management application in the department of physical examination. The results of this study showed that the number of patients with multiple drug resistant infections showed an increasing trend. Therefore, once the patients with multiple drug-resistant bacteria infection are found, the prevention and control of the patients with multiple drug-resistant bacteria should be strictly followed, and the patient's medication care should be highly valued. Also, the nurses need to be classified based on the knowledge and skill characteristics of the nurses in the department of physical examination, and compare the nursing effect before and after classification and grouping. The physicians and individuals receiving physical examinations in the department of physical examination had a higher degree of satisfaction for nursing effect after classification compared with those before classification. Classification and grouping management helps improve the nursing quality and overall quality of the nurses in the department of physical examination.

Single Versus Multiple Solid Organ Injuries Following Blunt Abdominal Trauma.

PubMed

El-Menyar, Ayman; Abdelrahman, Husham; Al-Hassani, Ammar; Peralta, Ruben; AbdelAziz, Hiba; Latifi, Rifat; Al-Thani, Hassan

2017-11-01

We aimed to describe the pattern of solid organ injuries (SOIs) and analyze the characteristics, management and outcomes based on the multiplicity of SOIs. A retrospective study in a Level 1 trauma center was conducted and included patients admitted with blunt abdominal trauma between 2011 and 2014. Data were analyzed and compared for patients with single versus multiple SOIs. A total of 504 patients with SOIs were identified with a mean age of 28 ± 13 years. The most frequently injured organ was liver (45%) followed by spleen (30%) and kidney (18%). One-fifth of patients had multiple SOIs, of that 87% had two injured organs. Patients with multiple SOIs had higher frequency of head injury and injury severity scores (p < 0.05). The majority of SOIs were treated nonoperatively, whereas operative management was required in a quarter of patients, mostly in patients with multiple SOIs (p = 0.01). Blood transfusion, sepsis and hospital stay were greater in multiple than single SOIs (p < 0.05). The overall mortality was 11% which was comparable between the two groups. In patients with single SOIs, the mortality was significantly higher in those who had pancreatic (28.6%) or hepatic injuries (13%) than the other SOIs. SOIs represent one-tenth of trauma admissions in Qatar. Although liver was the most frequently injured organ, the rate of mortality was higher in pancreatic injury. Patients with multiple SOIs had higher morbidity which required frequent operative management. Further prospective studies are needed to develop management algorithm based on the multiplicity of SOIs.

Management of hepatocellular adenoma: Solitary-uncomplicated, multiple and ruptured tumors

PubMed Central

Toso, Christian; Majno, Pietro; Andres, Axel; Rubbia-Brandt, Laura; Berney, Thierry; Buhler, Léo; Morel, Philippe; Mentha, Gilles

2005-01-01

AIM: While hepatocellular adenomas (HAs) have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs. METHODS: Twenty-five consecutive patients operated for solitary-uncomplicated (9), multiple (6), and ruptured (10) HAs were reviewed according to management strategies and outcomes. RESULTS: All solitary-uncomplicated HAs (ranged 2.2-14 cm in size) were removed. Out of 25 HAs, 2 (8%) included foci of carcinoma. In the multiple HA group, previously undiagnosed tumors were identified during surgery in 5/6 cases. In three cases with multiple spread HA, several lesions had to be left unresected. They remained unmodified after 4-, 6-, and 6-year radiological follow-up. Patients with ruptured HA (ranged 1.7-10 cm in size) were initially managed with hemodynamic support and angiography, allowing the embolization of actively bleeding tumors in two patients. All ruptured tumors were subsequently removed 5.5 d (range 4-70 d) after admission. CONCLUSION: Tumors suspected of HA, regardless of the size, should be resected, because of high chances of rupture causing bleeding, and/or containing malignant foci. Although it is desirable to remove all lesions of multiple HA, this may not be possible in some patients, for whom long-term radiological follow-up is advised. Ruptured HA can be managed by hemodynamic support and angiography, allowing scheduled surgery. PMID:16237767

Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ).

PubMed

Thomas, S; Kersten, P; Thomas, P W; Slingsby, V; Nock, A; Jones, R; Davies Smith, A; Galvin, K T; Baker, R; Hillier, C

2015-10-20

To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ('FACETS'). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life. A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS. All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions. Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme. 82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants' comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management. Individuals' comments highlighted the complex, multifaceted nature of fatigue management. Revising expectations and a greater acceptance of fatigue were important shifts following the programme. Findings support the relevance of a cognitive behavioural approach for fatigue management. Booster sessions might be a useful addition to the FACETS programme. Current controlled trials ISRCTN76517470; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

When Social Identities Collide: Commentary on "Gender in the Management Education Classroom"

ERIC Educational Resources Information Center

Patton, Eric

2010-01-01

This commentary to "Gender in the Management Education Classroom" (Bilimoria, O'Neil, Hopkins, & Murphy, 2010) employs social identity and self-categorization theory to analyze the incident described in the article. In any MBA classroom, students are dealing with multiple group memberships. Similar to workplace settings, when the focus is on…

Electronics. Criterion-Referenced Test (CRT) Item Bank.

ERIC Educational Resources Information Center

Davis, Diane, Ed.

This document contains 519 criterion-referenced multiple choice and true or false test items for a course in electronics. The test item bank is designed to work with both the Vocational Instructional Management System (VIMS) and the Vocational Administrative Management System (VAMS) in Missouri. The items are grouped into 15 units covering the…

Auto Mechanics. Criterion-Referenced Test (CRT) Item Bank.

ERIC Educational Resources Information Center

Tannehill, Dana, Ed.

This document contains 546 criterion-referenced multiple choice and true or false test items for a course in auto mechanics. The test item bank is designed to work with both the Vocational Instructional Management System (VIMS) and Vocational Administrative Management System (VAMS) in Missouri. The items are grouped into 35 units covering the…

The Relationship between Homework and Performance in an Introductory Operations Management Course.

ERIC Educational Resources Information Center

Peters, Michael; Kethley, Bryan; Bullington, Kimball

2002-01-01

Homework of 142 students in an operations management was graded and performance on a multiple-choice test was compared to that of 188 without graded homework. The treatment group had lower overall scores. Grading did not affect performance on quantitative questions but had a significant effect on nonquantitative questions. (SK)

The SYMLOG Dimensions and Small Group Conflict.

ERIC Educational Resources Information Center

Wall, Victor D., Jr.; Galanes, Gloria J.

1986-01-01

Explores the potential usefulness of R.F. Bales' systematic method for the multiple level observation of groups (SYMLOG) by testing the predictive capability of the three SYMLOG dimensions and the amount of member dispersion on each dimension with the amounts of conflict, reported satisfaction, styles of conflict management, and quality of…

Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group.

PubMed

Laubach, J; Garderet, L; Mahindra, A; Gahrton, G; Caers, J; Sezer, O; Voorhees, P; Leleu, X; Johnsen, H E; Streetly, M; Jurczyszyn, A; Ludwig, H; Mellqvist, U-H; Chng, W-J; Pilarski, L; Einsele, H; Hou, J; Turesson, I; Zamagni, E; Chim, C S; Mazumder, A; Westin, J; Lu, J; Reiman, T; Kristinsson, S; Joshua, D; Roussel, M; O'Gorman, P; Terpos, E; McCarthy, P; Dimopoulos, M; Moreau, P; Orlowski, R Z; Miguel, J S; Anderson, K C; Palumbo, A; Kumar, S; Rajkumar, V; Durie, B; Richardson, P G

2016-05-01

The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity. In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research. This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics. In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant. Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM.

48 CFR 1846.672-3 - Multiple consignee instructions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SPACE ADMINISTRATION CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports... description. (c) Block 17—Enter the “total” quantity shipped by item or, if applicable, grouped identical...

48 CFR 1846.672-3 - Multiple consignee instructions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SPACE ADMINISTRATION CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports... description. (c) Block 17—Enter the “total” quantity shipped by item or, if applicable, grouped identical...

Supporting multi-stakeholder environmental decisions.

PubMed

Hajkowicz, Stefan A

2008-09-01

This paper examines how multiple criteria analysis (MCA) can be used to support multi-stakeholder environmental management decisions. It presents a study through which 48 stakeholders from environmental, primary production and community interest groups used MCA to prioritise 30 environmental management problems in the Mackay-Whitsunday region of Queensland, Australia. The MCA model, with procedures for aggregating multi-stakeholder output, was used to inform a final decision on the priority of the region's environmental management problems. The result was used in the region's environmental management plan as required under Australia's Natural Heritage Trust programme. The study shows how relatively simple MCA methods can help stakeholders make group decisions, even when they hold strongly conflicting preferences.

Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: comparing standard and prolonged stent change intervals.

PubMed

Lawrence, Christopher; Romagnuolo, Joseph; Payne, K Mark; Hawes, Robert H; Cotton, Peter B

2010-09-01

Benign biliary strictures are typically managed endoscopically whereby an increasing size or number of plastic stents is placed at ERCP. Stents are often changed every 3 to 4 months based on the known median patency of a single biliary stent, but patency data for multiple biliary stents are lacking. To assess the incidence of occlusion-free survival of multiple plastic biliary stents and the rate of premature occlusion if left in longer than 6 months. Retrospective. Tertiary-care medical center (Charleston, SC). Consecutive patients who received multiple plastic stents for benign nonhilar biliary strictures from 1994 to 2008 were identified. Exchange of multiple plastic biliary stents within 6 months (group 1) or 6 months or longer (group 2) after placement. Symptomatic stent occlusion. Seventy-nine patients with nonhilar extrahepatic benign biliary stricture underwent 125 ERCPs with multiple plastic biliary stents. Stents were scheduled for removal/exchange within 6 months in 52 patients (86 ERCPs) compared with after 6 months in 22 patients (26 ERCPs). The median interval between multiple stent placement and removal/exchange was 90 days for group 1 and 242 days for group 2. Premature stent occlusion occurred in 4 of 52 (7.7%) patients in group 1 versus 1 of 22 (4.5%) in group 2, with significantly longer occlusion-free survival in group 2 (log-rank P < .0001). Retrospective study at a single tertiary referral center. Multiple plastic biliary stents for benign nonhilar strictures were associated with a low rate of premature symptomatic stent occlusion at more than 6 months and a longer occlusion-free survival. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

PubMed Central

Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

2015-01-01

Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients. PMID:26564013

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014.

PubMed

Bleich, Sara N; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Chang, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce; Anderson, Gerard

2015-11-12

Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.

Department of Defense Ecosystem Management Policy Evaluation

DTIC Science & Technology

2002-08-01

HQ Naval Facilities Engineering Command, DC • Tom Hillard, Fort Stewart, GA • Manual Joia , MCLB Barstow, CA • John Krupovage, Tinker AFB, OK...studies can follow single or multiple-case designs . Multiple cases strengthen the results and increase confidence in those results (Tellis 1997...groups having responsibility for maintaining their designated data layers (range, fish and wildlife, threatened and endangered species, forestry

Clinical features and outcomes of blunt splenic injury in children

PubMed Central

Yang, Kaiying; Li, Yanan; Wang, Chuan; Xiang, Bo; Chen, Siyuan; Ji, Yi

2017-01-01

Abstract Although the spleen is the most commonly injured intra-abdominal organ after blunt trauma, there are limited data available in China. The objectives of this study were to investigate the clinical features and determine the risk factors for operative management (OM) in children with blunt splenic injury (BSI). A review of the medical records of children diagnosed with BSI between January 2010 and September 2016 at West China Hospital of Sichuan University was performed. A total of 101 patients diagnosed with BSI were recruited, including 76 patients transferred from other hospitals. The male-to-female ratio was 2.06:1, with a mean age of 7.8 years old. The most common injury season was summer and the most common injury mechanism was road traffic accidents. Sixty-eight patients suffered multiple injuries. Thirty-four patients received blood transfusions. Two patients died from multiple organ failure or hemorrhagic shock. Significant differences were observed in the injury season, injury mechanism, injury date, and hemoglobin levels between the isolated injury group and the multiple injuries group. The overall operative rate was 29.7%. Multivariate regression analysis revealed that age, blood transfusion, and grade of injury were independent risk factors for OM. Our study provided evidence that the management of pediatric BSI was variable. The operative rate in pediatric BSI may be higher in certain patient groups. Although nonoperative management is one of the standard treatment options, our data suggest that OM is an appropriate way to treat patients who are hemodynamically unstable. PMID:29390566

Multiple Free Internal Limiting Membrane Flap Insertion in the Treatment of Macular Hole-Associated Retinal Detachment in High Myopia.

PubMed

Chen, San-Ni; Hsieh, Yi-Ting; Yang, Chung-May

2018-06-06

The aim of this paper was to evaluate the efficacy of multiple free internal limiting membrane (ILM) flap insertion in the management of macular hole-associated retinal detachment in high myopia. Eyes receiving operation for macular hole-associated retinal detachment were retrospectively recruited. Those in the study group received ILM peeling and multiple free ILM flap insertion, while those in the control group received ILM peeling only. Postoperative anatomical outcomes and best-corrected visual acuity were compared between the 2 groups. Twenty-seven eyes of 27 patients were recruited in this study (13 in the study group, 14 in the control group). After the operation, the retina was reattached in all cases in both groups. The macular hole closure rate was 100% in the study group but only 42.9% in the control group (adjusted p < 0.001). The eyes in the study group had better visual improvement (logMAR -0.58 ± 0.43) than those in the control group (logMAR -0.31 ± 0.50) with borderline significance (adjusted p = 0.078). For macular hole-associated retinal detachment in highly myopic eyes, the multiple free ILM flap insertion technique offers an effective way to close macular holes. Whether this result also means better visual outcome remains to be seen. © 2018 S. Karger AG, Basel.

The relational database model and multiple multicenter clinical trials.

PubMed

Blumenstein, B A

1989-12-01

The Southwest Oncology Group (SWOG) chose to use a relational database management system (RDBMS) for the management of data from multiple clinical trials because of the underlying relational model's inherent flexibility and the natural way multiple entity types (patients, studies, and participants) can be accommodated. The tradeoffs to using the relational model as compared to using the hierarchical model include added computing cycles due to deferred data linkages and added procedural complexity due to the necessity of implementing protections against referential integrity violations. The SWOG uses its RDBMS as a platform on which to build data operations software. This data operations software, which is written in a compiled computer language, allows multiple users to simultaneously update the database and is interactive with respect to the detection of conditions requiring action and the presentation of options for dealing with those conditions. The relational model facilitates the development and maintenance of data operations software.

Simulating the cumulative effects of multiple forest management strategies on landscape measures of forest sustainability

Treesearch

Eric J. Gustafson; David E. Lytle; Randy Swaty; Craig Loehle

2007-01-01

While the cumulative effects of the actions of multiple owners have long been recognized as critically relevant to efforts to maintain sustainable forests at the landscape scale, few studies have addressed these effects. We used the HARVEST timber harvest simulator to predict the cumulative effects of four owner groups (two paper companies, a state forest and non-...

A conspiracy of optimism: Sustained yield, multiple use, and intensive management on the national forests, 1945-1991

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

Hirt, P.W.

1991-01-01

This study focuses on two core national forest management policies; sustained yield and multiple use. Public and elected officials attempt to apply principles of sustainable development to publicly-owned forest lands to ensure that a wide variety of both market and nonmarket forest values are preserved for the benefit of present and future generations. Interest groups, the Forest Service, and policy makers have conceived of sustained yield and multiple use in different and evolving ways over the years. This study explores how these principles have been variously defined and either implemented or thwarted. After World War Two, with escalating demands onmore » national forest resources, the US Forest Service turned to intensive management as a technological method of enhancing natural forest productivity and mitigating the environmental effects of increased use. But the agency's optimistic vision of efficient, sustained production of forest commodities through technical mastery over nature has met overwhelming fiscal, environmental, technical, and political obstacles. Changing public values since the 1960s and popularization of ecology have initiated a growing skepticism toward the premises of intensive management.« less

[Magnet ingestions in children: a French multicenter study].

PubMed

Talvard, M; Mouttalib, S; Flaum, V; Viala, J; Galinier, P; Olives, J-P; Mas, E

2015-01-01

Digestive complications related to the ingestion of magnetic foreign bodies in children are increasing, especially in Asia and North America. In France, several case reports have been reported since 2008. We conducted a retrospective multicentric study to evaluate the frequency of ingestion of magnet foreign bodies and to describe the complicated cases that have occurred in France over the last 5 years. We report 40 cases of which 60% were multiple magnet ingestions. Eighty-eight percent of the children of the group who had swallowed multiple magnets needed interventional management by endoscopy (33%) or surgery (58%). Only two children (12.5%) of the group who swallowed one magnet required removal. This problem is not uncommon in France (2% of the 1132 foreign bodies investigated in the Toulouse center over 5 years), which justifies clear information for healthcare professionals and caregivers in order to avoid potential intestinal complications. We suggest interventional management or very close monitoring in the cases of multiple magnet ingestion. Meanwhile, in the majority of confirmed cases of simple magnet ingestions, we propose home monitoring. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A model of health education and management for osteoporosis prevention.

PubMed

Wang, Liang; Xu, Xiaowen; Zhang, Yan; Hao, Hongxia; Chen, Liying; Su, Tianjiao; Zhang, Yan; Ma, Weifeng; Xie, Yuanyuan; Wang, Tiantian; Yang, Fan; He, Li; Wang, Wenjiao; Fu, Xuemei; Ma, Yuanzheng

2016-12-01

Osteoporosis, a chronic disease with no therapeutic cure, affects a growing number of people as the aging population in China rapidly increases. Therefore, developing an evidence-based model of health education and management for osteoporosis prevention is required. In the present study, an osteoporosis club was established, which is a novel model of health education and management for osteoporosis prevention. A unified management of membership was used based on a digitized database. A total of 436 patients with osteoporosis were randomly assigned to the osteoporosis club group or the self-management control group. For the osteoporosis club group, multiple activities of health education were performed, including monthly systematic health education lectures, exercise programs and communication parties once a year. For the control group, the participants took charge of their own musculoskeletal health. All data of the participants were collected and evaluated prior to and following intervention. In the pre-intervention assessment, no significant difference was identified in the health education between the two groups. Through the four-year intervention, the osteoporosis knowledge, health beliefs, living behavior, medication compliance, quality of life and bone mineral density of the osteoporosis club group were improved significantly compared with the control group (P<0.001), while the pain degree of the osteoporosis club group was relieved significantly more compared with the control group (P<0.001). The results in the present study suggest that setting up an osteoporosis club is an evidence-based model of health education and management for osteoporosis prevention in China.

[Effects of a Multi-disciplinary Approached, Empowerment Theory Based Self-management Intervention in Older Adults with Chronic Illness].

PubMed

Park, Chorong; Song, Misoon; Cho, Belong; Lim, Jaeyoung; Song, Wook; Chang, Heekyung; Park, Yeon-Hwan

2015-04-01

The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness. A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function. Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups. The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.

Experience and management of chronic pain among patients with other complex chronic conditions.

PubMed

Butchart, Amy; Kerr, Eve A; Heisler, Michele; Piette, John D; Krein, Sarah L

2009-05-01

Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF). We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users. We compared health status and function between those with and without chronic pain within the 3 study groups. Among those with chronic pain, we compared pain location, severity, and treatment across groups. More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip, or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P<0.05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain. Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning, and quality of life and possibly also improve the management of their other major chronic health conditions.

Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes.

PubMed

Chesla, Catherine A; Fisher, Lawrence; Skaff, Marilyn M; Mullan, Joseph T; Gilliss, Catherine L; Kanter, Richard

2003-01-01

Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships. Research on families and chronic illness has focused almost exclusively on European American families. In this prospective study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos. Specifically, we tested how baseline family characteristics (structure, world view, and emotion management) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes. We found that emotion management predicted change in disease management in both groups of patients as hypothesized, while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans. Examining family context within ethnic groups is required to elucidate unique cultural patterns. Attending to culturally unique interpretations of constructs and measures is warranted. The import of family emotion management, specifically conflict resolution, in disease management deserves further study to support clinical intervention development. Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family contexts and individual health.

Epigenetics and cardiovascular disease

USDA-ARS?s Scientific Manuscript database

Despite advances in the prevention and management of cardiovascular disease (CVD), this group of multifactorial disorders remains a leading cause of mortality worldwide. CVD is associated with multiple genetic and modifiable risk factors; however, known environmental and genetic influences can only...

Experience with recurrent respiratory papillomatosis in a developing country: impact of tracheostomy.

PubMed

Orji, Foster Tochukwu; Okorafor, Ijeoma A; Akpeh, James O

2013-02-01

The frequent relapses of recurrent respiratory papillomatosis (RRP) sometimes demand repeated surgical excision with tracheostomy. This situation plays a vital role in the management of RRP in developing countries such as ours because of late presentation. This study was conducted to evaluate our experience with RRP and to determine the incidence and impact of tracheostomy in the overall management and outcomes of our patients. The records of 59 patients with histologically confirmed RRP treated between 1994 and 2008 at our tertiary institution were reviewed. We collected data such as age at onset, tracheostomy frequency and duration, number of required surgical excisions, papilloma spread to the lower airways. Patients' characteristics and the course of the disease were compared between a juvenile-onset papillomatosis (JoRRP) group and an adult-onset group (AdRRP). Overall, 68 % of our patients were in the JoRRP group (ages 2-11 years, mean 6 years). The other 32 % were 22-58 years of age (AdRRP group). Two cases of JoRRP continued into adult life. Multiple RRP dominated in the JoRRP group (93 %), whereas solitary papillomas predominated in the AdRRP group (63 %). Tracheostomy was performed because of upper airway obstruction in 42 % of our patients, with children accounting for 72 %. The mean duration of tracheostomy was 3.5 months, with 80 % lasting <4 months. Significantly more JoRRP patients had severe upper airway obstruction, required tracheostomy, and underwent multiple surgical excisions (p = 0.04, 0.02, and 0.009, respectively). Tracheobronchial spread occurred in a patient with prolonged tracheostomy. Multiple laryngeal papillomatosis clearly followed a more severe and less predictable course than the solitary type in both groups. Although there was a high incidence of tracheostomy in this study, short-duration tracheostomies accounted for the low incidence of extralaryngeal spread.

Management of multiple myeloma in resource-constrained settings.

PubMed

Kumar, Lalit; Kumar Sahoo, Ranjit

2016-12-01

The prognosis of patients with multiple myeloma (MM) has improved significantly in the past two decades. This is attributed to use of novel agents for induction, high-dose chemotherapy and autologous stem cell transplantation (ASCT), maintenance therapy, and improved supportive care. Currently, evidence-based management guidelines/recommendations developed by International societies/groups are being followed partially in low-resource settings. Lack of quality diagnostics (eg, cytogenetics/fluorescence in situ hybridization (FISH), serum free light chains), novel therapeutics, and trained manpower, and limited financial resources are key challanges. An optimal utilization of available resources with continued educational activities of treating physicians focused on improving knowledge in the management of such patients may be a way forward to improve the outcome of myeloma patients in these countries. Our current approach to the management of this disease is presented here through a discussion of clinical vignettes. Copyright © 2016 Elsevier Inc. All rights reserved.

Intrapleural cisplatin for management of malignant pleural effusion in a patient with plasma cell leucaemia.

PubMed

Agarwal, Abhishek; Klair, Jagpal; Patolia, Setu; Meena, Nikhil K

2015-06-29

Plasma cell leucaemia (PCL) is a rare aggressive form of multiple myeloma. It occasionally involves the pleura, causing malignant pleural effusion (MPE). MPE presents a management dilemma for physicians, given the different treatment options available with varying efficacy and side effects. We report a case of a 64-year-old man with MPE due to PCL, successfully managed with intrapleural cisplatin and a tunnelled pleural catheter. We believe this to be the first report of management of PCL-associated MPE with intrapleural cisplatin. 2015 BMJ Publishing Group Ltd.

Identity management strategies among HIV-positive Colombian gay men in London.

PubMed

Jaspal, Rusi; Williamson, Iain

2017-12-01

This study set out to explore the social-psychological aspects of living with HIV among a group of HIV-positive Colombian gay men in London, and the strategies that they deployed to manage ensuing threats to their identities. Focus group and individual interview data were collected from 14 Colombian gay men living with HIV, and were analysed using qualitative thematic analysis and identity process theory. The following themes are discussed: (1) identity struggles and conflicts in Colombia, (2), managing multiple layers of social stigma in England, and (3) changing interpersonal and intergroup dynamics, which highlight the inter-connections between sexual prejudice, sexual risk-taking and HIV stigma. Identity may be chronically threatened due to the multiple layers of stigma, which can limit the coping strategies available to individuals. Findings strongly support the need for action and programmes to highlight and tackle both racism and HIV stigma on the gay scene and to fund more specific resources for sub-communities of gay, bisexual and other men who have sex with men, which employ appropriately trained and culturally competent staff.

Development of a balance, safe mobility and falls management programme for people with multiple sclerosis.

PubMed

Gunn, Hilary; Endacott, Ruth; Haas, Bernhard; Marsden, Jonathan; Freeman, Jennifer

2017-08-07

To utilise stakeholder input to inform the structure, format and approach of a multiple sclerosis (MS) balance, safe mobility and falls management programme. Using a three-round nominal group technique, participants individually rated their agreement with 20 trigger statements, followed by a facilitated group discussion and re-rating. Three mixed groups included service users (n = 15) and providers (n = 19). Quantitative analysis determined agreement, whilst qualitative responses were analysed thematically. Median scores for each of the 20 trigger statements did not change significantly over sequential rounds, however, deviations around the medians indicated more agreement amongst participants over time. Key recommendations were: Aims and approach: The programme should be tailored to the needs of people with MS. Falls and participation-based outcomes are equally important. Structure and format: The programme should balance expected burden and anticipated benefit, moving away from models requiring weekly attendance and promoting and supporting self-efficacy. Optimising engagement: Support to maintain engagement and intensity of practice over the long term is essential. Sustainability: Adequate funding is necessary. Staff should have MS specific knowledge and experience. Participants collaboratively identified critical components of a MS balance, safe mobility and falls management programme. They also highlighted the importance of a collaborative, user-centred, MS-specific approach. Implications for Rehabilitation People with multiple sclerosis need condition-specific interventions focussed on maximising balance and safe mobility and reducing falls. Programme design should support self-efficacy and flexible engagement. Adequate support and funding are seen as essential by both service users and providers.

Patterns of wounding in hamadryas baboons (Papio hamadryas) in North American zoos.

PubMed

Wiley, Jodi N; Leeds, Austin; Carpenter, Kamisha D; Kendall, Corinne J

2018-03-01

In North American zoos, hamadryas baboons (Papio hamadryas) have traditionally been housed as single one-male units (single male groups). In recent years, efforts have been made to house hamadryas in groups composed of multiple one-male units (multi-male groups) to more closely mirror their natural social structure, in addition to all-male or bachelor groups to manage surplus males. Given that the majority of social conflict in hamadryas occurs between males during the acquisition and defense of females, it was thought that managing hamadryas in these multi-male groups would result in increased rates of wounding. To assess this, incidences of wounding were recorded over one year across seven zoos (10 social groups, 59 individuals). Overall, we found no difference in wounding rates between group types, or by sex, and group type. These data provide evidence that managing hamadryas in multi-male and bachelor groups is an effective husbandry practice that does not negatively impact the welfare of the individuals, in addition to providing a more species-appropriate social setting for hamadryas in zoos. As the management of hamadryas in multi-male and bachelor groups continues and expands, additional research will be needed to understand what factors contribute to optimal cohesion, and welfare of groups and if wounding rates change as group size continues to increase. © 2018 Wiley Periodicals, Inc.

Consensus Recommendations of the Multiple Sclerosis Study Group and Portuguese Neuroradiological Society for the Use of the Magnetic Resonance Imaging in Multiple Sclerosis in Clinical Practice: Part 1.

PubMed

Abreu, Pedro; Pedrosa, Rui; Sá, Maria José; Cerqueira, João; Sousa, Lívia; Da Silva, Ana Martins; Pinheiro, Joaquim; De Sá, João; Batista, Sónia; Simões, Rita Moiron; Pereira, Daniela Jardim; Vilela, Pedro; Vale, José

2018-05-30

Magnetic resonance imaging is established as a recognizable tool in the diagnosis and monitoring of multiple sclerosis patients. In the present, among multiple sclerosis centers, there are different magnetic resonance imaging sequences and protocols used to study multiple sclerosis that may hamper the optimal use of magnetic resonance imaging in multiple sclerosis. In this context, the Group of Studies of Multiple Sclerosis and the Portuguese Society of Neuroradiology, after a joint discussion, appointed a committee of experts to create recommendations adapted to the national reality on the use of magnetic resonance imaging in multiple sclerosis. The purpose of this document is to publish the first Portuguese consensus recommendations on the use of magnetic resonance imaging in multiple sclerosis in clinical practice. The Group of Studies of Multiple Sclerosis and the Portuguese Society of Neuroradiology, after discussion of the topic in national meetings and after a working group meeting held in Figueira da Foz on May 2017, have appointed a committee of experts that have developed by consensus several standard protocols on the use of magnetic resonance imaging in the diagnosis and follow-up of multiple sclerosis. The document obtained was based on the best scientific evidence and expert opinion. Subsequently, the majority of Portuguese multiple sclerosis consultants and departments of neuroradiology scrutinized and reviewed the consensus paper; comments and suggestions were considered. Technical magnetic resonance imaging protocols regarding diagnostic, monitoring and the recommended information to be included in the magnetic resonance imaging report will be published in a separate paper. We provide some practical guidelines to promote standardized strategies to be applied in the clinical practice setting of Portuguese healthcare professionals regarding the use of magnetic resonance imaging in multiple sclerosis. We hope that these first Portuguese magnetic resonance imaging guidelines, based in the best available clinical evidence and practices, will serve to optimize multiple sclerosis management and improve multiple sclerosis patient care across Portugal.

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study.

PubMed

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-05-11

To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Epigenetics lights up the obesity field

USDA-ARS?s Scientific Manuscript database

Despite advances in the prevention and management of cardiovascular disease (CVD), this group of multifactorial disorders remains a leading cause of mortality worldwide. CVD is associated with multiple genetic and modifiable risk factors; however, known environmental and genetic influences can only ...

How to maximally support local and regional biodiversity in applied conservation? Insights from pond management.

PubMed

Lemmens, Pieter; Mergeay, Joachim; De Bie, Tom; Van Wichelen, Jeroen; De Meester, Luc; Declerck, Steven A J

2013-01-01

Biodiversity and nature values in anthropogenic landscapes often depend on land use practices and management. Evaluations of the association between management and biodiversity remain, however, comparatively scarce, especially in aquatic systems. Furthermore, studies also tend to focus on a limited set of organism groups at the local scale, whereas a multi-group approach at the landscape scale is to be preferred. This study aims to investigate the effect of pond management on the diversity of multiple aquatic organism groups (e.g. phytoplankton, zooplankton, several groups of macro-invertebrates, submerged and emergent macrophytes) at local and regional spatial scales. For this purpose, we performed a field study of 39 shallow man-made ponds representing five different management types. Our results indicate that fish stock management and periodic pond drainage are crucial drivers of pond biodiversity. Furthermore, this study provides insight in how the management of eutrophied ponds can contribute to aquatic biodiversity. A combination of regular draining of ponds with efforts to keep ponds free of fish seems to be highly beneficial for the biodiversity of many groups of aquatic organisms at local and regional scales. Regular draining combined with a stocking of fish at low biomass is also preferable to infrequent draining and lack of fish stock control. These insights are essential for the development of conservation programs that aim long-term maintenance of regional biodiversity in pond areas across Europe.

Consensus guidelines on management of childhood convulsive status epilepticus.

PubMed

Mishra, Devendra; Sharma, Suvasini; Sankhyan, Naveen; Konanki, Ramesh; Kamate, Mahesh; Kanhere, Sujata; Aneja, Satinder

2014-12-01

Status epilepticus has a wide etiological spectrum, and significant morbidity and mortality. Management using a pre-determined uniform protocol leads to better outcomes. Multiple protocols for management of childhood status epilepticus are available, without much consensus. A 'Multi-disciplinary Consensus Development Workshop on Management of Status Epilepticus in Children in India' was organized. The invited experts included Pediatricians, Pediatric neurologists, Neurologists, Epileptologists, and Pediatric intensive care specialists from India, with experience in the relevant field. Experts had previously been divided into focus groups and had interacted on telephone and e-mail regarding their group recommendations, and developed consensus on the topic. During the meeting, each group presented their recommendations, which were deliberated upon by the house and a consensus was reached on various issues; the document was finalized after incorporating suggestions of experts on the draft document. To provide consensus guidelines on evaluation and management of convulsive status epilepticus in children in India (excluding neonatal and super-refractory status epilepticus). Each institution should use a pre-determined protocol for management of status epilepticus; pre-hospital management and early stabilization is the key to a satisfactory outcome of status epilepticus. Pharmacotherapy should not be delayed for any investigations; the initial management should consist of a parenteral benzodiazepine by any route feasible. Subsequent management has been detailed. The group also felt the need for more epidemiological research on status epilepticus from India, and identified certain research areas for the purpose.

Consolidation of medical groups into physician practice management organizations.

PubMed

Robinson, J C

1998-01-14

Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.

Motivational profiles in high school students: Differences in behavioural and emotional homework engagement and academic achievement.

PubMed

Regueiro, Bibiana; Núñez, José C; Valle, Antonio; Piñeiro, Isabel; Rodríguez, Susana; Rosário, Pedro

2016-12-12

This work examined whether combinations of academic and non-academic goals generated different motivational profiles in high school students. Besides, differences in homework behavioural engagement (i.e. amount of homework, time spent in homework, homework time management), homework emotional engagement (i.e. homework anxiety) and academic achievement were analysed. Participants were 714 high school students (43.4% boys and 56.6% girls). The study of potential motivational profiles was conducted by latent profile analysis, and the differences between the motivational profiles regarding homework variables and academic achievement were analysed using multivariate analysis. The results indicate the existence of five groups of motivational profiles: a group of students with multiple goals, a group of unmotivated students, two groups of students with a predominance of learning goals and, finally, a group comprising students with a high fear of failure. Both the group with multiple goals and the learning goals-oriented groups reported to do more homework, spending more time on homework, making better use of that time and having a higher academic achievement than counterparts. The avoidance-failure group and the group with multiple goals showed higher levels of homework anxiety. Globally, these results provide support for a person-centred approach. © 2016 International Union of Psychological Science.

Integrated management of waterbirds: Beyond the conventional

USGS Publications Warehouse

Erwin, R.M.

2002-01-01

Integrated waterbird management over the past few decades has implicitly referred to methods for managing wetlands that usually attempt to enhance habitat for taxonomic groups such as shorebirds and wading birds, in addition to waterfowl, the traditional focus group. Here I describe five elements of integration in management: taxonomic, spatial, temporal, population and habitat, and multiple-use management objectives. Spatial integration simply expands the scale of management concern. Rather than emphasizing management on a very limited number of impoundments or wetlands in small refuges or wildlife management areas, the vision is beginning to shift to connectivity within larger landscapes on the order of many square kilometers as telemetry data on daily and seasonal movements for many species become available. Temporal integration refers to the potential for either simultaneous management for waterbirds and commercial "crops" (e.g., crayfish and rice) or for temporally-staggered management such as row crop production in spring-summer growing seasons and waterbird management on fallow fields in the non-growing (winter) season. Integrating population dynamics with habitats has become a major research focus over the past decade. Identifying which wetlands are "sources" or "sinks" for specific populations provides managers with critical information about effective management. Further, the applications of spatially explicit population models place heavy demands on researchers to identify use patterns for breeding and dispersing individuals by age, sex, and reproductive class. Population viability analysis models require much the same information. Finally, multiple-use management integration refers to trying to optimize the uses of wetlands, when only one (perhaps secondary) use may include waterbird management. Depending upon the ownership and primary land use of a particular parcel of land containing wetlands and/or water bodies, managing for waterbirds may be an "easy sell" (e.g., public natural resource lands) or a very contentious one, where wetlands are created for industrial, aquaculture or urban uses. In the latter case, careful planning and implementation require broad stakeholder participation and education.

Integrated management of waterbirds: Beyond the conventional

USGS Publications Warehouse

Erwin, R.M.; Parsons, Katharine C.; Brown, Stephen C.; Erwin, R. Michael; Czech, Helen A.; Coulson, John C.

2002-01-01

Integrated waterbird management over the past few decades has implicitly referred to methods for managing wetlands that usually attempt to enhance habitat for taxonomic groups such as shorebirds and wading birds, in addition to waterfowl, the traditional focus group. Here I describe five elements of integration in management: taxonomic, spatial, temporal, population and habitat, and multiple-use management objectives. Spatial integration simply expands the scale of management concern. Rather than emphasizing management on a very limited number of impoundments or wetlands in small refuges or wildlife management areas, the vision is beginning to shift to connectivity within larger landscapes on the order of many square kilometers as telemetry data on daily and seasonal movements for many species become available. Temporal integration refers to the potential for either simultaneous management for waterbirds and commercial 'crops' (e.g., crayfish and rice) or for temporally-staggered management such as row crop production in spring-summer growing seasons and waterbird management on fallow fields in the non-growing (winter) season. Integrating population dynamics with habitats has become a major research focus over the past decade. Identifying which wetlands are ?sources? or ?sinks? for specific populations provides managers with critical information about effective management. Further, the applications of spatially explicit population models place heavy demands on researchers to identify use patterns for breeding and dispersing individuals by age, sex, and reproductive class. Population viability analysis models require much the same information. Finally, multiple-use management integration refers to trying to optimize the uses of wetlands, when only one (perhaps secondary) use may include waterbird management. Depending upon the ownership and primary land use of a particular parcel of land containing wetlands and/or water bodies, managing for waterbirds may be an ?easy sell? (e.g., public natural resource lands) or a very contentious one, where wetlands are created for industrial, aquaculture or urban uses. In the latter case, careful planning and implementation require broad stakeholder participation and education.

JCL Implementation On A Human Spaceflight Program

NASA Technical Reports Server (NTRS)

Kulpa, Vyga; Karpowich, Mike; Abel, Diana; Archiable, Wes; Carson, William

2013-01-01

Joint Confidence Level (JCL) analysis focuses on the integration of traditionally stove-piped programmatic components (schedule, cost and risk) to establish projected resource and schedule requirements at various confidence levels and to identify programmatic cost and schedule risk drivers. SLS Program consists of multiple Prime Contractors managed by independent SLS Elements which are integrated using SE&I and Program Management. SLS further integrates with GSDO and MPCV through ESD integrated working groups.

A multicenter, prospective, quasi-experimental evaluation study of a patient education program to foster multiple sclerosis self-management competencies.

PubMed

Feicke, Janine; Spörhase, Ulrike; Köhler, Jürgen; Busch, Claudia; Wirtz, Markus

2014-12-01

To determine the impact of the self-management training program "S.MS" for new multiple sclerosis (MS) patients. Multicenter, prospective, quasi-experimental study with 31 MS patients in the intervention group (training program) and 33 participants in the control group (CG) (brochures). Data were collected before, after and 6 months after the interventions. Analysis of change was done by ANCOVA with repeated measurements. At baseline, participants in CG were younger at the time of diagnosis, suffered more frequently from relapsing-remitting MS and took more MS-medication on a permanent basis. The intervention had a stable significant effect on each dimension of self-management ability, on total self-management ability (ES=0.194, p<0.001), on anxiety (ES=0.193, p=0.001), and on disease-specific quality of life (ES=0.120, p=0.007). Regarding depression, a significant interaction effect of time and intervention could be observed (ES=0.106, p=0.011). No effect was found on disease-specific knowledge. High participant acceptance was reported. "S.MS" participation was associated with a significant and sustained improvement of self-management abilities, anxiety and disease-specific quality of life in a quasi-experimental study design. Using RCT or CRT-designs would be desirable to further improve the evidence of treatment effectiveness. This study provides substantial evidence that "S.MS" fosters patients' self-management ability. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Interferential and horizontal therapies in chronic low back pain due to multiple vertebral fractures: a randomized, double blind, clinical study.

PubMed

Zambito, A; Bianchini, D; Gatti, D; Rossini, M; Adami, S; Viapiana, O

2007-11-01

Chronic low back pain due to multiple vertebral fractures is of difficult management. Electrical nerve stimulation is frequently used, but its efficacy has never been properly evaluated. In a randomized placebo-controlled clinical trial, we have shown that both interferential currents and horizontal therapy are more effective than placebo for functional. Multiple vertebral fractures almost invariably ensue in chronic low back pain that remains of difficult management. Electrical nerve stimulation is frequently used but its efficacy has never been properly evaluated. One hundred and fifteen women with chronic back pain due to previous multiple vertebral osteoporotic fractures (CBPMF) were randomly assigned to either interferential currents (IFT), horizontal therapy (HT) or sham HT administered for 30 minutes daily for 5 days per week for two weeks together with a standard exercise program. Efficacy assessment was obtained at baseline and at week 2, 6 and 14 and included a functional questionnaire (Backill), the standard visual analog scale (VAS) and the mean analgesic consumption. At week 2 a significant and similar improvement in both the VAS and Backill score was observed in the three groups. The two scores continued to improve in the two active groups with changes significantly (p < 0.001) greater than those observed in control patients at week 6 and 14. The use of analgesic medications improved only in the HT group. This randomized double-blind controlled study provides the first evidence that IFT and HT therapy are significantly effective in alleviating both pain and disability in patients with CBPMF.

Thiolated alginate-based multiple layer mucoadhesive films of metformin forintra-pocket local delivery: in vitro characterization and clinical assessment.

PubMed

Kassem, Abeer Ahmed; Issa, Doaa Ahmed Elsayed; Kotry, Gehan Sherif; Farid, Ragwa Mohamed

2017-01-01

Periodontal disease broadly defines group of conditions in which the supportive structure of the tooth (periodontium) is destroyed. Recent studies suggested that the anti-diabetic drug metformin hydrochloride (MF) has an osteogenic effect and is beneficial for the management of periodontitis. Development of strong mucoadhesive multiple layer film loading small dose of MF for intra-pocket application. Multiple layer film was developed by double casting followed by compression method. Either 6% carboxy methyl cellulose sodium (CMC) or sodium alginate (ALG) constituted the inner drug (0.6%) loaded layer. Thiolated sodium alginate (TSA; 2 or 4%) constituted the outer drug free layers to enhance mucoadhesion and achieve controlled drug release. Optimized formulation was assessed clinically on 20 subjects. Films were uniform, thin and hard enough for easy insertion into periodontal pockets. Based on water uptake and in vitro drug release, CMC based film with 4% TSA as an outer layer was the optimized formulation with enhanced mucoadhesion and controlled drug release (83.73% over 12 h). SEM showed the effective fabrication of the triple layer film in which connective lines between the layers could be observed. FTIR examination suggests possibility of hydrogen bonding between the -NH groups of metformin and -OH groups of CMC. DSC revealed the presence of MF mainly in the amorphous form. Clinical results indicated improvement of all clinical parameters six months post treatment. The results suggested that local application of the mucoadhesive multiple layer films loaded with metformin hydrochloride was able to manage moderate chronic periodontitis.

Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

PubMed

Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

2013-11-01

Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science.

Academic Leadership: Management of Groups or Leadership of Teams? A Multiple-Case Study on Designing and Implementing a Team-Based Development Programme for Academic Leadership

ERIC Educational Resources Information Center

Söderhjelm, Teresa; Björklund, Christina; Sandahl, Christer; Bolander-Laksov, Klara

2018-01-01

Demands on academic leadership are increasing, which raises the need for leadership training. This article describes development and implementation of a group training intervention in academic leadership at a departmental level. Little systematic research has addressed the question of what forms of leadership training are associated with…

A Phenomenological Inquiry into the Perceptions of Software Professionals on the Asperger's Syndrome/High Functioning Autism Spectrum and the Success of Software Development Projects

ERIC Educational Resources Information Center

Kendall, Leslie R.

2013-01-01

Individuals who have Asperger's Syndrome/High-Functioning Autism, as a group, are chronically underemployed and underutilized. Many in this group have abilities that are well suited for various roles within the practice of software development. Multiple studies have shown that certain organizational and management changes in the software…

Oncology disease management.

PubMed

Fetterolf, Donald E; Terry, Rachel

2007-02-01

Oncologic conditions are ubiquitous medical illnesses that present a particular challenge for medical management programs designed to address quality and cost issues in patient populations. Disease management strategies represent a reasonable and effective approach for employers and health plans in their arsenal of health management strategies. Multiple reasons exist for the development of specialized disease management programs that deal with cancer patients, some unique to this group of individuals. Health plans and/or employers have solid justification for addressing these issues directly through programs developed specifically to work with cancer patients. Whether developed within a health plan, or "carved out" to an external vendor, proper evaluation of outcomes is essential.

Examining occupational stress, sources of stress and stress management strategies through the eyes of management consultants: a multiple correspondence analysis for latent constructs.

PubMed

von Humboldt, Sofia; Leal, Isabel; Laneiro, Tito; Tavares, Patrícia

2013-12-01

To date, little research has yet focused in broad assessment for management consultancy professionals. This investigation aims to analyse management consultants' self-perceptions of occupational stress (SPoOS), sources of stress (SoS) and stress management strategies (SMS) and to find latent constructs that can work as major determinants in consultants' conceptualization of SPoOS, SoS and SMS. Measures were completed, including demographics and interviews. Complete data were available for 39 management consultants, 53.8% male and aged between 23 and 56 years (M = 38.0; SD = 9.2). The data were subjected to content analysis. Representation of the associations and latent constructs were analysed by a multiple correspondence analysis. Results indicated that 'intellectual disturber' (31.4%) was the most referred SPoOS, 'high workload' (15.1%) was identified as the most prevalent perceived SoS and 'coaching' (19.0%) was the most mentioned SMS. No significant differences between the two gender groups were found regarding the three total scores. SPoOS was explained by a two-factor model: 'organization-oriented' and 'person-oriented'. A three-dimension model formed by 'job concerns', 'organizational constraints' and 'career expectations' was indicated as a best-fit solution for SoS, and SMS was best explained in a three-dimension model by 'group dynamics strategies', 'organizational culture strategies' and 'individual support strategies'. This research makes a unique contribution for a better understanding of what defines SPoOS, SoS and SMS for management consultants. Copyright © 2013 John Wiley & Sons, Ltd.

Perspectives on Self-Management in Multiple Sclerosis

PubMed Central

Knaster, Elizabeth S.; Johnson, Kurt; McMullen, Kara A.; Ehde, Dawn M.

2011-01-01

The aim of this study was to elucidate the experience of self-management among people with multiple sclerosis (MS) and gather their input to inform a self-management intervention. Twelve people with MS participated in focus groups in which they were asked open-ended questions about MS symptoms, challenges, overcoming challenges, symptom management, and treatment preferences. The results suggest four major themes: 1) “The Everyday Experience of MS,” including comments about symptoms and their impact on functioning; 2) “Motivation for Self-Management,” including descriptions of motivation originating from physical necessity, success with other management techniques, and external sources; 3) “Coping Strategies and Skills,” including descriptions of changing behaviors, expanding social support networks, finding resources, utilizing medical treatment, and monitoring symptoms; and 4) “Vision for a Self-Management Intervention,” including suggestions that an intervention be individualized, be motivating, and provide resources. The results of this study can inform the design and implementation of self-management interventions. Experiences described by participants are consistent with other qualitative reports suggesting the active role people with MS play in managing their condition. Intervention approaches must consider the complex constellation of symptoms associated with MS and provide individualized treatments that enhance the person's ability to manage their symptoms, barriers presented by such symptoms, and their health care. PMID:24453718

Palatability and oral cavity tolerability of THC:CBD oromucosal spray and possible improvement measures in multiple sclerosis patients with resistant spasticity: a pilot study.

PubMed

Lus, Giacomo; Cantello, Roberto; Danni, Maura Chiara; Rini, Agusto; Sarchielli, Paola; Tassinari, Tiziana; Signoriello, Elisabetta

2018-04-01

Complaints about Δ 9 -tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray (Sativex ® ; GW Pharma Ltd, Salisbury, UK) in the management of multiple sclerosis spasticity include unpleasant taste and oral mucosal anomalies. This pilot study assessed the use of sugar-free chewing gum and/or a refrigerated bottle of THC:CBD oromucosal spray to mitigate these effects. Patients with multiple sclerosis spasticity (n = 52) at six sites in Italy who were receiving THC:CBD oromucosal spray and had associated oral mucosal effects were randomized into Group A (chewing gum; n = 15); Group B (cold bottle; n = 20); and Group C (cold bottle + chewing gum; n = 17). Taste perception in patients receiving chewing gum ± cold bottle intervention (Groups A and C combined) was significantly (p = 0.0001) improved from baseline to week 4 while maintaining spasticity control. Patient comfort, satisfaction and treatment adherence may benefit from these interventions.

Venue of receiving diabetes self-management education and training and its impact on oral diabetic medication adherence.

PubMed

Wu, Jun; Davis-Ajami, Mary Lynn; Noxon, Virginia; Lu, Zhiqiang Kevin

2017-04-01

To determine predictors associated with the diabetes self-management education and training (DSME) venue and its impact on oral antidiabetic (OAD) medication adherence. The Medical Expenditure Panel Survey household component (MEPS-HC) data (2010-2012) identified adults with diabetes prescribed OAD medication(s) who completed a supplemental Diabetes Care Survey (DCS). Based on the DCS responses to questions about the number and type of DSME venue(s), two groups were created: (1) multiple venues (a physician or health professional plus internet and/or group classes) vs (2) single venue (physician or health professional only). The medication possession ratio (MPR) measured medication adherence, with 0.80 the cut-point defining adherent. Logistic regression examined factors associated with the DSME venue and its effect on OAD medication adherence. Of the 2119 respondents, 41.6% received DSME from multiple venues. Age (<65years), education-level (college or higher), high-income, and diet modification were significantly more likely associated with receiving DSME from multiple venues. In single vs multiple venues, medication adherence was suboptimal (mean MPR 0.66 vs 0.64, p=0.245), and venue showed no influence on adherence (OR: 0.92, 95% CI, 0.73-1.16). Sociodemographic characteristics influence where adults with diabetes receive DSME. Adding different DSME venues may not address suboptimal OAD medication adherence. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Conceptual framework of the Controlling Asthma in American Cities Project.

PubMed

Herman, Elizabeth Jane

2011-02-01

The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the "program theory" of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need.

Approaches to the management of agents used for the treatment of multiple sclerosis: consensus statements from a panel of U.S. managed care pharmacists and physicians.

PubMed

Miller, Ross M; Happe, Laura E; Meyer, Kellie L; Spear, Rachel J

2012-01-01

Multiple sclerosis (MS) is a chronic, disabling, and costly disease with several treatment options available; however, there is variability in evidence-based clinical guidelines. Therefore, payers are at a disadvantage when making management decisions without the benefit of definitive guidance from treatment guidelines. To outline approaches for the management of agents used to treat MS, as determined from a group of U.S. managed care pharmacists and physicians. A modified Delphi process was used to develop consensus statements regarding MS management approaches. The panel was composed of experts in managed care and included 8 pharmacy directors and 6 medical directors presently or previously involved in formulary decision making from 12 health plans, 1 specialty pharmacy, and 1 consulting company. These decision makers, who have experience designing health care benefits that include MS treatments, provided anonymous feedback through 2 rounds of web-based surveys and participated in 1 live panel meeting held in December 2010. Consensus was defined as a mean response of at least 3.3 or 100% of responses either "agree" or "strongly agree" (i.e., no panelist answered "disagree" or "strongly disagree") on a 4-item Likert scale (1=strongly disagree, 2=disagree, 3=agree, 4=strongly agree). After 3 phases, these managed care representatives reached consensus on 25 statements for management of patients with MS. Consistent with managed care principles, this group of managed care experts found that health plans should consider efficacy, effectiveness, and safety, as well as patient preference, when evaluating MS therapies for formulary placement. Cost and contracting should be considered if efficacy and safety are judged to be comparable between agents. The consensus statements developed by a panel of managed care representatives provide some insight into decision making in formulary and utilization management of MS therapies.

Stress self-management: an intervention for women with physical disabilities.

PubMed

Hughes, Rosemary B; Robinson-Whelen, Susan; Taylor, Heather B; Hall, John W

2006-01-01

We sought to develop and evaluate the efficacy of an innovative, theory-driven, group stress self-management intervention designed to ameliorate stress and promote health among women with physical disabilities such as spinal cord injury, multiple sclerosis, and arthritis. We recruited a voluntary sample of 78 community-living women with disabilities who were randomly assigned to either the group stress management intervention or the wait-listed control group, and we used a within- and between-groups pretest/posttest design with a 3-month follow-up. Group differences in changes over time on measures of perceived stress and mental health offer support for the efficacy of the intervention. At the 3-month follow-up assessment, the intervention group also showed greater improvement on measures of pain and role limitations owing to physical health when compared the wait-listed control group. Perceived stress was supported as a mediator of the effect of the intervention on mental health. We found support for social connectedness and self-efficacy as mediators of the relation between the intervention and perceived stress; however, there was relatively weak evidence for differential change over time in those proposed mediators. This study provides the first of its kind, that is, an evaluation of the efficacy of a stress self-management intervention designed specifically for women with physical disabilities. The results are consistent with a model in which the stress management intervention enhances self-efficacy and social connectedness, which leads to reduced stress, which then contributes to improved mental health.

Influence of an injury reduction program on injury and fitness outcomes among soldiers

PubMed Central

Knapik, J; Bullock, S; Canada, S; Toney, E; Wells, J; Hoedebecke, E; Jones, B

2004-01-01

Objective: This study evaluated the influence of a multiple injury control intervention on injury and physical fitness outcomes among soldiers attending United States Army Ordnance School Advanced Individual Training. Methods: The study design was quasiexperimental involving a historical control group (n = 2559) that was compared to a multiple intervention group (n = 1283). Interventions in the multiple intervention group included modified physical training, injury education, and a unit based injury surveillance system (UBISS). The management responsible for training independently formed an Injury Control Advisory Committee that examined surveillance reports from the UBISS and recommended changes to training. On arrival at school, individual soldiers completed a demographics and lifestyle questionnaire and took an army physical fitness test (APFT: push-ups, sit-ups, and two mile run). Injuries among soldiers were tracked by a clinic based injury surveillance system that was separate from the UBISS. Soldiers completed a final APFT eight weeks after arrival at school. Results: Cox regression (survival analysis) was used to examine differences in time to the first injury while controlling for group differences in demographics, lifestyle characteristics, and physical fitness. The adjusted relative risk of a time loss injury was 1.5 (95% confidence interval 1.2 to 1.8) times higher in the historical control men and 1.8 (95% confidence interval 1.1 to 2.8) times higher in the historical control women compared with the multiple intervention men and women, respectively. After correcting for the lower initial fitness of the multiple intervention group, there were no significant differences between the multiple intervention and historical control groups in terms of improvements in push-ups, sit-ups, or two mile run performance. Conclusions: This multiple intervention program contributed to a reduction in injuries while improvements in physical fitness were similar to a traditional physical training program previously used at the school. PMID:14760025

Objective Structured Assessment of Technical Skills (OSATS) evaluation of theoretical versus hands-on training of vaginal breech delivery management: a randomized trial.

PubMed

Buerkle, Bernd; Rueter, Katharina; Hefler, Lukas A; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

2013-12-01

To compare the skills of performing a vaginal breech (VB) delivery after hands-on training versus demonstration. We randomized medical students to a 30-min demonstration (group 1) or a 30-min hands-on (group 2) training session using a standardized VB management algorithm on a pelvic training model. Subjects were tested with a 25 item Objective Structured Assessment of Technical Skills (OSATS) scoring system immediately after training and 72 h thereafter. OSATS scores were the primary outcome. Performance time (PT), self assessment (SA), confidence (CON), and global rating scale (GRS) were the secondary outcomes. Statistics were performed using the Mann-Whitney U-test, chi-square test, and multiple linear regression analysis. 172 subjects were randomized. OSATS scores (primary outcome) were significantly higher in group 2 (n=88) compared to group 1 (n=84) (21.18±2.29 vs. 20.19±2.37, respectively; p=0.006). The secondary outcomes GRS (10.31±2.28 vs. 9.17±2.21; p=0.001), PT (214.60±57.97 s vs. 246.98±59.34 s; p<0.0001), and CON (3.14±0.89 vs. 2.85±0.90; p=0.04) were also significantly different between groups, favoring group 2. After 72 h, primary and secondary outcomes were not significantly different between groups. In a multiple linear regression analysis, group assignment (odds ratio [OR] 1.60; 95% confidence interval [CI] 1.14-2.05; p<0.0001) and gender (OR 2.91; 95% CI 2.45-3.38; p<0.0001) independently influenced OSATS scores. Hands-on training leads to a significant improvement of VB management in a pelvic training model, but this effect was only seen in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Knowledge production and learning for sustainable landscapes: seven steps using social-ecological systems as laboratories.

PubMed

Angelstam, Per; Elbakidze, Marine; Axelsson, Robert; Dixelius, Malcolm; Törnblom, Johan

2013-03-01

There are multiple challenges regarding use and governance of landscapes' goods, functions and intangible values for ecosystem health and human well-being. One group of challenges is to measure and assess principal sustainability dimensions through performance targets, so stakeholders have transparent information about states and trends. Another group is to develop adaptive governance at multiple levels, and management of larger geographical areas across scales. Addressing these challenges, we present a framework for transdisciplinary research using multiple landscapes as place-based case studies that integrates multiple research disciplines and non-academic actors: (1) identify a suite of landscapes, and for each (2) review landscape history, (3) map stakeholders, use and non-use values, products and land use, (4) analyze institutions, policies and the system of governance, (5) measure ecological, economic, social and cultural sustainability, (6) assess sustainability dimensions and governance, and finally (7) make comparisons and synthesize. Collaboration, communication and dissemination are additional core features. We discuss barriers bridges and bridges for applying this approach.

Facilitating a teleconference-delivered fatigue management program: perspectives of occupational therapists.

PubMed

Dunleavy, Leah; Preissner, Katharine L; Finlayson, Marcia L

2013-12-01

Telehealth refers to the provision of health information and services across a geographical distance. Little is known about the experiences of occupational therapists using this method of service delivery. The study explored the process of facilitating a telehealth intervention from the perspective of occupational therapists. Occupational therapists completed SOAP (Subjective, Objective, Assessment, and Plan) notes after facilitating group-based, teleconference-delivered fatigue management groups to people with multiple sclerosis. Notes were also documented after therapist team meetings. All SOAP notes and field notes were subjected to thematic analysis. Five major themes were identified. "Managing time" was the central theme and was facilitated by professional foundation and challenged by logistics. Managing time contributed to challenging work, which led to the realization that it can work! Based on study findings, the theory and research on clinical reasoning, professional development, and adult learning are relevant to developing curricula that prepare occupational therapists for using telehealth approaches in practice.

Using interviews and focus groups with resource managers to explore risk perceptions and responses to climate scenarios

NASA Astrophysics Data System (ADS)

Clifford, K. R.; Travis, W.; Rangwala, I.; Rondeau, R.; Young, L.

2016-12-01

Resource managers in the western U.S. are increasingly tasked to incorporate climate change into management decisions and long-term planning, but this task is complicated by multiple challenges, among them the need to bridge between the differing perspectives and prerogatives of scientists and resource managers. As part of a larger, iterative, interdisciplinary, multi-landscape research project that built on a prior climate vulnerability research, we conducted more than 50 semi-structured interviews and four focus groups with resource managers in the Gunnison Basin in western Colorado. The interviews addressed the managers' risk perceptions and knowledge about the resources and landscapes, while the focus groups asked resource managers to reflect on their own resource decision-making in light of three narrative future climate scenarios created by scientists on the research team. While time-intensive, the interviews and focus groups produced important insights into the managers' understanding of both the resources in question and the future climate scenarios. We found that the managers' mental models of their systems, and their conceptions of landscape changes and future threats, were diverse and sometimes in conflict with those held by the research team. The managers' responses to the climate scenarios reflected divergent and nuanced perceptions of risk, adaptation and uncertainty, heavily shaped by personal experience—which could be a constraint under rapidly changing future conditions. Our deployment of social science methodologies facilitated the co-production of climate adaptation strategies and a bridge between and among scientists and managers. The participants found the focus groups helpful since they (1) provided space to focus on decision-making under climate change, rather than fixate on details of the science, and (2) facilitated interaction with colleagues from other agencies. Climate scientists used participant feedback to inform future scenario development. The use of small focus groups to engage with climate scenarios could add value to other ongoing efforts to promote landscape-scale adaptation.

Dysglycemia, Glycemic Variability, and Outcome After Cardiac Arrest and Temperature Management at 33°C and 36°C.

PubMed

Borgquist, Ola; Wise, Matt P; Nielsen, Niklas; Al-Subaie, Nawaf; Cranshaw, Julius; Cronberg, Tobias; Glover, Guy; Hassager, Christian; Kjaergaard, Jesper; Kuiper, Michael; Smid, Ondrej; Walden, Andrew; Friberg, Hans

2017-08-01

Dysglycemia and glycemic variability are associated with poor outcomes in critically ill patients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." Thirty-six sites in Europe and Australia. All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. Targeted temperature management at 33°C or 36°C. Nonparametric tests as well as multiple logistic regression and mixed effects logistic regression models were used. Median glucose concentrations on hospital admission differed significantly between Cerebral Performance Category outcomes (p < 0.0001). Hyper- and hypoglycemia were associated with poor neurologic outcome (p = 0.001 and p = 0.054). In the multiple logistic regression models, the median glycemic level was an independent predictor of poor Cerebral Performance Category (Cerebral Performance Category, 3-5) with an odds ratio (OR) of 1.13 in the adjusted model (p = 0.008; 95% CI, 1.03-1.24). It was also a predictor in the mixed model, which served as a sensitivity analysis to adjust for the multiple time points. The proportion of hyperglycemia was higher in the 33°C group compared with the 36°C group. Higher blood glucose levels at admission and during the first 36 hours, and higher glycemic variability, were associated with poor neurologic outcome and death. More patients in the 33°C treatment arm had hyperglycemia.

Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals.

PubMed

Methley, Abigail; Campbell, Stephen; Cheraghi-Sohi, Sudeh; Chew-Graham, Carolyn

2017-06-01

To explore perspectives and experiences of people with multiple sclerosis (MS) and health care professionals of mental health support for MS in the UK. 24 people with MS, 13 practice nurses, 12 general practitioners (GPs) and 9 MS specialist nurses were recruited through community groups and primary care practices across North West England. Semi-structured interviews were conducted, and data analyzed thematically using constant comparative analysis within and across the data sets. The theoretical framework of candidacy was used to interrogate data. Four themes were identified: candidates for care, management choices, defining roles, and permeability and responsiveness. Candidacy for care, and symptom management, depended on the framing of symptoms through a social or medical model of depression. Normalizing symptoms could prevent help-seeking by patients. Reported referral behavior varied by professional group, based on perceived remit, competency and training needs. GPs were perceived by patients and other professionals as central for management of mental health needs in MS, but may not perceive this role themselves, suggesting a need for increased knowledge, training, and improved access to specialist care. Implications for Rehabilitation Anxiety and depression are common in people with MS. Management of mental health needs in people with MS relies on complex decisions made by both people with MS and health care professionals. General practitioners may play a key role in the ongoing management of mental health needs of people with MS.

Collaborative engineering and design management for the Hobby-Eberly Telescope tracker upgrade

NASA Astrophysics Data System (ADS)

Mollison, Nicholas T.; Hayes, Richard J.; Good, John M.; Booth, John A.; Savage, Richard D.; Jackson, John R.; Rafal, Marc D.; Beno, Joseph H.

2010-07-01

The engineering and design of systems as complex as the Hobby-Eberly Telescope's* new tracker require that multiple tasks be executed in parallel and overlapping efforts. When the design of individual subsystems is distributed among multiple organizations, teams, and individuals, challenges can arise with respect to managing design productivity and coordinating successful collaborative exchanges. This paper focuses on design management issues and current practices for the tracker design portion of the Hobby-Eberly Telescope Wide Field Upgrade project. The scope of the tracker upgrade requires engineering contributions and input from numerous fields including optics, instrumentation, electromechanics, software controls engineering, and site-operations. Successful system-level integration of tracker subsystems and interfaces is critical to the telescope's ultimate performance in astronomical observation. Software and process controls for design information and workflow management have been implemented to assist the collaborative transfer of tracker design data. The tracker system architecture and selection of subsystem interfaces has also proven to be a determining factor in design task formulation and team communication needs. Interface controls and requirements change controls will be discussed, and critical team interactions are recounted (a group-participation Failure Modes and Effects Analysis [FMEA] is one of special interest). This paper will be of interest to engineers, designers, and managers engaging in multi-disciplinary and parallel engineering projects that require coordination among multiple individuals, teams, and organizations.

Impact of concomitant trauma in the management of blunt splenic injuries.

PubMed

Lo, Albert; Matheson, Anne-Marie; Adams, Dave

2004-09-10

Conservative management of isolated blunt splenic injuries has become widely accepted for haemodynamically stable patients, but may be untenable in those with multiple injuries. A retrospective review was performed to evaluate of our cumulative experience with non-operative management of splenic injuries, and to identify the risk factors for operative management. Eighty patients were identified. Demographics, mechanism of injury, injury severity score (ISS), clinical signs at presentation, utility of computed tomography scans and methods of treatment (operative management vs conservative management) were documented and statistically analysed to identify predictors for operative management. Initially, 45 patients (56%) were managed without operation, while 35 patients underwent urgent laparotomy - with 26 (74% in operative group) of these having splenectomy performed. Two patients (out of 45) failed conservative management and required delayed splenectomy, a 96% success rate for intended conservative management. Thus, overall rates of 54% non-operative management and 65% splenic conservation were achieved. The mean ISS of the operative management group (ISS=30) was higher than that of the non-operative treatment group (ISS=13, p<0.05), reflecting not only the grade of the splenic injury but also the severity of concomitant trauma. Risk factors for patients with blunt splenic injuries requiring operative management include ISS > or =16, hypotension, GCS < or =13, and requirement for blood transfusion (p<0.05). Appropriate patient selection is the most important element of non-operative management. Patients with splenic injuries who are haemodynamically stable can be managed non-operatively with acceptable outcome. However, in the presence of concomitant trauma, there is an increasing trend towards operative management.

Who to Blame: Irrational Decision-Makers or Stupid Modelers? (Arne Richter Award for Outstanding Young Scientists Lecture)

NASA Astrophysics Data System (ADS)

Madani, Kaveh

2016-04-01

Water management benefits from a suite of modelling tools and techniques that help simplifying and understanding the complexities involved in managing water resource systems. Early water management models were mainly concerned with optimizing a single objective, related to the design, operations or management of water resource systems (e.g. economic cost, hydroelectricity production, reliability of water deliveries). Significant improvements in methodologies, computational capacity, and data availability over the last decades have resulted in developing more complex water management models that can now incorporate multiple objectives, various uncertainties, and big data. These models provide an improved understanding of complex water resource systems and provide opportunities for making positive impacts. Nevertheless, there remains an alarming mismatch between the optimal solutions developed by these models and the decisions made by managers and stakeholders of water resource systems. Modelers continue to consider decision makers as irrational agents who fail to implement the optimal solutions developed by sophisticated and mathematically rigours water management models. On the other hand, decision makers and stakeholders accuse modelers of being idealist, lacking a perfect understanding of reality, and developing 'smart' solutions that are not practical (stable). In this talk I will have a closer look at the mismatch between the optimality and stability of solutions and argue that conventional water resources management models suffer inherently from a full-cooperation assumption. According to this assumption, water resources management decisions are based on group rationality where in practice decisions are often based on individual rationality, making the group's optimal solution unstable for individually rational decision makers. I discuss how game theory can be used as an appropriate framework for addressing the irrational "rationality assumption" of water resources management models and for better capturing the social aspects of decision making in water management systems with multiple stakeholders.

Value Encounters - Modeling and Analyzing Co-creation of Value

NASA Astrophysics Data System (ADS)

Weigand, Hans

Recent marketing and management literature has introduced the concept of co-creation of value. Current value modeling approaches such as e3-value focus on the exchange of value rather than co-creation. In this paper, an extension to e3-value is proposed in the form of a “value encounter”. Value encounters are defined as interaction spaces where a group of actors meet and derive value by each one bringing in some of its own resources. They can be analyzed from multiple strategic perspectives, including knowledge management, social network management and operational management. Value encounter modeling can be instrumental in the context of service analysis and design.

[Consensus document on spasticity in patients with multiple sclerosis. Grupo de Enfermedades Desmielinizantes de la Sociedad Española de Neurología].

PubMed

Oreja-Guevara, Celia; Montalban, Xavier; de Andrés, Clara; Casanova-Estruch, Bonaventura; Muñoz-García, Delicias; García, Inmaculada; Fernández, Óscar

2013-10-16

Multiple sclerosis is a chronic neurological inflammatory demyelinating disease. Specialists involved in the symptomatic treatment of this disease tend to apply heterogeneous diagnostic and treatment criteria. To establish homogeneous criteria for treating spasticity based on available scientific knowledge, facilitating decision-making in regular clinical practice. A group of multiple sclerosis specialists from the Spanish Neurological Society demyelinating diseases working group met to review aspects related to spasticity in this disease and draw up the consensus. After an exhaustive bibliographic search and following a metaplan technique, a number of preliminary recommendations were established to incorporate into the document. Finally, each argument was classified depending on the degree of recommendation according to the SIGN (Scottish Intercollegiate Guidelines Network) system. The resulting text was submitted for review by the demyelinating disease group. An experts' consensus was reached regarding spasticity triggering factors, related symptoms, diagnostic criteria, assessment methods, quality of life and therapeutic management (drug and non-drug) criteria. The recommendations included in this consensus can be a useful tool for improving the quality of life of multiple sclerosis patients, as they enable improved diagnosis and treatment of spasticity.

Outcomes Evaluation of a Weekly Nurse Practitioner-Managed Symptom Management Clinic for Patients With Head and Neck Cancer Treated With Chemoradiotherapy

PubMed Central

Mason, Heidi; DeRubeis, Mary Beth; Foster, Jared C.; Taylor, Jeremy M.G.; Worden, Francis P.

2016-01-01

Purpose/Objectives To determine whether improved monitoring through close follow-up with a nurse practitioner (NP) could enhance treatment compliance and decrease frequency of hospitalizations. Design Retrospective chart review. Setting An academic National Cancer Institute–designated comprehensive cancer center. Sample 151 patients aged 45–65 years diagnosed with stage III or IV oropharyngeal cancer. Methods Patients were nonrandomized to one of two groups: a prechemotherapy clinic group and a weekly NP-led clinic group. After examination of descriptive statistics, multiple linear and logistic regressions were used to compare groups across patient outcomes. Main Research Variables Hospitalization, chemotherapy dose deviations, and chemotherapy treatment completion. Findings The average number of visits during traditional treatment was three and, after initiation of the NP-led clinic, the number was six. The hospitalization rate was 28% in the traditional clinic group compared to 12% in the NP-led group. The rate of chemotherapy dose deviations was 48% in the traditional clinic group compared to 6% in the NP-led clinic group. Forty-six percent of patients in the traditional clinic group received the full seven scheduled doses of chemotherapy compared to 90% of patients seen in the NP-led clinic group. Conclusions A weekly NP-led symptom management clinic reduces rates of hospitalization and chemotherapy dose deviations and increases chemotherapy completion in patients receiving intensive chemoradiotherapy for oropharyngeal cancer. Implications for Nursing Patients receiving chemoradiotherapy benefit from close monitoring for toxicities by NPs to successfully complete their treatment and avoid hospitalization. Knowledge Translation Early interventions to manage toxicities in patients with head and neck cancer can improve outcomes. NPs are in a key position to manage these toxicities and, when symptoms are controlled, costs are reduced. PMID:24007925

The delicate balance of keeping it all together: Using social capital to manage multiple medications for patients on dialysis.

PubMed

Parker, Wendy M; Ferreira, Kristine; Vernon, Lauren; Cardone, Katie E

Patients with end-stage kidney disease (ESKD) typically have high medication burdens with numerous medications and specialized instructions. Limited data exist regarding ESKD patient perspectives on medication management. Why can some patients self-manage? Which organizational techniques are used? This project sought to determine experiences and attitudes regarding medication management among hemodialysis patients. Group interviews were conducted with adult patients from 3 dialysis facilities. Semi-structured interviews solicited information about medication self-management and views on related services. Interviews were recorded and transcribed and data were analyzed using inductive, thematic coding. Participants reported medication regimens complicated by the dialysis schedule, co-morbid conditions and multiple prescribers. Patients engaged in various coping strategies, including reliance on activating social capital and/or family social support, to manage their medications and health. When described, most thought medication management services would be beneficial, but not necessarily for themselves, despite some having histories of medication mismanagement. Patients on hemodialysis often develop strategies for managing medications that rely heavily on a social network, and strategies may not be discussed with healthcare providers. Social capital is a useful framework for considering patients' lifestyles and support structure when designing a medication regimen. Future research should explore this idea more proactively. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of Multi-Flight Common Routes for Traffic Flow Management

NASA Technical Reports Server (NTRS)

Sheth, Kapil; Clymer, Alexis; Morando, Alex; Shih, Fu-Tai

2016-01-01

When severe convective weather requires rerouting aircraft, FAA traffic managers employ severe weather avoidance plans (e.g., Playbook routes, Coded Departure Routes, etc.) These routes provide pilots with safe paths around weather-affected regions, and provide controllers with predictable, and often well-established flight plans. However, they often introduce large deviations to the nominal flight plans, which may not be necessary as weather conditions change. If and when the imposed traffic management initiatives (TMIs) become stale, updated shorter path flight trajectories may be found en route, providing significant time-savings to the affected flights. Multiple Flight Common Routes (MFCR) is a concept that allows multiple flights that are within a specified proximity or region, to receive updated shorter flight plans in an operationally efficient manner. MFCR is believed to provide benefits to the National Airspace System (NAS) by allowing traffic managers to update several flight plans of en route aircraft simultaneously, reducing operational workload within the TMUs of all affected ARTCCs. This paper will explore some aspects of the MFCR concept by analyzing multiple flights that have been selected for rerouting by the NAS Constraint Evaluation and Notification Tool (NASCENT). Various methods of grouping aircraft with common or similar routes will be presented, along with a comparison of the efficacy of these methods.

The selective conservative management of small traumatic pneumothoraces following stab injuries is safe: experience from a high-volume trauma service in South Africa.

PubMed

Kong, V Y; Oosthuizen, G V; Clarke, D L

2015-02-01

The selective conservative management of small pneumothoraces (PTXs) following stab injuries is controversial. We reviewed a cohort of patients managed conservatively in a high volume trauma service in South Africa. A retrospective review over a 2-year period identified 125 asymptomatic patients with small PTXs measuring <2 cm on chest radiograph who were managed conservatively. Of the 125 patients included in the study, 92% were male (115/125), and the median age for all patients was 21 years (19-24). Ninety-seven per cent (121/125) of the weapons involved were knives, and 3% (4/125) were screwdrivers. Sixty-one per cent of all injuries were on the left side. Eighty-two per cent (102/125) sustained a single stab, and 18% (23/125) had multiple stabs. Thirty-nine per cent (49/125) had a PTX <0.5 cm (Group A), 26% (32/125) were ≥ 0.5 to <1 cm (Group B), 19% (24/125) were ≥ 1 to <1.5 cm (Group C) and 15% (20/125) were ≥ 1.5 to <2 cm (Group D). Three per cent of all patients (4/125) eventually required ICDs (one in Group C, three in Group D). All four patients had ICDs in situ for 24 h. The remaining 97% (121/125) were all managed successfully by active clinical observation alone. There were no subsequent readmissions, morbidity or mortality as a direct result of our conservative approach. The selective conservative management of asymptomatic small PTXs from stab injuries is safe if undertaken in the appropriate setting.

Developing objectives with multiple stakeholders: adaptive management of horseshoe crabs and Red Knots in the Delaware Bay

USGS Publications Warehouse

McGowan, Conor P.; Lyons, James E.; Smith, David

2015-01-01

Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

Classification systems for natural resource management

USGS Publications Warehouse

Kleckner, Richard L.

1981-01-01

Resource managers employ various types of resource classification systems in their management activities such as inventory, mapping, and data analysis. Classification is the ordering or arranging of objects into groups or sets on the basis of their relationships, and as such, provide the resource managers with a structure for organizing their needed information. In addition of conforming to certain logical principles, resource classifications should be flexible, widely applicable to a variety of environmental conditions, and useable with minimal training. The process of classification may be approached from the bottom up (aggregation) or the top down (subdivision) or a combination of both, depending on the purpose of the classification. Most resource classification systems in use today focus on a single resource and are used for a single, limited purpose. However, resource managers now must employ the concept of multiple use in their management activities. What they need is an integrated, ecologically based approach to resource classification which would fulfill multiple-use mandates. In an effort to achieve resource-data compatibility and data sharing among Federal agencies, and interagency agreement has been signed by five Federal agencies to coordinate and cooperate in the area of resource classification and inventory.

Developing Objectives with Multiple Stakeholders: Adaptive Management of Horseshoe Crabs and Red Knots in the Delaware Bay

NASA Astrophysics Data System (ADS)

McGowan, Conor P.; Lyons, James E.; Smith, David R.

2015-04-01

Structured decision making (SDM) is an increasingly utilized approach and set of tools for addressing complex decisions in environmental management. SDM is a value-focused thinking approach that places paramount importance on first establishing clear management objectives that reflect core values of stakeholders. To be useful for management, objectives must be transparently stated in unambiguous and measurable terms. We used these concepts to develop consensus objectives for the multiple stakeholders of horseshoe crab harvest in Delaware Bay. Participating stakeholders first agreed on a qualitative statement of fundamental objectives, and then worked to convert those objectives to specific and measurable quantities, so that management decisions could be assessed. We used a constraint-based approach where the conservation objectives for Red Knots, a species of migratory shorebird that relies on horseshoe crab eggs as a food resource during migration, constrained the utility of crab harvest. Developing utility functions to effectively reflect the management objectives allowed us to incorporate stakeholder risk aversion even though different stakeholder groups were averse to different or competing risks. While measurable objectives and quantitative utility functions seem scientific, developing these objectives was fundamentally driven by the values of the participating stakeholders.

The integrated supplier: key to cost management and multi-franchise capitation contracting.

PubMed

Schuweiler, R C

1996-05-01

Capitation...most healthcare providers do not work under it, comprehend it, or even want it, yet supply capitation contracting seminars are popping up everywhere creating the feeling that the bandwagon is leaving, and it might be time to get on board. Not true. Supply capitation is not for all organizations. Capitation contracting is not easy and there are not many successful models to help the uninitiated. If a panacea is sought for reducing supply costs, capitation is only one component of a systematic strategy to reduce materiel costs. This article suggests a direction using the Group Health Materiel Management (Group Health Cooperative of Puget Sound, WA) experience as a point of reference. It advocates a systematic approach that focuses on expense reduction in: cost of goods, holding cost of inventory, labor cost associated with all materiel processes, distribution cost (transportation and par stock pick, pack, and replenishment), product utilization, variation in product standards, and waste stream byproducts. At Group Health (GH) these issues are primarily addressed through the use of: information systems, supplier certification/selection processes, group purchasing compliance, supply channel management, supply capitation contracting programs, standardization, and utilization management. Because of managed care organizational structure, Group Health Cooperative supply capitation contracting, as performed at GH, is discussed not as a quick fix solution but in the spirit of sharing our experience with others who may be considering it as a cost savings tactic in the context of a broad-based materiel management strategy. This article highlights the experiences of GH beginning with materiel management's business process assumptions toward multiple-franchise supply capitation.

Education & Recycling: Educator's Waste Management Resource and Activity Guide 1994.

ERIC Educational Resources Information Center

California State Dept. of Conservation. Sacramento. Div. of Recycling.

This activity guide for grades K-12 reinforces the concepts of recycling, reducing, and reusing through a series of youth-oriented activities. The guide incorporates a video-based activity, multiple session classroom activities, and activities requiring group participation and student conducted research. Constructivist learning theory was…

Sub-Lexical Reading Intervention in a Student with Dyslexia and Asperger's Disorder

ERIC Educational Resources Information Center

Wright, Craig; Conlon, Elizabeth; Wright, Michalle; Dyck, Murray

2011-01-01

Dyslexia is a common presenting condition in clinic and educational settings. Unlike the homogenous groups used in randomised trials, educators typically manage children who have multiple developmental problems. Investigations are required into how these complex cases respond to treatment identified as efficacious by controlled trials. This study…

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study

PubMed Central

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-01-01

Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. PMID:25968001

Objective structured assessment of technical skills evaluation of theoretical compared with hands-on training of shoulder dystocia management: a randomized controlled trial.

PubMed

Buerkle, Bernd; Pueth, Julia; Hefler, Lukas A; Tempfer-Bentz, Eva-Katrin; Tempfer, Clemens B

2012-10-01

To compare the skills of performing a shoulder dystocia management algorithm after hands-on training compared with demonstration. We randomized medical students to a 30-minute hands-on (group 1) and a 30-minute demonstration (group 2) training session teaching a standardized shoulder dystocia management scheme on a pelvic training model. Participants were tested with a 22-item Objective Structured Assessment of Technical Skills scoring system after training and 72 hours thereafter. Objective Structured Assessment of Technical Skills scores were the primary outcome. Performance time, self-assessment, confidence, and global rating scale were the secondary outcomes. Statistics were performed using Mann-Whitney U test, χ test, and multiple linear regression analysis. Two hundred three participants were randomized. Objective Structured Assessment of Technical Skills scores were significantly higher in group 1 (n=103) compared with group 2 (n=100) (17.95±3.14 compared with 15.67±3.18, respectively; P<.001). The secondary outcomes global rating scale (GRS; 10.94±2.71 compared with 8.57±2.61, respectively; P<.001), self-assessment (3.15±0.94 compared with 2.72±1.01; P=.002), and confidence (3.72±0.98 compared with 3.34±0.90, respectively; P=.005), but not performance time (3:19±0:48 minutes compared with 3:31±1:05 minutes; P=.1), were also significantly different, favoring group 1. After 72 hours, Objective Structured Assessment of Technical Skills scores were still significantly higher in group 1 (n=67) compared with group 2 (n=60) (18.17±2.76 compared with 14.98±3.03, respectively; P<.001) as were GRS (10.80±2.62 compared with 8.15±2.59; P<.001) and self assessment (SA; 3.44±0.87 compared with 2.95±0.94; P=.003). In a multiple linear regression analysis, group assignment (group 1 compared with 2; P<.001) and sex (P=.002) independently influenced Objective Structured Assessment of Technical Skills scores. Hands-on training helps to achieve a significant improvement of shoulder dystocia management on a pelvic training model. www.ClinicalTrials.gov, NCT01618565. I.

Management of insulin pump therapy in children with type 1 diabetes.

PubMed

Abdullah, Nadeem; Pesterfield, Claire; Elleri, Daniela; Dunger, David B

2014-12-01

Insulin pump therapy is a current treatment option for children and adolescents with type 1 diabetes. Insulin pumps can provide a greater flexibility in insulin administration and meal planning, as compared with multiple insulin injections, and they may be particularly suitable for the paediatric age group. Many young people with diabetes have integrated insulin pumps into their daily practice. The use of insulin pumps can also be supplemented by the information retrieved from continuous glucose monitoring in the sensor-augmented pump therapy, which may improve glycaemic control. In this review, we describe the principles of pump therapy and summarise features of commercially available insulin pumps, with focus on practical management and the advantages and disadvantages of this technology. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Differential diagnosis of Mendelian and mitochondrial disorders in patients with suspected multiple sclerosis

PubMed Central

Katz Sand, Ilana B.; Honce, Justin M.; Lublin, Fred D.

2015-01-01

Several single gene disorders share clinical and radiologic characteristics with multiple sclerosis and have the potential to be overlooked in the differential diagnostic evaluation of both adult and paediatric patients with multiple sclerosis. This group includes lysosomal storage disorders, various mitochondrial diseases, other neurometabolic disorders, and several other miscellaneous disorders. Recognition of a single-gene disorder as causal for a patient’s ‘multiple sclerosis-like’ phenotype is critically important for accurate direction of patient management, and evokes broader genetic counselling implications for affected families. Here we review single gene disorders that have the potential to mimic multiple sclerosis, provide an overview of clinical and investigational characteristics of each disorder, and present guidelines for when clinicians should suspect an underlying heritable disorder that requires diagnostic confirmation in a patient with a definite or probable diagnosis of multiple sclerosis. PMID:25636970

Efficacy of rasagiline in patients with the parkinsonian variant of multiple system atrophy: a randomised, placebo-controlled trial.

PubMed

Poewe, Werner; Seppi, Klaus; Fitzer-Attas, Cheryl J; Wenning, Gregor K; Gilman, Sid; Low, Phillip A; Giladi, Nir; Barone, Paolo; Sampaio, Cristina; Eyal, Eli; Rascol, Olivier

2015-02-01

Multiple system atrophy is a complex neurodegenerative disorder for which no effective treatment exists. We aimed to assess the effect of rasagiline on symptoms and progression of the parkinsonian variant of multiple system atrophy. We did this randomised, double-blind, placebo-controlled trial between Dec 15, 2009, and Oct 20, 2011, at 40 academic sites specialised in the care of patients with multiple systemic atrophy across 12 countries. Eligible participants aged 30 years or older with possible or probable parkinsonian variant multiple system atrophy were randomly assigned (1:1), via computer-generated block randomisation (block size of four), to receive either rasagiline 1 mg per day or placebo. Randomisation was stratified by study centre. The investigators, study funder, and personnel involved in patient assessment, monitoring, analysis and data management were masked to group assignment. The primary endpoint was change from baseline to study end in total Unified Multiple System Atrophy Rating Scale (UMSARS) score (parts I and II). Analysis was by modified intention to treat. The trial is registered with ClinicalTrials.gov, number NCT00977665. We randomly assigned 174 participants to the rasagiline group (n=84) or the placebo group (n=90); 21 (25%) patients in the rasagiline group and 15 (17%) in the placebo group withdrew from the study early. At week 48, patients in the rasagiline group had progressed by an adjusted mean of 7·2 (SE 1·2) total UMSARS units versus 7·8 (1·1) units in those in the placebo group. This treatment difference of -0·60 (95% CI -3·68 to 2·47; p=0·70) was not significant. 68 (81%) patients in the rasagiline group and 67 (74%) patients in the placebo group reported adverse events, and we recorded serious adverse events in 29 (35%) versus 23 (26%) patients. The most common adverse events in the rasagiline group were dizziness (n=10 [12%]), peripheral oedema (n=9 [11%]), urinary tract infections (n=9 [11%]), and orthostatic hypotension (n=8 [10%]). In this population of patients with the parkinsonian variant of multiple system atrophy, treatment with rasagiline 1 mg per day did not show a significant benefit as assessed by UMSARS. The study confirms the sensitivity of clinical outcomes for multiple system atrophy to detect clinically significant decline, even in individuals with early disease. Teva Pharmaceutical Industries and H Lundbeck A/S. Copyright © 2015 Elsevier Ltd. All rights reserved.

Relationship of various factors affecting the sustainable private forest management at Pajangan District, Special Regions Yogyakarta, Indonesia

NASA Astrophysics Data System (ADS)

Widayanto, B.; Karsidi, R.; Kusnandar; Sutrisno, J.

2018-03-01

Forests have a role and function in providing good atmosphere with stable oxygen content and affecting global climate stability. Good forest management will provide stable climatic conditions in global climate change. A good forest is managed to provide a sustainable environment condition. This study aims to analyze the relationship of various factors affecting the sustainability of private forests management. This research is a quantitative research with survey method and determination of sampling are was by purposive sampling. Sampling method using multiple stage cluster sampling with 60 samples. From the results it was found that the successful sustainable private forest management influenced by various factors, such as group dynamics, stakeholder support, community institutions, and farmer participation. The continuity of private forest management is determined by the fulfillment of economic, social and environmental dimensions. The most interesting finding is that the group dynamics conditions are very good, whereas the sense of togetherness among community is very strong under limited resources managing private forests. The sense of togetherness resulted creativity to diversify business and thus reduced the pressure in exploiting the forest. Some people think that managing the people's forest as a culture so that its existence can be more sustainable.

Multiple curved descending approaches and the air traffic control problem

NASA Technical Reports Server (NTRS)

Hart, S. G.; Mcpherson, D.; Kreifeldt, J.; Wemple, T. E.

1977-01-01

A terminal area air traffic control simulation was designed to study ways of accommodating increased air traffic density. The concepts that were investigated assumed the availability of the microwave landing system and data link and included: (1) multiple curved descending final approaches; (2) parallel runways certified for independent and simultaneous operation under IFR conditions; (3) closer spacing between successive aircraft; and (4) a distributed management system between the air and ground. Three groups each consisting of three pilots and two air traffic controllers flew a combined total of 350 approaches. Piloted simulators were supplied with computer generated traffic situation displays and flight instruments. The controllers were supplied with a terminal area map and digital status information. Pilots and controllers also reported that the distributed management procedure was somewhat more safe and orderly than the centralized management procedure. Flying precision increased as the amount of turn required to intersect the outer mark decreased. Pilots reported that they preferred the alternative of multiple curved descending approaches with wider spacing between aircraft to closer spacing on single, straight in finals while controllers preferred the latter option. Both pilots and controllers felt that parallel runways are an acceptable way to accommodate increased traffic density safely and expeditiously.

Ecosystem services capacity across heterogeneous forest types: understanding the interactions and suggesting pathways for sustaining multiple ecosystem services.

PubMed

Alamgir, Mohammed; Turton, Stephen M; Macgregor, Colin J; Pert, Petina L

2016-10-01

As ecosystem services supply from tropical forests is declining due to deforestation and forest degradation, much effort is essential to sustain ecosystem services supply from tropical forested landscapes, because tropical forests provide the largest flow of multiple ecosystem services among the terrestrial ecosystems. In order to sustain multiple ecosystem services, understanding ecosystem services capacity across heterogeneous forest types and identifying certain ecosystem services that could be managed to leverage positive effects across the wider bundle of ecosystem services are required. We sampled three forest types, tropical rainforests, sclerophyll forests, and rehabilitated plantation forests, over an area of 32,000m(2) from Wet Tropics bioregion, Australia, aiming to compare supply and evaluate interactions and patterns of eight ecosystem services (global climate regulation, air quality regulation, erosion regulation, nutrient regulation, cyclone protection, habitat provision, energy provision, and timber provision). On average, multiple ecosystem services were highest in the rainforests, lowest in sclerophyll forests, and intermediate in rehabilitated plantation forests. However, a wide variation was apparent among the plots across the three forest types. Global climate regulation service had a synergistic impact on the supply of multiple ecosystem services, while nutrient regulation service was found to have a trade-off impact. Considering multiple ecosystem services, most of the rehabilitated plantation forest plots shared the same ordination space with rainforest plots in the ordination analysis, indicating that rehabilitated plantation forests may supply certain ecosystem services nearly equivalent to rainforests. Two synergy groups and one trade-off group were identified. Apart from conserving rainforests and sclerophyll forests, our findings suggest two additional integrated pathways to sustain the supply of multiple ecosystem services from a heterogeneous tropical forest landscape: (i) rehabilitation of degraded forests aiming to provide global climate regulation and habitat provision ecosystem services and (ii) management intervention to sustain global climate regulation and habitat provision ecosystem services. Copyright © 2016 Elsevier B.V. All rights reserved.

A Chronic Care Ostomy Self-Management Program for Cancer Survivors

PubMed Central

Krouse, Robert S.; Grant, Marcia; McCorkle, Ruth; Wendel, Christopher S.; Cobb, Martha D.; Tallman, Nancy J.; Ercolano, Elizabeth; Sun, Virginia; Hibbard, Judith H.; Hornbrook, Mark C.

2016-01-01

Background Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial-and-error to improve self-management. Methods This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at six-month follow-up (Patient Activation Measure, Self-Efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with Ostomy Care Survey, and the City of Hope Quality of Life - Ostomy). Changes from pre- to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. Results Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4–4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including Patient Activation (p=0.0004), Self-Efficacy (p=0.006), Total HRQOL (p=0.01), physical well-being (p=0.005), and social well-being (p=0.002). Survivor anxiety was significantly reduced by follow-up (p=0.047). Conclusions This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors. PMID:26804708

A chronic care ostomy self-management program for cancer survivors.

PubMed

Krouse, Robert S; Grant, Marcia; McCorkle, Ruth; Wendel, Christopher S; Cobb, Martha D; Tallman, Nancy J; Ercolano, Elizabeth; Sun, Virginia; Hibbard, Judith H; Hornbrook, Mark C

2016-05-01

Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management. This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047). This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.

High-risk multiple myeloma: a multifaceted entity, multiple therapeutic challenges.

PubMed

Muchtar, Eli; Magen, Hila; Gertz, Morie A

2017-06-01

The term high-risk multiple myeloma is aimed to identify a heterogeneous group of patients who are more likely to progress and die early of their disease. Therefore, recognition of these patients is crucial. With the increase in the number of treatment options, the outcome for high-risk patients has probably improved, although the true extent of this improvement remains unknown, due to both the heterogeneous components of high-risk disease and its under-representation in clinical trials. In this article, we review the definitions of high-risk disease, emphasizing the fact that no single definition can represent the entire high-risk population. In the second part, we review the treatment options available for the management of high-risk myeloma as well as our general approach for high-risk disease. In light of the poor prognosis associated with high-risk myeloma, even in the current era, new approaches for the management of this subset of patients are needed.

Management of necrotising appendicitis associated with widespread necrotising enterocolitis of the small and large bowel and perforated duodenal ulcer.

PubMed

Gupta, Vaibhav; Zani, Augusto; Jackson, Paul; Singh, Shailinder

2015-06-08

A 7-year-old boy presented in septic shock secondary to appendicitis with generalised peritonitis. Following crystalloid resuscitation, he underwent surgery. Faecopurulent contamination and free air were found. This was secondary to a perforated and gangrenous appendix, multiple large and small bowel segments with perforations, patches of necrosis, interspersed with healthy bowel and segments of questionable viability. There was also a perforated duodenal ulcer. Necrotic segments were resected using a 'clip-and-drop' technique to shorten operative duration and guide resection to preserve bowel length. After six laparotomies and multiple bowel resections, the child was discharged home with an ileostomy that was subsequently reversed. He is currently on a normal diet and pursuing all activities appropriate for his age. Perforated appendicitis can be associated with widespread bowel necrosis and multiple perforations. A conservative damage limitation approach using the 'clip-and-drop' technique and relook laparotomies is useful in the management of extensive bowel necrosis in children. 2015 BMJ Publishing Group Ltd.

Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities.

PubMed

Motl, Robert W; Mowry, Ellen M; Ehde, Dawn M; LaRocca, Nicholas G; Smith, Kathy E; Costello, Kathleen; Shinto, Lynne; Ng, Alexander V; Sullivan, Amy B; Giesser, Barbara; McCully, Kevin K; Fernhall, Bo; Bishop, Malachy; Plow, Matthew; Casaccia, Patrizia; Chiaravalloti, Nancy D

2018-03-01

People with multiple sclerosis (MS) have identified "wellness" and associated behaviors as a high priority based on "social media listening" undertaken by the National MS Society (i.e. the Society). The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda. The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness. That process informed a group-mediated activity for developing and prioritizing research goals for wellness in MS. This served as a background for articulating the mission and objectives of the Society's Wellness Research Working Group. The primary mission of the Wellness Research Working Group is the provision of scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (i.e. wellness) in people with MS as well as managing the disease and its consequences.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program.

PubMed

Urgenson, Lauren S; Ryan, Clare M; Halpern, Charles B; Bakker, Jonathan D; Belote, R Travis; Franklin, Jerry F; Haugo, Ryan D; Nelson, Cara R; Waltz, Amy E M

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

Visions of Restoration in Fire-Adapted Forest Landscapes: Lessons from the Collaborative Forest Landscape Restoration Program

NASA Astrophysics Data System (ADS)

Urgenson, Lauren S.; Ryan, Clare M.; Halpern, Charles B.; Bakker, Jonathan D.; Belote, R. Travis; Franklin, Jerry F.; Haugo, Ryan D.; Nelson, Cara R.; Waltz, Amy E. M.

2017-02-01

Collaborative approaches to natural resource management are becoming increasingly common on public lands. Negotiating a shared vision for desired conditions is a fundamental task of collaboration and serves as a foundation for developing management objectives and monitoring strategies. We explore the complex socio-ecological processes involved in developing a shared vision for collaborative restoration of fire-adapted forest landscapes. To understand participant perspectives and experiences, we analyzed interviews with 86 respondents from six collaboratives in the western U.S., part of the Collaborative Forest Landscape Restoration Program established to encourage collaborative, science-based restoration on U.S. Forest Service lands. Although forest landscapes and group characteristics vary considerably, collaboratives faced common challenges to developing a shared vision for desired conditions. Three broad categories of challenges emerged: meeting multiple objectives, collaborative capacity and trust, and integrating ecological science and social values in decision-making. Collaborative groups also used common strategies to address these challenges, including some that addressed multiple challenges. These included use of issue-based recommendations, field visits, and landscape-level analysis; obtaining support from local agency leadership, engaging facilitators, and working in smaller groups (sub-groups); and science engagement. Increased understanding of the challenges to, and strategies for, developing a shared vision of desired conditions is critical if other collaboratives are to learn from these efforts.

From the Children’s Oncology Group: Evidence-based recommendations for PEG-asparaginase nurse monitoring, hypersensitivity reaction management, and patient/family education

PubMed Central

Woods, Deborah; Winchester, Kari; Towerman, Alison; Gettinger, Katie; Carey, Christina; Timmermann, Karen; Langley, Rachel; Browne, Emily

2017-01-01

PEG-aspariginase is a backbone chemotherapy agent in pediatric acute lymphoblastic leukemia and in some non-Hodgkin lymphoma therapies. Nurses lack standardized guidelines for monitoring patients receiving PEG-asparaginase and for educating patients/families about hypersensitivity reaction risks. An electronic search of six databases using publication years 2000–2015 and multiple professional organizations and clinical resources was conducted. Evidence sources were reviewed for topic applicability. Each of the final 23 sources was appraised by two team members. The GRADE system was used to assign a quality and strength rating for each recommendation. Multiple recommendations were developed: four relating to nurse monitoring of patients during and after drug administration, eight guiding hypersensitivity reaction management, and four concerning patient/family educational content. These strong recommendations were based on moderate, low, or very-low quality evidence. Several recommendations relied upon generalized drug hypersensitivity guidelines. Additional research is needed to safely guide PEG-asparaginase monitoring, hypersensitivity reaction management and patient/family education. Nurses administering PEG-asparaginase play a critical role in the early identification and management of hypersensitivity reactions. PMID:28602129

When Stakeholders Rebel: Lessons from a Safe Schools Program

ERIC Educational Resources Information Center

Gastic, Billie; Irby, Decoteau J.; Zdanis, Maureen

2008-01-01

In this essay, we describe our experiences working with a rebellious primary stakeholder, Sylvia, as evaluators of a district-wide safe schools program. Given the breadth of the program and its multiple target constituencies, we were confronted with the challenges of managing a large number of stakeholders, or those individuals and groups that…

78 FR 79007 - Certain Multiple Mode Outdoor Grills and Parts Thereof; Commission Determination Not To Review an...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... Antonio, Texas; Kmart Corporation of Hoffman Estates, Illinois; Sears Brands Management Corporation, Sears... Specialty Brands, LLC, (2) change the name of Respondent Rankam Group to Rankam Metal Products Manufactory... Kamado Joe Company is a trade name for the legal entity Premier Specialty Brands, LLC; Rankam Metal...

Multiple Race Reporting. AIR 2001 Annual Forum Paper.

ERIC Educational Resources Information Center

Dahra, Amita; Howard, Kyland

For more than 20 years the standards set in Statistical Policy Directive No. 15 of the Office of Management and Budget (OMB) have provided a common language to define and group the social constructs of "race" and "ethnicity." The definitions were developed to provide consistency in the collection of data by various federal…

Gathering Requirements for Teacher Tools: Strategies for Empowering Teachers through Co-Design

ERIC Educational Resources Information Center

Matuk, Camillia; Gerard, Libby; Lim-Breitbart, Jonathan; Linn, Marcia

2016-01-01

Technology can enhance teachers' practice in multiple ways. It can help them better understand patterns in their students' thinking, manage class progress at individual and group levels, and obtain evidence to inform modifications to curriculum and instruction. Such technology is most effective when it is aligned with teachers' goals and…

HDF Update

NASA Technical Reports Server (NTRS)

Pourmal, Elena

2016-01-01

The HDF Group maintains and evolves HDF software used by NASA ESDIS program to manage remote sense data. In this talk we will discuss new features of HDF (Virtual Datasets, Single writerMultiple reader access, Community supported HDF5 compression filters) that address storage and IO performance requirements of the applications that work with the ESDIS data products.

The Use of Group Contingencies for Preventing and Managing Disruptive Behaviors

ERIC Educational Resources Information Center

Hulac, David M.; Benson, Nicholas

2010-01-01

Disruptive behaviors requiring intervention occur across multiple school systems, including individual students and classrooms. Such behaviors, including talking aloud in class, getting out of one's seat, or more serious behaviors, can be frustrating for other students as well as teachers, who are trying to help students meet ever-increasing…

Power of Persuasion: Becoming the Influencer

ERIC Educational Resources Information Center

Johnson, William C.; Young, Norman

2012-01-01

The ability to effectively communicate an idea is as important as the idea itself. Facility managers are called on to perform an incredible variety of tasks taking into account a diverse group of stakeholders and multiple competing priorities. Becoming a powerful influencer and sharpening one's skills of persuasion will prove to be a fundamental…

Biodiversity conservation in agriculture requires a multi-scale approach.

PubMed

Gonthier, David J; Ennis, Katherine K; Farinas, Serge; Hsieh, Hsun-Yi; Iverson, Aaron L; Batáry, Péter; Rudolphi, Jörgen; Tscharntke, Teja; Cardinale, Bradley J; Perfecto, Ivette

2014-09-22

Biodiversity loss--one of the most prominent forms of modern environmental change--has been heavily driven by terrestrial habitat loss and, in particular, the spread and intensification of agriculture. Expanding agricultural land-use has led to the search for strong conservation strategies, with some suggesting that biodiversity conservation in agriculture is best maximized by reducing local management intensity, such as fertilizer and pesticide application. Others highlight the importance of landscape-level approaches that incorporate natural or semi-natural areas in landscapes surrounding farms. Here, we show that both of these practices are valuable to the conservation of biodiversity, and that either local or landscape factors can be most crucial to conservation planning depending on which types of organisms one wishes to save. We performed a quantitative review of 266 observations taken from 31 studies that compared the impacts of localized (within farm) management strategies and landscape complexity (around farms) on the richness and abundance of plant, invertebrate and vertebrate species in agro-ecosystems. While both factors significantly impacted species richness, the richness of sessile plants increased with less-intensive local management, but did not significantly respond to landscape complexity. By contrast, the richness of mobile vertebrates increased with landscape complexity, but did not significantly increase with less-intensive local management. Invertebrate richness and abundance responded to both factors. Our analyses point to clear differences in how various groups of organisms respond to differing scales of management, and suggest that preservation of multiple taxonomic groups will require multiple scales of conservation. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

A Multidisciplinary Approach to a Pediatric Difficult Airway Simulation Course.

PubMed

Lind, Meredith Merz; Corridore, Marco; Sheehan, Cameron; Moore-Clingenpeel, Melissa; Maa, Tensing

2018-02-01

Objective To design and assess an advanced pediatric airway management course, through simulation-based team training and with multiple disciplines, to emphasize communication and cooperation across subspecialties and to provide a common skill set and knowledge base. Methods Trainees from anesthesiology, emergency medicine, critical care, pediatric surgery, and otolaryngology at a tertiary children's hospital participated in a 1-day workshop emphasizing airway skills and complex airway simulations. Small groups were multidisciplinary to promote teamwork. Participants completed pre- and postworkshop questionnaires. Results Thirty-nine trainees participated over the 3-year study period. Compared with their precourse responses, participants' postcourse responses indicated either agreement or strong agreement that the multidisciplinary format (1) helped in the development of team communication skills and (2) was preferred over single-discipline training. Improvement in confidence in managing critical airway situations and in advanced airway management skills was significant ( P < .05). Eighty-one percent of participants had improved confidence in following the hospital's critical airway protocol, and 64% were better able to locate advanced airway management equipment. Discussion Multiple subspecialists manage pediatric respiratory failure, where successful care requires complex handoffs and teamwork. Multidisciplinary education to teach advanced airway management, teamwork, and communication skills is practical and preferred by learners and is possible to achieve despite differences in experience. Future study is required to better understand the impact of this course on patient care outcomes. Implications for Practice Implementation of a pediatric difficult airway course through simulation-based team training is feasible and preferred by learners among multiple disciplines. A multidisciplinary approach exposes previously unrecognized knowledge gaps and allows for better communication and collaboration among the fields.

Treatment optimization in MS: Canadian MS Working Group updated recommendations.

PubMed

Freedman, Mark S; Selchen, Daniel; Arnold, Douglas L; Prat, Alexandre; Banwell, Brenda; Yeung, Michael; Morgenthau, David; Lapierre, Yves

2013-05-01

The Canadian Multiple Sclerosis Working Group (CMSWG) developed practical recommendations in 2004 to assist clinicians in optimizing the use of disease-modifying therapies (DMT) in patients with relapsing multiple sclerosis. The CMSWG convened to review how disease activity is assessed, propose a more current approach for assessing suboptimal response, and to suggest a scheme for switching or escalating treatment. Practical criteria for relapses, Expanded Disability Status Scale (EDSS) progression and MRI were developed to classify the clinical level of concern as Low, Medium and High. The group concluded that a change in treatment may be considered in any RRMS patient if there is a high level of concern in any one domain (relapses, progression or MRI), a medium level of concern in any two domains, or a low level of concern in all three domains. These recommendations for assessing treatment response should assist clinicians in making more rational choices in their management of relapsing MS patients.

Using evidence-integrated e-learning to enhance case management continuing education for psychiatric nurses: a randomised controlled trial with follow-up.

PubMed

Liu, Wen-I; Rong, Jiin-Ru; Liu, Chieh-Yu

2014-11-01

E-learning is a flexible strategy to improve nurses' knowledge of case management, but there are methodological limitations in previous research into the effectiveness of such programs. To describe the development and effectiveness of an evidence-integrated e-learning program in case management continuing education for Taiwanese psychiatric nurses. Multiple methods were adopted to develop the program and a randomised controlled trial with repeated measures was employed to evaluate it. The e-learning program was developed in four stages: (1) systematic review of literature; (2) needs assessment through a national survey and focus group; (3) development of learning materials; and (4) pilot test. Following program development, psychiatric nurses were recruited and randomly allocated into an experimental or comparison group. The experimental group participated in an e-learning continuing education program. The case management knowledge index with sufficient reliability and validity and a satisfaction survey were used to determine the outcomes. A generalised estimating equation was used to assess the difference between the 2 groups before, after, and at 3 months follow-up. The learning material comprised 5 simulated learning modules, self-assessment questions, learning cases, sharing experiences, and learning resources. A total of 200 participants completed the 3 measurements. Knowledge scores in the experimental group significantly exceeded those in the comparison group after the program and at the 3-month follow-up. Participants reported positive learning perceptions. The program provides an evidence-based educational resource for nursing continuing education in case management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

PubMed Central

Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin

2012-01-01

Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source. PMID:23055773

Future directions in treatment of brain metastases

PubMed Central

Barani, Igor J.; Larson, David A.; Berger, Mitchel S.

2013-01-01

Background: Brain metastases affect up to 30% of patients with cancer. Management of brain metastases continues to evolve with ever increasing focus on cognitive preservation and quality of life. This manuscript reviews current state of brain metastases management and discusses various treatment controversies with focus on future clinical trials. Stereotactic radiosurgery (SRS) and whole-brain radiotherapy (WBRT) are discussed in context of multiple (4+ brain metastases) as well as new approaches combining radiation and targeted agents. A brief discussion of modified WBRT approaches, including hippocampal-avoidance WBRT (HA-WBRT) is included as well as a section on recently presented results of Radiation Therapy Oncology Group (RTOG) 0614, a randomized, double-blind, placebo-controlled trial of menantine for prevention of neurocognitive injury after WBRT. Methods: A search of selected studies relevant to management of brain metastases was performed in PubMed as well as in various published meeting abstracts. This data was collated and analyzed in context of contemporary management and future clinical trial plans. This data is presented in tabular form and discussed extensively in the text. Results: The published data demonstrate continued evolution of clinical trials and management strategies designed to minimize and/or prevent cognitive decline following radiation therapy management of brain metastases. Hippocampal avoidance whole-brain radiation therapy (HA-WBRT) and radiosurgery treatments for multiple brain metastases are discussed along with preliminary results of RTOG 0614, a trial of memantine therapy to prevent cognitive decline following WBRT. Trial results appear to support the use of memantine for prevention of cognitive decline. Conclusions: Different management strategies for multiple brain metastases (>4 brain metastases) are currently being evaluated in prospective clinical trials to minimize the likelihood of cognitive decline following WBRT. PMID:23717793

Future directions in treatment of brain metastases.

PubMed

Barani, Igor J; Larson, David A; Berger, Mitchel S

2013-01-01

Brain metastases affect up to 30% of patients with cancer. Management of brain metastases continues to evolve with ever increasing focus on cognitive preservation and quality of life. This manuscript reviews current state of brain metastases management and discusses various treatment controversies with focus on future clinical trials. Stereotactic radiosurgery (SRS) and whole-brain radiotherapy (WBRT) are discussed in context of multiple (4+ brain metastases) as well as new approaches combining radiation and targeted agents. A brief discussion of modified WBRT approaches, including hippocampal-avoidance WBRT (HA-WBRT) is included as well as a section on recently presented results of Radiation Therapy Oncology Group (RTOG) 0614, a randomized, double-blind, placebo-controlled trial of menantine for prevention of neurocognitive injury after WBRT. A search of selected studies relevant to management of brain metastases was performed in PubMed as well as in various published meeting abstracts. This data was collated and analyzed in context of contemporary management and future clinical trial plans. This data is presented in tabular form and discussed extensively in the text. The published data demonstrate continued evolution of clinical trials and management strategies designed to minimize and/or prevent cognitive decline following radiation therapy management of brain metastases. Hippocampal avoidance whole-brain radiation therapy (HA-WBRT) and radiosurgery treatments for multiple brain metastases are discussed along with preliminary results of RTOG 0614, a trial of memantine therapy to prevent cognitive decline following WBRT. Trial results appear to support the use of memantine for prevention of cognitive decline. Different management strategies for multiple brain metastases (>4 brain metastases) are currently being evaluated in prospective clinical trials to minimize the likelihood of cognitive decline following WBRT.

Patient-centered priorities for improving medication management and adherence.

PubMed

McMullen, Carmit K; Safford, Monika M; Bosworth, Hayden B; Phansalkar, Shobha; Leong, Amye; Fagan, Maureen B; Trontell, Anne; Rumptz, Maureen; Vandermeer, Meredith L; Brinkman, William B; Burkholder, Rebecca; Frank, Lori; Hommel, Kevin; Mathews, Robin; Hornbrook, Mark C; Seid, Michael; Fordis, Michael; Lambert, Bruce; McElwee, Newell; Singh, Jasvinder A

2015-01-01

The Centers for Education and Research on Therapeutics convened a workshop to examine the scientific evidence on medication adherence interventions from the patient-centered perspective and to explore the potential of patient-centered medication management to improve chronic disease treatment. Patients, providers, researchers, and other stakeholders (N = 28) identified and prioritized ideas for future research and practice. We analyzed stakeholder voting on priorities and reviewed themes in workshop discussions. Ten priority areas emerged. Three areas were highly rated by all stakeholder groups: creating tools and systems to facilitate and evaluate patient-centered medication management plans; developing training on patient-centered prescribing for providers; and increasing patients' knowledge about medication management. However, priorities differed across stakeholder groups. Notably, patients prioritized using peer support to improve medication management while researchers did not. Engaging multiple stakeholders in setting a patient-centered research agenda and broadening the scope of adherence interventions to include other aspects of medication management resulted in priorities outside the traditional scope of adherence research. Workshop participants recognized the potential benefits of patient-centered medication management but also identified many challenges to implementation that require additional research and innovation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Scaling Agile Infrastructure to People

NASA Astrophysics Data System (ADS)

Jones, B.; McCance, G.; Traylen, S.; Barrientos Arias, N.

2015-12-01

When CERN migrated its infrastructure away from homegrown fabric management tools to emerging industry-standard open-source solutions, the immediate technical challenges and motivation were clear. The move to a multi-site Cloud Computing model meant that the tool chains that were growing around this ecosystem would be a good choice, the challenge was to leverage them. The use of open-source tools brings challenges other than merely how to deploy them. Homegrown software, for all the deficiencies identified at the outset of the project, has the benefit of growing with the organization. This paper will examine what challenges there were in adapting open-source tools to the needs of the organization, particularly in the areas of multi-group development and security. Additionally, the increase in scale of the plant required changes to how Change Management was organized and managed. Continuous Integration techniques are used in order to manage the rate of change across multiple groups, and the tools and workflow for this will be examined.

Managing the unmanageable: the nature and impact of drug risk in physician groups.

PubMed

Lipton, Helene Levens; Agnew, Jonathan D; Stebbins, Marilyn R; Kuo, Angela; Dudley, R Adams

2005-08-01

As drug costs rose in the 1990s, health maintenance organizations (HMOs) began transferring risk for prescription drug expenditures to physician groups. With principal-agent theory as a framework for understanding drug-risk transfer, we used a multiple case-study design to examine the relationship between the level of drug risk that a physician group accepts and the physician group's adoption of drug-use management strategies. The data demonstrated that adoption of drug-use management innovations was not related to level of risk for pharmacy costs and that factors other than drug-risk level (e.g., contracting and data issues, financial and market factors, and physician group assessments of the fairness and incentives of risk contracts) can influence the principal-agent relationship. The data also revealed a novel form of information asymmetry between physicians and HMOs and unexpected failures of HMOs to fully enable their physician-agents. We believe these observations reflect the complexity of relationships in the health care system and have implications for the use of incentives. Based on principal-agent theory and our findings, we offer an alternative approach to drug-risk contracting that reduces physicians responsibility for aspects of drug use that are beyond their control while maintaining the incentives to manage drug costs and use that were the original intent of drug-risk contracting.

Online Depressive Symptom Self-Management: Comparing Program Outcomes for Adults With Multiple Sclerosis Versus Those With Other Chronic Diseases.

PubMed

Tietjen, Kiira; Wilson, Marian; Amiri, Solmaz; Dietz, Jeremy

2018-02-01

The goals of the study were to evaluate participant engagement and effects of an Internet-based, self-directed program for depressive symptoms. We compared outcomes of adults with multiple sclerosis (MS) with those of adults with other chronic diseases. This was a secondary analysis of a randomized controlled pilot study. Data were explored for differences between people diagnosed with MS and those with other chronic disease diagnoses. Data were obtained from 47 participants who participated in the original parent study (11 had MS). Participants with at least a moderate preexisting depressive symptom burden on the Patient Health Questionnaire (PHQ) were randomly divided into either a control group or the 8-week "Think Clearly About Depression" online depression self-management program. Study tools were administered at baseline, week 4, and week 8 to evaluate whether the online program improved depressive symptom self-management. Analysis examined differences between participants with and without an MS diagnosis in the treatment and control groups. Average baseline depressive symptom burdens were severe for those with MS and those without MS as measured by the PHQ. Number needed to treat analysis indicated that 1 in every 2 treatment group participants with MS found clinically significant reductions in depressive symptoms by week 8. All participants with MS completed all online program modules. When compared with those with other chronic diseases, participants with MS showed a trend toward greater improvements in the PHQ and health distress scores in addition to self-efficacy in exercising regularly, social/recreational activities, and controlling/managing depression at the end of 8 weeks. An online depressive symptom self-management program is acceptable to people with MS and may be helpful to address undertreated depressive symptoms. The number of participants limits available statistics and ability to generalize results.

Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.

PubMed

Field, B E; Devich, L E; Carlson, R W

1989-08-01

We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. We describe our experience with 20 hopelessly ill patients with multiple organ failure vs a similar group treated before the development of the supportive care team. Although there was no difference in mortality (100 percent), the length of stay in the medical ICU for patients with multiple organ failure decreased by 12 days to 6 days. Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.

Older Adults’ Satisfaction with a Medication Dispensing Device in Home Care

PubMed Central

Demiris, George; Marek, Karen D.

2014-01-01

Introduction Older adults with multiple chronic conditions face the complex task of medication management involving multiple medications of varying doses at different times. Advances in telehealth technologies have resulted in home-based devices for medication management and health monitoring of older adults. We examined older adults’ perceptions of a telehealth medication dispensing device as part of a clinical trial involving home health care clients, nurse coordination and use of the medication dispensing device. Methods Ninety-six frail older adult participants who used the medication dispensing device for 12 months completed a satisfaction survey related to perceived usefulness and reliability. Results were analyzed and grouped by themes in the following areas: Ease of Use, Reliability, Medication Management Assistance, Routine Task Performance and Acceptability. Results Nearly all participants perceived the medication dispensing device as very easy to use, very reliable and helpful in management of their medications. Eighty-four percent of participants expressed a desire to use the machine in the future. Conclusion The technology-enhanced medication management device in this study is an acceptable tool for older adults to manage medication in collaboration with home care nurses. Improved usability and cost models for medication dispensers are areas for future research. Trial Registration clinicaltrials.gov identifier: NCT01321853 PMID:23323721

Mortality in perforated peptic ulcer patients after selective management of stratified poor risk cases.

PubMed

Rahman, M Mizanur; Islam, M Saiful; Flora, Sabrina; Akhter, S Fariduddin; Hossain, Shahid; Karim, Fazlul

2007-12-01

Perforated peptic ulcer disease continues to inflict high morbidity and mortality. Although patients can be stratified according to their surgical risk, optimal management has yet to be described. In this study we demonstrate a treatment option that improves the mortality among critically ill, poor risk patients with perforated peptic ulcer disease. In our study, two series were retrospectively reviewed: group A patients (n = 522) were treated in a single surgical unit at the Dhaka Medical College Hospital, Dhaka, Bangladesh during the 1980s. Among them, 124 patients were stratified as poor risk based on age, delayed presentation, peritoneal contamination, and coexisting medical problems. These criteria were the basis for selecting a group of poor risk patients (n = 84) for minimal surgical intervention (percutaneous peritoneal drainage) out of a larger group of patients, group B (n = 785) treated at Khulna Medical College Hospital during the 1990s. In group A, 479 patients underwent conventional operative management with an operative mortality of 8.97%. Among the 43 deaths, 24 patients were >60 years of age (55.8%), 12 patients had delayed presentation (27.9%), and 7 patients were in shock or had multiple coexisting medical problems (16.2%). In group B, 626 underwent conventional operative management, with 26 deaths at a mortality rate of 4.15%. Altogether, 84 patients were stratified as poor risk and were managed with minimal surgical intervention (percutaneous peritoneal drainage) followed by conservative treatment. Three of these patients died with an operative mortality of 3.5%. Minimal surgical intervention (percutaneous peritoneal drainage) can significantly lower the mortality rate among a selected group of critically ill, poor risk patients with perforated peptic ulcer disease.

Periodontal soft tissue root coverage procedures: a consensus report from the AAP Regeneration Workshop.

PubMed

Tatakis, Dimitris N; Chambrone, Leandro; Allen, Edward P; Langer, Burton; McGuire, Michael K; Richardson, Christopher R; Zabalegui, Ion; Zadeh, Homayoun H

2015-02-01

Management of gingival recession defects, a common periodontal condition, using root coverage procedures is an important aspect of periodontal regenerative therapy. The goal of the periodontal soft tissue root coverage procedures group was to develop a consensus report based on the accompanying systematic review of root coverage procedures, including priorities for future research and identification of the best evidence available to manage different clinical scenarios. The group reviewed and discussed the accompanying systematic review, which covered treatment of single-tooth recession defects, multiple-tooth recession defects, and additional focused questions on relevant clinical topics. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group also identified priorities for future research. All reviewed root coverage procedures provide significant reduction in recession depth, especially for Miller Class I and II recession defects. Subepithelial connective tissue graft (SCTG) procedures provide the best root coverage outcomes. Acellular dermal matrix graft (ADMG) or enamel matrix derivative (EMD) in conjunction with a coronally advanced flap (CAF) can serve as alternatives to autogenous donor tissue. Additional research is needed to do the following: 1) assess the treatment outcomes for multiple-tooth recession defects, oral sites other than maxillary canine and premolar teeth, and Miller Class III and IV defects; 2) assess the role of patient- and site-specific factors on procedure outcomes; and 3) obtain evidence on patient-reported outcomes. Predictable root coverage is possible for single-tooth and multiple-tooth recession defects, with SCTG procedures providing the best root coverage outcomes. Alternatives to SCTG are supported by evidence of varying strength. Additional research is needed on treatment outcomes for specific oral sites. Clinical Recommendation: For Miller Class I and II single-tooth recession defects, SCTG procedures provide the best outcomes, whereas ADMG or EMD in conjunction with CAF may be used as an alternative.

Economics of production efficiency: Nutritional grouping of the lactating cow.

PubMed

Cabrera, V E; Kalantari, A S

2016-01-01

Nutritional grouping of lactating cows under total mixed ration (TMR) feeding systems has been discussed in the literature since 1970. Most studies have concluded that using multiple, more-homogeneous TMR feeding groups is economically beneficial because of either nutrient cost savings, improved productivity, or both. Nonetheless, no consensus has been formed around this technique nor has it been widely adopted. By using optimal criteria for grouping and more precise nutrient specifications of diets, the latest studies have reported a consistently greater income over feed cost ($/cow per year) with multiple TMR groups compared with 1 TMR (3 TMR=$46 and 2 TMR=$21 to $39). Critical factors that determine the economic value of nutritional grouping are: (1) criteria for grouping, (2) nutrient specifications of diets, (3) effects on milk production, (4) health and environmental benefits, (5) number, size, and frequency of grouping, and (6) additional costs and benefits. It has been documented that grouping cows according to their simultaneous nutritional requirements (a.k.a., cluster grouping) is optimal. Cluster grouping is superior to other methods, such as grouping according to days in milk, milk production, or production and body weight combined. However, the dairy industry still uses less-than-optimal grouping criteria. Using cluster grouping will enhance the positive economic effects of multiple TMR. In addition, nutrient specifications of diets for groups do not seem optimal either. Milk lead factors, which are only based on group average milk production, are used. Diets could, however, be formulated more precisely based on overall group nutrient requirements. Providing more precise diets should also be in favor of grouping economics. Furthermore, an area that requires more attention is the potential negative effect of grouping on the milk production of moved cows because of either or both social interactions or diet concentration changes. Although the literature is inconclusive on this subject matter, the latest studies indicate that multiple TMR groups economically outperform 1 TMR, even after considering plausible potential milk losses when grouping. Moreover, additional positive effects of nutritional grouping of improved herd health and environmental stewardship should be translated into economic benefits. Finally, additional costs of management, labor, facilities, and equipment required for grouping are farm specific. The few studies that have integrated these factors in their analyses found that multiple TMR groups would still be economically superior to 1 TMR. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Case management in capitated long-term care

PubMed Central

Zawadski, Rick T.; Eng, Catherine

1988-01-01

For a very impaired population needing multiple interrelated services, the case management approach used by On Lok Senior Health Services in San Francisco, California, produces a responsive, flexible service system. Case management in On Lok's consolidated model has three key characteristics: (1) a true multidisciplinary team of medical as well as nonmedical personnel who separately assess, then, as a group, plan with the client and/or the family the services to be given; (2) use of the same team to assess needs and deliver services; and (3) team access to a potentially unlimited array of services, with freedom to adapt or create needed services. PMID:10312976

Relationship between assertiveness and burnout among nurse managers.

PubMed

Suzuki, Eiko; Saito, Miyuki; Tagaya, Akira; Mihara, Rieko; Maruyama, Akiko; Azuma, Tomomi; Sato, Chifumi

2009-12-01

We aimed to clarify the relationship between assertiveness and burnout among nurse managers at university hospitals. The directors at three university hospitals agreed to cooperate with our study. During a one-month period from May to June 2007, a self-administered questionnaire was distributed to 203 nurse managers (head and sub-head nurses). The Japanese version of the Rathus Assertiveness Schedule (J-RAS) and the Japanese version of the Maslach Burnout Inventory (MBI) were used as scales. Burnout was operationally defined as a total MBI score in the highest tertile. Valid responses were obtained from 172 nurse managers. The mean J-RAS score of the burnout group (-14.3) was significantly lower than that of the non-burnout group (-3.3). Responses about work experience and age showed no significant group difference. Total MBI score was inversely correlated with J-RAS score (R = -0.30, P < 0.01). Multiple logistic regression analyses indicated a decrease in the risk of burnout by 26% (0.74 times) for every 10 point increase in the J-RAS score, and by 60% (0.40 times) for greater satisfaction with own care provision. The results suggest that increasing assertiveness and satisfaction with own care provision contributes to preventing burnout among Japanese nurse managers.

[Supporting patients in self-management: moving to a personalised approach].

PubMed

Eikelenboom, N; van Lieshout, J; Jacobs, A; Verhulst, F; Lacroix, J; van Halteren, A; Klomp, M; Smeele, I; Wensing, M

2016-01-01

The aim of this research was to assess the effect of providing personalised self-management support on patient activation (knowledge, skills, self-efficacy) and self-management behaviour. Cluster randomised trial in 15 general practices (Dutch Trial Register No.: NTR 3960). Patients aged 18 years or older with a chronic condition were invited to participate in the study. The Self-Management Screening (SeMaS) questionnaire - which illustrates barriers to self-management - was used as a tool for personalised self-management support. Nurse practitioners in the intervention practices were trained for 2 hours in using SeMaS and personalising self-management support on the basis of the SeMaS profile. At baseline and after 6 months, patients filled in questionnaires on patient activation (PAM-13) and lifestyle. Using data from the questionnaires and medical records, the use of individual care plans, referrals to self-management interventions, self-monitoring and healthcare use were assessed. We used a multiple multilevel regression model for data analysis. After 6 months, no difference was found in patient activation between the control group (n = 348) and the intervention group (n = 296). 29.4% of the patients in the intervention group performed self-monitoring, versus 15.2% in the control group (regression coefficient r = 0.9, p = 0.01). In the per-protocol analysis (control n = 348; intervention n = 136), the number of individual care plans (r = 1.3, p = 0.04) and the number of patients performing self-monitoring (r = 1.0; p = 0.01) were higher in the intervention group. Personalised self-management support with the use of the SeMaS method stimulates self-monitoring and the use of individual care plans. The intervention had no effect on patient activation or lifestyle. Given the positive secondary outcomes, the further potential of the tool should be researched.

Achieving optimal welfare for the Nile hippopotamus (Hippopotamus amphibius) in North American zoos and aquariums.

PubMed

Tennant, Kaylin S; Segura, Valerie D; Morris, Megan C; Snyder, Kristen Denninger; Bocian, David; Maloney, Dan; Maple, Terry L

2017-07-29

Compared to other megafauna managed in zoos and aquariums, the current state of welfare for the Nile hippopotamus (Hippopotamus amphibius) is poorly understood. Complex behavior and physiological characteristics make hippos a difficult species to manage. Thus, hippos in managed care are currently at risk for a decreased state of welfare. In an effort to assess and improve conditions for this species, a survey was administered to North American institutions housing Nile hippos. This assessment utilized a multiple-choice format and consisted of questions relating to group structure, behavior, and exhibit design, allowing for the creation of cross-institutional, welfare-based analysis. Responses were gathered from 85.29% of the institutions to which the survey was distributed. Despite recommendations for maintaining groups of at least five individuals (Forthman, 1998), only 34.25% of hippos in North America were housed in groups of three or more. The survey also highlighted that 39.29% of institutions secure their hippos in holding areas overnight, despite their highly active nocturnal propensities. A better understanding of hippo behavior and environmental preferences can be used to inform wellness-oriented management practices to achieve a state of "optimal welfare". Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of acupressure on fatigue in women with multiple sclerosis.

PubMed

Bastani, Farideh; Sobhani, Marzie; Emamzadeh Ghasemi, Hormat Sadat

2015-01-26

Multiple sclerosis (MS) is the most common cause of progressive neurological disability. The prevalence of MS is much more common in women than men. The women are exposed to a variety of symptoms including fatigue. Acupressure is a noninvasive procedure that can be used to control symptoms including fatigue. The aim of the study was to evaluate the effect of acupressure on fatigue in women with multiple sclerosis. A randomized clinical trial was conducted on 100 women with MS at Tehran MS Association. The subjects were equally allocated to experimental group and a placebo group (50 women per group) by blocking randomization method. The experimental group were received acupressure, at the true points (ST36, SP6, LI4) and the placebo group, were received touching at the same points. Fatigue was measured by a Fatigue Severity Scale (FSS) in the groups at immediately prior to, two and four weeks after the beginning of the intervention. The data was analyzed using descriptive and inferential statistics by SPSS version 17. The findings indicated no differences in demographic characteristics and the severity of fatigue at the baseline in two groups (p=0.54). But there were significant reductions of the mean score of fatigue in the experimental group compared to the placebo group immediately, two and four weeks after the intervention respectively (p=0.03, p?0/001, p=0.04). According to the findings, the study provided an alternative method for health care providers including nurses to train acupressure to the clients with MS to managing their fatigue.

Impact of generalist care managers on patients with diabetes.

PubMed

Dorr, David A; Wilcox, Adam; Donnelly, Steven M; Burns, Laurie; Clayton, Paul D

2005-10-01

To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed. Exposure patients had one or more contacts with a care manager; controls were matched on utilization, demographics, testing, and baseline glucose control. Using role-specific information technology to support their efforts, care managers assessed patients' readiness for change, followed guidelines, and educated and motivated patients. Patient data collected as part of an electronic patient record were combined with care manager-created databases to assess timely testing of glycosylated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels and changes in LDL and HbA1c levels. In a multivariable model, the odds of being overdue for testing for HbA1c decreased by 21 percent in the exposure group (n=1,185) versus the control group (n=4,740). The odds of being tested when overdue for HbA1c or LDL increased by 49 and 26 percent, respectively, and the odds of HbA1c <7.0 percent also increased by 19 percent in the exposure group. The average HbA1c levels decreased more in the exposure group than in the controls. The effect on LDL was not significant. Generalist care managers using computer-supported diabetes management helped increase adherence to guidelines for testing and control of HbA1c levels, leading to improved health status of patients with diabetes.

Thoracic paravertebral block versus intravenous patient-controlled analgesia for pain treatment in patients with multiple rib fractures.

PubMed

Yeying, Ge; Liyong, Yuan; Yuebo, Chen; Yu, Zhang; Guangao, Ye; Weihu, Ma; Liujun, Zhao

2017-12-01

Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower in the TPVB group than in the IVPCA group at rest and during coughing ( P < 0.05). Patients in the TPVB group had a higher PaO 2 and PaO 2 /FiO 2 and lower P (A-a) O 2 compared with the IVPCA group ( P < 0.05). Moreover, patients in the TPVB group showed higher FVC, FEV1/FVC, and PEFR, and fewer complications than did the IVPCA group ( P < 0.05). Conclusion TPVB is superior to IVPCA in pain relief and preservation of pulmonary function in patients with MRFs.

Maturity of hospital information systems: Most important influencing factors.

PubMed

Vidal Carvalho, João; Rocha, Álvaro; Abreu, António

2017-07-01

Maturity models facilitate organizational management, including information systems management, with hospital organizations no exception. This article puts forth a study carried out with a group of experts in the field of hospital information systems management with a view to identifying the main influencing factors to be included in an encompassing maturity model for hospital information systems management. This study is based on the results of a literature review, which identified maturity models in the health field and relevant influencing factors. The development of this model is justified to the extent that the available maturity models for the hospital information systems management field reveal multiple limitations, including lack of detail, absence of tools to determine their maturity and lack of characterization for stages of maturity structured by different influencing factors.

Intermittent grazing: A management tool to reduce the impact of lupine-induced Crooked Calf Syndrome (CCS)

USDA-ARS?s Scientific Manuscript database

The Lupinus genus is a large group of legumes, some of which cause a congenital condition in cattle referred to as “Crooked Calf Syndrome” (CCS). Only Lupines that contain the alkaloids anagyrine or ammodendrine are problematic to cattle producers. The syndrome is manifest by a series of multiple ...

Supporting Infant Teachers in Their Care of Fussy Babies

ERIC Educational Resources Information Center

Jurie, Cindy; Baker, Marsha

2008-01-01

Child care teachers cope with juggling multiple competing demands: (1) managing relationships with parents; (2) coping with individual infant temperaments; and (3) meeting the group needs of the other infants in their care. Infant teachers often play a unique role in that they may be the first adults to listen and understand what the experience of…

Medical Group Structural Integration May Not Ensure That Care Is Integrated, From The Patient's Perspective.

PubMed

Kerrissey, Michaela J; Clark, Jonathan R; Friedberg, Mark W; Jiang, Wei; Fryer, Ashley K; Frean, Molly; Shortell, Stephen M; Ramsay, Patricia P; Casalino, Lawrence P; Singer, Sara J

2017-05-01

Structural integration is increasing among medical groups, but whether these changes yield care that is more integrated remains unclear. We explored the relationships between structural integration characteristics of 144 medical groups and perceptions of integrated care among their patients. Patients' perceptions were measured by a validated national survey of 3,067 Medicare beneficiaries with multiple chronic conditions across six domains that reflect knowledge and support of, and communication with, the patient. Medical groups' structural characteristics were taken from the National Study of Physician Organizations and included practice size, specialty mix, technological capabilities, and care management processes. Patients' survey responses were most favorable for the domain of test result communication and least favorable for the domain of provider support for medication and home health management. Medical groups' characteristics were not consistently associated with patients' perceptions of integrated care. However, compared to patients of primary care groups, patients of multispecialty groups had strong favorable perceptions of medical group staff knowledge of patients' medical histories. Opportunities exist to improve patient care, but structural integration of medical groups might not be sufficient for delivering care that patients perceive as integrated. Project HOPE—The People-to-People Health Foundation, Inc.

Evaluating the Impact of Diabetes Self-Management Education Methods on Knowledge, Attitudes and Behaviours of Adult Patients With Type 2 Diabetes Mellitus.

PubMed

Adam, Laura; O'Connor, Colleen; Garcia, Alicia C

2017-11-23

Diabetes self-management refers to all activities patients undertake to care for their illness, promote health and prevent the long- and short-term effects of diabetes. This study compared the effectiveness of 2 diabetes self-management education methods by examining changes in glycated hemoglobin (A1C) levels and knowledge, attitudes and behaviours (KABs) after traditional group education (TE) or with diabetes conversation maps (CMs). The CMs group was postulated to show greater decrease in A1C levels and improved KABs scores compared to the TE group. A sample of 21 eligible clients from Diabetes Care Guelph were randomly assigned into 2 groups, 10 receiving education through CMs and 11 through TE. Changes in knowledge and attitude were determined by using questionnaires and repeated-measures pretest and post-test design before and after the education sessions. Changes in A1C levels were determined by comparing values at baseline and at 3 months after receiving diabetes education. Two focus groups were conducted to obtain participants' perceptions of the education methods and self-reported KABs changes. Significant differences in knowledge and attitude score changes were observed from baseline/initial education and after 3 months. Both groups had significant decreases in A1C levels from baseline to 3 months afterward. Focus groups revealed themes common to both groups, such as benefits of early education, need for multiple lifestyle behaviour changes and feelings of social support. CMs had significant impact and are effective for group education. The changes observed may lead to improved diabetes self-management, thus reducing costly health complications related to poorly controlled diabetes. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Effect of aquatic exercise training on fatigue and health-related quality of life in patients with multiple sclerosis.

PubMed

Kargarfard, Mehdi; Etemadifar, Masoud; Baker, Peter; Mehrabi, Maryam; Hayatbakhsh, Reza

2012-10-01

To examine the effectiveness of aquatic exercise training on fatigue and health-related quality of life (HRQOL) in women with multiple sclerosis (MS). Randomized controlled trial, 4-week and 8-week follow-up. Referral center of a multiple sclerosis society. Women (N=32) diagnosed with relapsing-remitting MS (mean age ± SD, 32.6±8.0y) were recruited into this study. After undergoing baseline testing by a neurologist, participants were randomly assigned to either an intervention (aquatic exercise) or a control group. The intervention consisted of 8 weeks supervised aquatic exercise in a swimming pool (3 times a week, each session lasting 60min). At baseline, 4 weeks, and 8 weeks, fatigue and HRQOL were assessed by a blind assessor using the Modified Fatigue Impact Scale and the Multiple Sclerosis Quality of Life-54 questionnaire, respectively. A mixed-model approach to repeated-measures analysis of variance was used to detect within- and between-subject effects. Findings are based on 21 patients (10 from the exercise group and 11 from the control group) who had data available on outcomes. There was no significant difference between the 2 groups at the baseline. Patients in the aquatic exercise group showed significant improvements in fatigue and subscores of HRQOL after 4 and 8 weeks compared with the control group. Results obtained from the intention-to-treat analysis were consistent with those of per-protocol analysis. The findings suggest that aquatic exercise training can effectively improve fatigue and HRQOL of patients with MS and should be considered in the management of this relatively common public health problem. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Changes to processes in estuaries and coastal waters due to intense multiple pressures - An introduction and synthesis

NASA Astrophysics Data System (ADS)

Mitchell, Steven B.; Jennerjahn, Tim C.; Vizzini, Salvatrice; Zhang, Weiguo

2015-04-01

From the 2013 ECSA conference 'Estuaries and Coastal Areas in Times of Intense Change' a theme emerged that has ended up being the focus of this Special Issue of Estuarine Coastal and Shelf Science, namely 'Changes to processes in estuaries and coastal waters due to intense multiple pressures'. Many parts of the world are continuing to experience unprecedented rates of economic growth, and those responsible for managing coastal and estuarine areas must respond accordingly. At the same time, global climate change and sea level rise are also continuing, placing new or more intense pressures on coastal areas that must be dealt with in ways that are as far as possible managed as a result of good scientific understanding. There are other pressures too, which depend on the system concerned. This article provides an overview of the papers contained within the Special Issue and provides a discussion of how these fit within the main theme of intense multiple stressors, considering how a balance can be achieved between the needs of various different stakeholders and interest groups, and the sustainability of the system concerned. We categorise the papers in four main groupings: (1) stressors related to sea level rise; (2) stressors related to changes in fresh water inputs; (3) stressors related to anthropogenic pollution; and (4) the use of indicators as a means of assessing the effects of stressors, and reflect on the fact that despite the diversity of different challenges and geographical regions involved many of the approaches and discussions contained within the Special Issue have strong similarities, leading to a set of overarching principles that should be considered when making recommendations on management strategies.

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.

Information-based management mode based on value network analysis for livestock enterprises

NASA Astrophysics Data System (ADS)

Liu, Haoqi; Lee, Changhoon; Han, Mingming; Su, Zhongbin; Padigala, Varshinee Anu; Shen, Weizheng

2018-01-01

With the development of computer and IT technologies, enterprise management has gradually become information-based management. Moreover, due to poor technical competence and non-uniform management, most breeding enterprises show a lack of organisation in data collection and management. In addition, low levels of efficiency result in increasing production costs. This paper adopts 'struts2' in order to construct an information-based management system for standardised and normalised management within the process of production in beef cattle breeding enterprises. We present a radio-frequency identification system by studying multiple-tag anti-collision via a dynamic grouping ALOHA algorithm. This algorithm is based on the existing ALOHA algorithm and uses an improved packet dynamic of this algorithm, which is characterised by a high-throughput rate. This new algorithm can reach a throughput 42% higher than that of the general ALOHA algorithm. With a change in the number of tags, the system throughput is relatively stable.

A multi-criteria assessment of fishing gear impacts in demersal fisheries.

PubMed

Innes, James P; Pascoe, Sean

2010-01-01

Fishing gears have multiple impacts on the marine environment, and policies to reduce these impacts through modifying fishing gears are becoming common place. Different modifications result in different changes in the set of environmental impacts, and imply different sets of costs and benefits for different stakeholder groups. In this study, the analytic hierarchy process (AHP) is used to quantify the relative importance of the environmental impacts of fishing to different stakeholder groups. Forty eight individuals representing six different stakeholder groups (ecologists, biologists, economists, gear technologists, fishers and fisheries managers) were surveyed. As expected, fishers and gear technologists placed substantially greater importance on reducing discarding of commercial fish species than on habitat damage. Priorities of other stakeholder groups varied, but all placed greater priority on habitats than the commercial sector. The results suggest that management aimed at reducing environmental impacts of fishing broader than just discarding is appropriate, but such moves are likely to be opposed by the fishing industry. The derived weights also have a direct application to fisheries management, as they allow otherwise non-commensurate impacts to be aggregated into an overall impact to compare environmental benefits from alternative modifications of fishing gear. Copyright 2009 Elsevier Ltd. All rights reserved.

Reduced mortality: the unexpected impact of a telephone-based care management intervention for older adults in managed care.

PubMed

Alkema, Gretchen E; Wilber, Kathleen H; Shannon, George R; Allen, Douglas

2007-08-01

This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program (CA Program) designed to link those with high health care utilization to home- and community-based services. Secondary data from the CA Program, part of the California HealthCare Foundation's Elders in Managed Care Initiative. Randomized-control trial in which participants (N=781) were randomly assigned to intent-to-treat (ITT) and control groups. ITT group received telephonic social care management and 12 months of follow-up. Various multivariate analyses were used to evaluate mortality risk throughout multiple study periods controlling for sociodemographic characteristics, health status, and health care utilization. Older adults (65+) enrolled in a Medicare managed care plan who had high health care utilization in the previous year. ITT group had a significantly lower odds of mortality throughout the study (OR=0.55; p=.005) and during the care management intervention (OR=0.45; p=.006), whereas differential risk in the postintervention period was not statistically significant. Other significant predictors of mortality were age, gender, three chronic conditions (cancer, heart disease, and kidney disease), and emergency room utilization. Findings suggest that the care advocate model of social care management affected mortality while the program was in progress, but not after completion of the intervention phase. Key model elements accounted for the findings, which include individualized targeting, assessment, and monitoring; consumer choice, control, and participant self-management; and bridging medical and social service delivery systems through direct linkages and communication.

Preparing future fisheries professionals to make good decisions

USGS Publications Warehouse

Colvin, Michael E.; Peterson, James T.

2017-01-01

Future fisheries professionals will face decision-making challenges in an increasingly complex field of fisheries management. Though fisheries students are well trained in the use of the scientific method to understand the natural world, they are rarely exposed to structured decision making (SDM) as part of an undergraduate or graduate education. Specifically, SDM encourages users (e.g., students, managers) to think critically and communicate the problem and then identify specific, measurable objectives as they relate to the problem. Next, users must think critically and creatively about management alternatives that can be used to meet the objectives—there must be more than one alternative or there is no decision to be made. Lastly, the management alternatives are evaluated with regard to how likely they are to succeed in terms of multiple, possibly completing, objectives, such as how stakeholder groups value outcomes of management actions versus monetary cost. We believe that exposure to SDM and its elements is an important part of preparing future fisheries professional to meet the challenges they may face. These challenges include reduced budgets, the growth of potentially competing natural resource interest groups, and stakeholder desire to be involved in management decisions affecting public trust resources, just to name a few.

A Multi-stakeholder Approach to Moving Beyond Tree Mortality in the Sierra Nevada

NASA Astrophysics Data System (ADS)

Balachowski, J.; Buluc, L.; Fischer, C.; Ko, J.; Ostoja, S.

2017-12-01

The US Forest Service has estimated that 102 million trees have died in California since 2010. This die off event has been attributed to the combined effects of historical land management practices, fire suppression, insect outbreaks, and climate-related stressors. This tree mortality event represents the largest and most significant ecological disturbance in California in centuries, if not longer. Both scientists and managers recognize the need to rethink our approach to forest management in the face of a changing climate and increasingly frequent, uncharacteristically large wildfires, while budgets and staffing capacity continue to decrease. Addressing the uncertainly in managing under climate change with fewer financial resources will require multiple partners and stakeholders—including federal and state agencies, local governments, and non-governmental organizations—to work together to identify common goals and paths moving forward. The USDA California Climate Hub and USFS Region 5 convened a symposium on drought and tree mortality in July 2017. With nearly 170 attendees across a wide range of sectors, the event provided a meaningful opportunity for reflection, analysis, and consideration of next steps. Among the outcomes of this symposium was the identification of areas in which our capacity for individual and synergistic action is stronger, and those in which it is lacking that will thus require additional attention and effort. From this symposium, which included a series of smaller, stakeholder and partner working groups, we collectively identified research and information needs, possible policy adjustments, future management actions, and funding needs and opportunities. Here, we present these findings and suggest approaches for addressing the current tree mortality event based on the shared interests of multiple, diverse stakeholder groups.

Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study.

PubMed

Swendeman, Dallas; Ramanathan, Nithya; Baetscher, Laura; Medich, Melissa; Scheffler, Aaron; Comulada, W Scott; Estrin, Deborah

2015-05-01

Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants. Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.

Supporting self-management by Community Matrons through a group intervention; an action research study.

PubMed

Barkham, Abigail M; Ersser, Steven J

2017-07-01

The aim of this study was to examine the feasibility and impact of a group intervention by Community Matrons to support those living with multiple long-terms conditions. Little evidence exists as to how the role of the Community Matron (CM) should be delivered to effectively enhance disease self-management and levels of self-efficacy for the service users. This qualitative participatory action research study explored the use of group work as a method of intervention by CMs. A purposive sample of 29 participants was recruited. Each patient group had 8-10 participants, led by a CM working in both the researcher and practitioner role, operating over 12-month period. Data were collected by participant observation, researcher reflexive account and interviews. Grounded theory method was used to systematically analyse the data. Three main data categories emerged: (i) comparison by patients that leads to re-motivation of the self; (ii) learning, leading to enhanced self-management techniques, through storytelling and understanding of each other's experiences; and (iii) ownership that resulted in the self-awareness, cognisance and insight into the role of the support group they were based in and how it benefited them. The core category of 'Taking back the self - understanding the whole,' conveyed the impact that this care delivery method had upon readjusting the balance of power between health professional and service users and its consequence in refreshing and improving their self-management and the patients' self-efficacy. It was concluded that CM intervention using a model of group learning can lead to more effective and efficient support, through improving self-efficacy and patients' related self-management ability. © 2017 John Wiley & Sons Ltd.

Measuring service line competitive position. A systematic methodology for hospitals.

PubMed

Studnicki, J

1991-01-01

To mount a broad effort aimed at improving their competitive position for some service or group of services, hospitals have begun to pursue product line management techniques. A few hospitals have even reorganized completely under the product line framework. The benefits include focusing accountability for operations and results, facilitating coordination between departments and functions, stimulating market segmentation, and promoting rigorous examination of new and existing programs. As part of its strategic planning process, a suburban Baltimore hospital developed a product line management methodology with six basic steps: (1) define the service lines (which they did by grouping all existing diagnosis-related groups into 35 service lines), (2) determine the contribution of each service line to total inpatient volume, (3) determine trends in service line volumes (by comparing data over time), (4) derive a useful comparison group (competing hospitals or groups of hospitals with comparable size, scope of services, payer mix, and financial status), (5) review multiple time frames, and (6) summarize the long- and short-term performance of the hospital's service lines to focus further analysis. This type of systematic and disciplined analysis can become part of a permanent strategic intelligence program. When hospitals have such a program in place, their market research, planning, budgeting, and operations will be tied together in a true management decision support system.

Evaluation of a nurse-led management program to complement the treatment of adolescent acute lymphoblastic leukemia patients.

PubMed

Lin, Hailong; Zhou, Shiyan; Zhang, Dongxiu; Huang, Leting

2016-11-01

To evaluate a nurse-led management model of adolescent acute lymphoblastic leukemia (ALL) patients and improve their psychological care and quality of life. Seventy-three adolescent ALL patients participated in an open, controlled clinical trial and were randomized into a nurse-led management model group (n=36) and a doctor-led management model group (n=37). Two assessment questionnaires were administered to assess and compare the 2 models during a 1.5-year follow-up period: the hospital anxiety and depression scale (HADS) questionnaire was administered at 6 different time points, and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) at 3 different time points. There were no differences in anxiety and depression between the groups according to the first-administered questionnaire (the mean anxiety and depression scores of the nurse-led group were 14.2±4.1 and 10.8±2.7, respectively; those of the doctor-led group were 13.8±3.8 and 10.6±2.2, respectively). However, repeated measures analysis of variance detected differences in subsequent HADS-based scores as a function of time between the 2 groups (p<0.05). Moreover, the Holm-Sidak's multiple comparisons tests showed that patients of the nurse-led group had significantly decreased mean anxiety scores compared to those in the doctor-led group at the third and subsequent sessions, as well as in mean depression scores from the second session onwards (all p<0.05). According to the last-administered EORTC QLQ-C30 questionnaire, there were statistical differences in cognitive, emotional, social, and quality of life scales between the 2 groups (all p<0.05), but not in role and physical scales (all p>0.05). It is necessary to offer unique cognitive, psychological, and behavioral management models to adolescent ALL patients that are tailored toward their age group. Strengthening such management is more conducive to alleviating or even reversing psychological problems, and to improving patients' quality of life while ensuring complication-free follow-up periods. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Long-term Clinical and Cost Outcomes of a Pharmacist-managed Risk Factor Management Clinic in Singapore: An Observational Study.

PubMed

Tan, She Hui; Kng, Kwee Keng; Lim, Sze Mian; Chan, Alexandre; Loh, Jason Kwok Kong; Lee, Joyce Yu-Chia

2017-12-01

Few studies have determined the benefits of pharmacist-run clinics within a tertiary institution, and specifically on their capability to improve clinical outcomes as well as reduce the cost of illness. This study was designed to investigate the effectiveness of a pharmacist-managed risk factor management clinic (RFMP) in an acute care setting through the comparison of clinical (improvement in glycosylated hemoglobin level) and cost outcomes with patients receiving usual care. This single-center, observational study included patients aged ≥21 years old and diagnosed with type 2 diabetes mellitus (DM) who received care within the cardiology department of a tertiary institution between January 1, 2014, and December 31, 2015. The intervention group comprised patients who attended the RFMP for 3 to 6 months, and the usual-care group comprised patients who received standard cardiologist care. Univariate analysis and multiple linear regression were conducted to analyze the clinical and cost outcomes. A total of 142 patients with DM (71 patients in the intervention group and 71 patients in the usual-care group) with similar baseline characteristics were included. After adjusting for differences in baseline systolic blood pressure and triglyceride levels, the mean reduction in glycosylated hemoglobin level at 6 months from baseline in the intervention group was significantly lower by 0.78% compared with the usual-care group. Patients in the usual-care group had a significantly higher risk of hospital admissions within the 12 months from baseline compared with the intervention group (odds ratio, 3.84 [95% CI, 1.17-12.57]; P = 0.026). Significantly lower mean annual direct medical costs were also observed in the intervention group (US $8667.03 [$17,416.20] vs US $56,665.02 [$127,250.10]; P = 0.001). The pharmacist-managed RFMP exhibited improved clinical outcomes and reduced health care costs compared with usual care within a tertiary institute. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis

PubMed Central

Larson-Williams, Linnea M; Youngblood, Amber Q; Peterson, Dawn Taylor; Zinkan, J Lynn; White, Marjorie L; Abdul-Latif, Hussein; Matalka, Leen; Epps, Stephen N; Tofil, Nancy M

2016-01-01

AIM To investigate the use of a multidisciplinary, longitudinal simulation to educate pediatric residents and nurses on management of pediatric diabetic ketoacidosis. METHODS A multidisciplinary, multiple step simulation course was developed by faculty and staff using a modified Delphi method from the Pediatric Simulation Center and pediatric endocrinology department. Effectiveness of the simulation for the residents was measured with a pre- and post-test and a reference group not exposed to simulation. A follow up post-test was completed 3-6 mo after the simulation. Nurses completed a survey regarding the education activity. RESULTS Pediatric and medicine-pediatric residents (n = 20) and pediatric nurses (n = 25) completed the simulation course. Graduating residents (n = 16) were used as reference group. Pretest results were similar in the control and intervention group (74% ± 10% vs 76% ± 15%, P = 0.658). After completing the intervention, participants improved in the immediate post-test in comparison to themselves and the control group (84% ± 12% post study; P < 0.05). The 3-6 mo follow up post-test results demonstrated knowledge decay when compared to their immediate post-test results (78% ± 14%, P = 0.761). Residents and nurses felt the interdisciplinary and longitudinal nature of the simulation helped with learning. CONCLUSION Results suggest a multidisciplinary, longitudinal simulation improves immediate post-intervention knowledge but important knowledge decay occurs, future studies are needed to determine ways to decrease this decay. PMID:27896145

Wellness and multiple sclerosis: The National MS Society establishes a Wellness Research Working Group and research priorities

PubMed Central

Motl, Robert W; Mowry, Ellen M; Ehde, Dawn M; LaRocca, Nicholas G; Smith, Kathy E; Costello, Kathleen; Shinto, Lynne; Ng, Alexander V; Sullivan, Amy B; Giesser, Barbara; McCully, Kevin K; Fernhall, Bo; Bishop, Malachy; Plow, Matthew; Casaccia, Patrizia; Chiaravalloti, Nancy D

2017-01-01

Background: People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. the Society). Objective: The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda. Method: The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness. Results: That process informed a group-mediated activity for developing and prioritizing research goals for wellness in MS. This served as a background for articulating the mission and objectives of the Society’s Wellness Research Working Group. Conclusion: The primary mission of the Wellness Research Working Group is the provision of scientific evidence supporting the application of lifestyle, behavioral, and psychosocial approaches for promoting optimal health of mind, body, and spirit (i.e. wellness) in people with MS as well as managing the disease and its consequences. PMID:28080254

An original model of the northern Gulf of Mexico using Ecopath with Ecosim and its implications for the effects of fishing on ecosystem structure and maturity

NASA Astrophysics Data System (ADS)

Geers, T. M.; Pikitch, E. K.; Frisk, M. G.

2016-07-01

The Gulf of Mexico (GoM) is a valuable ecosystem both socially and economically, and fisheries contribute substantially to this value. Gulf menhaden, Brevoortia patronus, support the largest fishery in the Gulf (by weight) and provide forage for marine mammals, seabirds and commercially and recreationally important fish species. Understanding the complex interactions among multiple fisheries and myriad unfished species requires tools different from those used in traditional single-species management. One such tool, Ecopath with Ecosim (EwE) is increasingly being used to construct food web models of aquatic ecosystems and to evaluate fisheries management options within a broader, ecosystem context. Here, an EwE model was developed to examine the impact of Gulf fisheries on ecosystem structure and maturity. This model builds on previously published EwE models of the GoM, and is tailored to the range and habitat of Gulf menhaden. The model presented here consists of 47 functional groups, including 4 seabird groups, 1 marine mammal group, 3 elasmobranch groups, 26 bony fish groups, 9 invertebrate groups, 3 primary producer groups and 1 detritus group. A number of different management scenarios for Gulf fisheries were modeled and the results were evaluated in terms of impacts on ecosystem maturity and development. The results of the model simulations indicated that the northern Gulf of Mexico is in an immature state (sensuOdum, 1969). Management scenarios that increased fishing pressure over time consistently resulted in a decrease in the maturity indices. In particular, we found that Gulf menhaden, as a key forage fish in the ecosystem, plays a substantial role in the structure and functioning of the ecosystem.

Bladder function and falls in individuals with multiple sclerosis.

PubMed

Sung, JongHun; Shen, Sa; Motl, Robert W; Sosnoff, Jacob J

2016-11-01

To examine the association between bladder function and falls while controlling for mobility in individuals with multiple sclerosis (MS). A total of 92 ambulatory individuals with MS (mean age ± SD = 59.1 ± 7.3 years, female n = 69) were divided into two groups based on self-reported bladder function (none-mild n = 43 versus moderate-severe n = 49). The main outcome measure was a number of self-reported falls in the previous 3 months. Participants' demographic information (age, type of MS, gender, use of the assistive device) was also collected. The balance was quantified with the Berg balance scale, and walking speed was indexed with the timed 25-foot walk test. Negative binomial regression analysis was used to examine the association between bladder function and falls in individuals with MS while controlling for balance and walking. The median number of self-reported falls in the previous 3 months was 2 (interquartile range, 0-4). The severe bladder dysfunction group was more likely (incidence rate ratio = 1.84) to have a greater number of self-reported falls compared to mild bladder dysfunction group when balance and walking were taken into account. Bladder dysfunction is related to falls history independently of mobility in individuals with MS. Future research examining whether bladder management programmes have an impact on fall incidence in MS is warranted. Implications for rehabilitation Bladder dysfunction and falls are common health concerns in individuals with multiple sclerosis. Bladder dysfunction was associated with the number of falls in individuals with MS, and this association was independent of mobility. Bladder management should be included in fall prevention strategies in individuals with MS.

Additive effects prevail: The response of biota to multiple stressors in an intensively monitored watershed.

PubMed

Gieswein, Alexander; Hering, Daniel; Feld, Christian K

2017-09-01

Freshwater ecosystems are impacted by a range of stressors arising from diverse human-caused land and water uses. Identifying the relative importance of single stressors and understanding how multiple stressors interact and jointly affect biology is crucial for River Basin Management. This study addressed multiple human-induced stressors and their effects on the aquatic flora and fauna based on data from standard WFD monitoring schemes. For altogether 1095 sites within a mountainous catchment, we used 12 stressor variables covering three different stressor groups: riparian land use, physical habitat quality and nutrient enrichment. Twenty-one biological metrics calculated from taxa lists of three organism groups (fish, benthic invertebrates and aquatic macrophytes) served as response variables. Stressor and response variables were subjected to Boosted Regression Tree (BRT) analysis to identify stressor hierarchy and stressor interactions and subsequently to Generalised Linear Regression Modelling (GLM) to quantify the stressors standardised effect size. Our results show that riverine habitat degradation was the dominant stressor group for the river fauna, notably the bed physical habitat structure. Overall, the explained variation in benthic invertebrate metrics was higher than it was in fish and macrophyte metrics. In particular, general integrative (aggregate) metrics such as % Ephemeroptera, Plecoptera and Trichoptera (EPT) taxa performed better than ecological traits (e.g. % feeding types). Overall, additive stressor effects dominated, while significant and meaningful stressor interactions were generally rare and weak. We concluded that given the type of stressor and ecological response variables addressed in this study, river basin managers do not need to bother much about complex stressor interactions, but can focus on the prevailing stressors according to the hierarchy identified. Copyright © 2017 Elsevier B.V. All rights reserved.

Management of penetrating colon and rectal injuries in the pediatric patient.

PubMed

Haut, Elliott R; Nance, Michael L; Keller, Martin S; Groner, Jonathan I; Ford, Henri R; Kuhn, Ann; Tuchfarber, Barbara; Garcia, Victor; Schwab, C William; Stafford, Perry W

2004-09-01

Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. For the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.

How do older people with sight loss manage their general health? A qualitative study.

PubMed

Burton, Amy E; Gibson, Jonathan M; Shaw, Rachel L

2016-11-01

Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

Evaluating use and outcomes of mobility technology: a multiple stakeholder analysis.

PubMed

Hammel, Joy; Southall, Kenneth; Jutai, Jeffrey; Finlayson, Marcia; Kashindi, Gabriel; Fok, Daniel

2013-07-01

This qualitative, multi-site study compared and contrasted the outcomes of mobility technology (MT) and the factors influencing these outcomes from the perspective of MT users, caregivers, and professionals involved in MT service delivery. Qualitative focus groups were held in the USA and Canada with multiple stakeholder groups (consumer: n = 45, caregiver: n = 10, service provider: n = 10). Data were analyzed thematically. MT outcomes were conceptualized by participants as a match between expectations for MT and the actual outcomes experienced. Several factors influenced the match including a) MT features, b) environmental factors (e.g. built/physical environment, societal context of acceptance, MT delivery systems/policies), and c) the ability to self-manage the interaction across person, technology and environment, which involved constant negotiation and strategizing. Stakeholders identified MT outcomes that corresponded to ICF levels including body structure and function, activity, and participation across environments; however, varied on their importance and influence on MT impact. The conceptual fit model and factors related to self-management of MT represent new knowledge and provide a framework for stakeholder-based evaluation of MT outcomes. Implications for MT assessment, service delivery, outcomes research, and interventions are discussed.

Arts and health as a practice of liminality: Managing the spaces of transformation for social and emotional wellbeing with primary school children

PubMed Central

Atkinson, Sarah; Robson, Mary

2012-01-01

Intervention to enhance wellbeing through participation in the creative arts has a transformative potential, but the spatialities to this are poorly theorised. The paper examines arts-based interventions in two primary schools in which small groups of children are taken out of their everyday classrooms to participate in weekly sessions. The paper argues that such intervention is usefully seen as a practice of liminality, a distinct time and space that needs careful management to realise a transformative potential. Such management involves negotiating multiple sources of tension to balance different modes of power, forms of art practices and permeability of the liminal time-space. PMID:22840601

A Web-Based Operating Room Management Educational Tool.

PubMed

Tsai, Mitchell H; Haddad, Daniel J; Friend, Alexander F; Bender, S Patrick; Davidson, Melissa L

2016-08-01

In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no significant difference between the groups of residents, suggesting that the web-based module is as effective as traditional didactics.

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

PubMed Central

de Mel, Sanjay; Chen, Yunxin; Gopalakrishnan, Sathish Kumar; Ooi, Melissa; Teo, Constance; Tan, Daryl; Teo, Min Li Claire; Tso, Allison CY; Lee, Lian King; Nagarajan, Chandramouli; Goh, Yeow Tee; Chng, Wee Joo

2017-01-01

Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment. PMID:27609508

Neurofibromatoses: part 1 - diagnosis and differential diagnosis.

PubMed

Rodrigues, Luiz Oswaldo Carneiro; Batista, Pollyanna Barros; Goloni-Bertollo, Eny Maria; de Souza-Costa, Danielle; Eliam, Lucas; Eliam, Miguel; Cunha, Karin Soares Gonçalves; Darrigo-Junior, Luiz Guilherme; Ferraz-Filho, José Roberto Lopes; Geller, Mauro; Gianordoli-Nascimento, Ingrid F; Madeira, Luciana Gonçalves; Malloy-Diniz, Leandro Fernandes; Mendes, Hérika Martins; de Miranda, Débora Marques; Pavarino, Erika Cristina; Baptista-Pereira, Luciana; Rezende, Nilton A; Rodrigues, Luíza de Oliveira; da Silva, Carla Menezes; de Souza, Juliana Ferreira; de Souza, Márcio Leandro Ribeiro; Stangherlin, Aline; Valadares, Eugênia Ribeiro; Vidigal, Paula Vieira Teixeira

2014-03-01

Neurofibromatoses (NF) are a group of genetic multiple tumor growing predisposition diseases: neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SCH), which have in common the neural origin of tumors and cutaneous signs. They affect nearly 80 thousand of Brazilians. In recent years, the increased scientific knowledge on NF has allowed better clinical management and reduced complication morbidity, resulting in higher quality of life for NF patients. In most cases, neurology, psychiatry, dermatology, clinical geneticists, oncology and internal medicine specialists are able to make the differential diagnosis between NF and other diseases and to identify major NF complications. Nevertheless, due to its great variability in phenotype expression, progressive course, multiple organs involvement and unpredictable natural evolution, NF often requires the support of neurofibromatoses specialists for proper treatment and genetic counseling. This Part 1 offers step-by-step guidelines for NF differential diagnosis. Part 2 will present the NF clinical management.

Iterative Development of an Application to Support Nuclear Magnetic Resonance Data Analysis of Proteins.

PubMed

Ellis, Heidi J C; Nowling, Ronald J; Vyas, Jay; Martyn, Timothy O; Gryk, Michael R

2011-04-11

The CONNecticut Joint University Research (CONNJUR) team is a group of biochemical and software engineering researchers at multiple institutions. The vision of the team is to develop a comprehensive application that integrates a variety of existing analysis tools with workflow and data management to support the process of protein structure determination using Nuclear Magnetic Resonance (NMR). The use of multiple disparate tools and lack of data management, currently the norm in NMR data processing, provides strong motivation for such an integrated environment. This manuscript briefly describes the domain of NMR as used for protein structure determination and explains the formation of the CONNJUR team and its operation in developing the CONNJUR application. The manuscript also describes the evolution of the CONNJUR application through four prototypes and describes the challenges faced while developing the CONNJUR application and how those challenges were met.

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma.

PubMed

de Mel, Sanjay; Chen, Yunxin; Gopalakrishnan, Sathish Kumar; Ooi, Melissa; Teo, Constance; Tan, Daryl; Teo, Min Li Claire; Tso, Allison Cy; Lee, Lian King; Nagarajan, Chandramouli; Goh, Yeow Tee; Chng, Wee Joo

2017-02-01

Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment. Copyright: © Singapore Medical Association.

Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors.

PubMed

Oruche, Ukamaka M; Robb, Sheri L; Aalsma, Matt; Pescosolido, Bernice; Brown-Podgorski, Brittany; Draucker, Claire Burke

2017-12-01

This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs. Copyright © 2017 Elsevier Inc. All rights reserved.

Social and Economic Analysis Branch: integrating policy, social, economic, and natural science

USGS Publications Warehouse

Schuster, Rudy; Walters, Katie D.

2015-01-01

The Fort Collins Science Center's Social and Economic Analysis Branch provides unique capabilities in the U.S. Geological Survey by leading projects that integrate social, behavioral, economic, and natural science in the context of human–natural resource interactions. Our research provides scientific understanding and support for the management and conservation of our natural resources in support of multiple agency missions. We focus on meeting the scientific needs of the Department of the Interior natural resource management bureaus in addition to fostering partnerships with other Federal and State managers to protect, restore, and enhance our environment. The Social and Economic Analysis Branch has an interdisciplinary group of scientists whose primary functions are to conduct both theoretical and applied social science research, provide technical assistance, and offer training to support the development of skills in natural resource management activities. Management and research issues associated with human-resource interactions typically occur in a unique context and require knowledge of both natural and social sciences, along with the skill to integrate multiple science disciplines. In response to these challenging contexts, Social and Economic Analysis Branch researchers apply a wide variety of social science concepts and methods which complement our rangeland/agricultural, wildlife, ecology, and biology capabilities. The goal of the Social and Economic Analysis Branch's research is to enhance natural-resource management, agency functions, policies, and decisionmaking.

Multiple left anterior descending coronary artery to left ventricular fistula - A case series and literature review.

PubMed

Iyer, Praneet; Yelisetti, Rishitha

2017-10-01

Coronary artery fistulas (CAFs) are found in 0.3-0.8% of patients who undergo coronary angiography. CAFs are defined as single or multiple, small or large direct communications that arise from one or more coronary arteries and enter into one of the four cardiac chambers or major vessels. We present two cases of multiple coronary artery fistulas arising from diagonal and left anterior descending (LAD) branches of left coronary artery draining into the left ventricle. In both the cases, No intervention was performed. Of the congenital fistulas, two major groups are identified: solitary CAFs or coronary artery-left ventricular multiple micro-fistulas (CALVMMFs). Noninvasive techniques such as transthoracic echocardiography, transesophageal echocardiography and magnetic resonance imaging are becoming increasingly popular for diagnosis and follow-up of CAFs. Despite the advent of these newer non-invasive modalities, coronary angiography remains the gold standard for diagnosis. Treatment of CAFs is indicated when the patients are symptomatic with left ventricular volume overload, myocardial ischemia, left ventricular dysfunction or in the presence of a large or increasing left-to-right shunt. If the fistula is small and hemodynamically insignificant, it can be managed with conservative management. Multiple left anterior descending to left ventricle (LV) fistulas are extremely rare and, as per our literature review, we noted only a few case reports of coronary artery fistulas between branches of LAD and left ventricle.

Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial.

PubMed

Blikman, Lyan Jm; van Meeteren, Jetty; Twisk, Jos Wr; de Laat, Fred Aj; de Groot, Vincent; Beckerman, Heleen; Stam, Henk J; Bussmann, Johannes Bj

2017-10-01

Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS). To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue. A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength - CIS20r) and participation (Impact on Participation and Autonomy scale - IPA). Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = -0.81; 95% confidence interval (CI), -3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35). The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition.

Risk factors for opioid overdose and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain.

PubMed

Wilder, Christine M; Miller, Shannon C; Tiffany, Elizabeth; Winhusen, Theresa; Winstanley, Erin L; Stein, Michael D

2016-01-01

Rising overdose fatalities among U.S. veterans suggest veterans taking prescription opioids may be at risk for overdose. However, it is unclear whether veterans prescribed chronic opioids are aware of this risk. The objective of this study was to identify risk factors and determine awareness of risk for opioid overdose in veterans treated with opioids for chronic pain, using veterans treated with methadone or buprenorphine for opioid use disorder as a high-risk comparator group. In the current study, 90 veterans on chronic opioid medication, for either opioid use disorder or pain management, completed a questionnaire assessing risk factors, knowledge, and self-estimate of risk for overdose. Nearly all veterans in both groups had multiple overdose risk factors, although individuals in the pain management group had on average a significantly lower total number of risk factors than did individuals in the opioid use disorder group (5.9 versus 8.5, p < .0001). On average, participants treated for pain management scored slightly but significantly lower on knowledge of opioid overdose risk factors (12.1 versus 13.5, p < .01). About 70% of participants, regardless of group, believed their overdose risk was below that of the average American adult. There was no significant relationship between self-estimate of overdose risk and either number or knowledge of opioid overdose risk factors. Our results suggest that veterans in both groups underestimated their risk for opioid overdose. Expansion of overdose education to include individuals on chronic opioids for pain management and a shift in educational approaches to overdose prevention may be indicated.

LabVIEW Task Manager v. 1.10.0

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

Vargo, Timothy D.

LabVIEW Task Manager is a debugging tool for use during code development in the National Instruments (NI) LabVIEW® IDE. While providing a dynamic & big-picture view of running code, an expandable/collapsible tree diagram displays detailed information (both static and dynamic) on all VIs in memory, belonging to a selected project/target. It allows for interacting with single or multiple selected VIs at a time, providing significant benefits while troubleshooting, and has the following features: Look & Feel similar to Windows® Task Manager; Selection of project/target; Lists all VIs in memory, grouped by class/library; Searches for and enumerates clones in memory; DropInmore » VI for including dynamically referenced clones (Clone Beacon); 'Refresh Now' (F5) re-reads all VIs in memory and adds new ones to the tree; Displays VI name, owning class/library, state, path, data size & code size; Displays VI FP Behavior, Reentrant?, Reentrancy Type, Paused? & Highlight?; Sort by any column, including by library name; Filter by item types vi, ctl, and vit/ctt; Filter out vi.lib and global VIs; Tracking of, and ability to toggle, execution highlighting on multiple selected VIs; Tracking of paused VIs with ability to Pause/Resume/TogglePause multiple selected VIs; DropIn VI for pausing on a condition; If a clone initiates a pause, a different pause symbol is used for all clones of that same reentrant original VI; Select multiple VIs and open or close their FPs or BDs; Double Click a VI from the tree to bring the BD (first choice) or FP to front, if already open; and Select multiple top-level VIs and Abort them.« less

Land management: data availability and process understanding for global change studies.

PubMed

Erb, Karl-Heinz; Luyssaert, Sebastiaan; Meyfroidt, Patrick; Pongratz, Julia; Don, Axel; Kloster, Silvia; Kuemmerle, Tobias; Fetzel, Tamara; Fuchs, Richard; Herold, Martin; Haberl, Helmut; Jones, Chris D; Marín-Spiotta, Erika; McCallum, Ian; Robertson, Eddy; Seufert, Verena; Fritz, Steffen; Valade, Aude; Wiltshire, Andrew; Dolman, Albertus J

2017-02-01

In the light of daunting global sustainability challenges such as climate change, biodiversity loss and food security, improving our understanding of the complex dynamics of the Earth system is crucial. However, large knowledge gaps related to the effects of land management persist, in particular those human-induced changes in terrestrial ecosystems that do not result in land-cover conversions. Here, we review the current state of knowledge of ten common land management activities for their biogeochemical and biophysical impacts, the level of process understanding and data availability. Our review shows that ca. one-tenth of the ice-free land surface is under intense human management, half under medium and one-fifth under extensive management. Based on our review, we cluster these ten management activities into three groups: (i) management activities for which data sets are available, and for which a good knowledge base exists (cropland harvest and irrigation); (ii) management activities for which sufficient knowledge on biogeochemical and biophysical effects exists but robust global data sets are lacking (forest harvest, tree species selection, grazing and mowing harvest, N fertilization); and (iii) land management practices with severe data gaps concomitant with an unsatisfactory level of process understanding (crop species selection, artificial wetland drainage, tillage and fire management and crop residue management, an element of crop harvest). Although we identify multiple impediments to progress, we conclude that the current status of process understanding and data availability is sufficient to advance with incorporating management in, for example, Earth system or dynamic vegetation models in order to provide a systematic assessment of their role in the Earth system. This review contributes to a strategic prioritization of research efforts across multiple disciplines, including land system research, ecological research and Earth system modelling. © 2016 John Wiley & Sons Ltd.

A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue.

PubMed

van Kessel, Kirsten; Wouldes, Trecia; Moss-Morris, Rona

2016-05-01

To pilot and compare the efficacy of an internet-based cognitive behavioural therapy self-management programme with (MSInvigor8-Plus) and without (MSInvigor8-Only) the use of email support in reducing fatigue severity and impact (primary outcomes), and depressed and anxious mood (secondary outcomes). Randomized controlled trial using an independent randomization system built into the website and intention-to-treat analysis. Participants were recruited through the local Multiple Sclerosis Society and hospital neurological services in New Zealand. A total of 39 people (aged 31-63 years), experiencing multiple sclerosis fatigue, able to walk with and without walking aids, were randomized to MSInvigor8-Only (n = 20) or to MSInvigor8-Plus (n = 19). MSInvigor8 is an eight-session programme based on cognitive behaviour therapy principles including psycho-education, self-monitoring, and changing unhelpful activity and thought patterns. Outcome measures included fatigue severity (Chalder Fatigue Scale) and impact (Modified Fatigue Impact Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). Assessments were performed at baseline and at 10 weeks. The MSInvigor8-Plus condition resulted in significantly greater reductions in fatigue severity (F [1,36] = 9.09, p < 0.01) and impact (F [1,36] = 6.03, p < 0.02) compared with the MSInvigor8-Only condition. Large between-group effect sizes for fatigue severity (d = 0.99) and fatigue impact (d = 0.81) were obtained. No significant differences were found between the groups on changes in anxiety and depression. MSInvigor8 delivered with email-based support is a potentially promising, acceptable, and cost-effective approach to treating fatigue in people with multiple sclerosis in New Zealand. © The Author(s) 2015.

Who's responsible for the care of women during and after a pregnancy affected by gestational diabetes?

PubMed

Wilkinson, Shelley A; Lim, Siew S; Upham, Susan; Pennington, Andrew; O'Reilly, Sharleen L; Asproloupos, Dino; McIntyre, H David; Dunbar, James A

2014-08-04

Despite its increasing incidence and high conferred risk to women and their children, gestational diabetes mellitus (GDM) is managed inconsistently during and after pregnancy due to an absence of a systemic approach to managing these women. New guidelines for GDM testing and diagnosis are based on stronger evidence, but raise concerns about increased workloads and confusion in a landscape of multiple, conflicting guidelines. Postnatal care and long-term preventive measures are particularly fragmented, with no professional group taking responsibility for this crucial role. Clearer guidelines and assistance from existing frameworks, such as the National Gestational Diabetes Register, could enable general practitioners to take ownership of the management of women at risk of type 2 diabetes following GDM, applying the principles of chronic disease management long term.

Testing the effectiveness of a self-efficacy based exercise intervention for adults with venous leg ulcers: protocol of a randomised controlled trial

PubMed Central

2014-01-01

Background Exercise and adequate self-management capacity may be important strategies in the management of venous leg ulcers. However, it remains unclear if exercise improves the healing rates of venous leg ulcers and if a self-management exercise program based on self-efficacy theory is well adhered to. Method/design This is a randomised controlled in adults with venous leg ulcers to determine the effectiveness of a self-efficacy based exercise intervention. Participants with venous leg ulcers are recruited from 3 clinical sites in Australia. After collection of baseline data, participants are randomised to either an intervention group or control group. The control group receive usual care, as recommended by evidence based guidelines. The intervention group receive an individualised program of calf muscle exercises and walking. The twelve week exercise program integrates multiple elements, including up to six telephone delivered behavioural coaching and goal setting sessions, supported by written materials, a pedometer and two follow-up booster calls if required. Participants are encouraged to seek social support among their friends, self-monitor their weekly steps and lower limb exercises. The control group are supported by a generic information sheet that the intervention group also receive encouraging lower limb exercises, a pedometer for self-management and phone calls at the same time points as the intervention group. The primary outcome is the healing rates of venous leg ulcers which are assessed at fortnightly clinic appointments. Secondary outcomes, assessed at baseline and 12 weeks: functional ability (range of ankle motion and Tinetti gait and balance score), quality of life and self-management scores. Discussion This study seeks to address a significant gap in current wound management practice by providing evidence for the effectiveness of a home-based exercise program for adults with venous leg ulcers. Theory-driven, evidence-based strategies that can improve an individual’s exercise self-efficacy and self-management capacity could have a significant impact in improving the management of people with venous leg ulcers. Information gained from this study will provide much needed information on management of this chronic disease to promote health and independence in this population. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000475842. PMID:25277416

SeaSketch: Implementation of a Decision-Support Platform for a Channel Islands National Marine Sanctuary Multi-sector Working Group

NASA Astrophysics Data System (ADS)

Goldberg, G.; McClintock, W.

2016-12-01

Effective interagency and cross-sector coordination is essential to ecosystem based management which depends on processes characterized by collaboration and science-based information. Many technological barriers that exist in the development of science-based management plans are closely tied to process challenges, such as the sharing of data and information or the inclusion of parties with varied levels of technical experience. The Channel Islands National Marine Sanctuary has convened a diverse working group to develop recommendations for the management of marine shipping in and around the Santa Barbara Channel, as well as recommendations regarding research needs and outreach strategies. Working group members take a multi-issue approach with four distinct goals related to the reduction of ship strikes on whales, emissions and air quality, conflicting ocean uses, and issues of navigational safety. Members range from industry representatives, scientists, and multiple local and federal government entities. The recommended management plans will be based in the best-available science, and will build off of previous efforts, making this an interesting case study of adaptive management. In addition to support from the Sanctuary and professional facilitators, the group is using a decision-support platform, SeaSketch (safepassage.seasketch.org). SeaSketch is a web-based GIS that supports collaborative science-based marine spatial planning (MSP). Each feature supports a step of the MSP process, from data gathering, identification of data needs, the design of spatial plans, evaluation of those plans with analytics, and map-based forums that facilitate data-driven discussions. Working group members are able to access these tools to explore management options and collaborate remotely, in addition to using the platform during in-person meetings and webinars. Empowering diverse audiences to engage in the design of science-based plans is of key importance to developing ecosystem-based management plans where multi-sector participation and inter-agency coordination are critical.

SeaSketch: Implementation of a Decision-Support Platform for a Channel Islands National Marine Sanctuary Multi-sector Working Group

NASA Astrophysics Data System (ADS)

Goldberg, G.; McClintock, W.

2016-02-01

Effective interagency and cross-sector coordination is essential to ecosystem based management which depends on processes characterized by collaboration and science-based information. Many technological barriers that exist in the development of science-based management plans are closely tied to process challenges, such as the sharing of data and information or the inclusion of parties with varied levels of technical experience. The Channel Islands National Marine Sanctuary has convened a diverse working group to develop recommendations for the management of marine shipping in and around the Santa Barbara Channel, as well as recommendations regarding research needs and outreach strategies. Working group members take a multi-issue approach with four distinct goals related to the reduction of ship strikes on whales, emissions and air quality, conflicting ocean uses, and issues of navigational safety. Members range from industry representatives, scientists, and multiple local and federal government entities. The recommended management plans will be based in the best-available science, and will build off of previous efforts, making this an interesting case study of adaptive management. In addition to support from the Sanctuary and professional facilitators, the group is using a decision-support platform, SeaSketch (safepassage.seasketch.org). SeaSketch is a web-based GIS that supports collaborative science-based marine spatial planning (MSP). Each feature supports a step of the MSP process, from data gathering, identification of data needs, the design of spatial plans, evaluation of those plans with analytics, and map-based forums that facilitate data-driven discussions. Working group members are able to access these tools to explore management options and collaborate remotely, in addition to using the platform during in-person meetings and webinars. Empowering diverse audiences to engage in the design of science-based plans is of key importance to developing ecosystem-based management plans where multi-sector participation and inter-agency coordination are critical.

Application of ANP and DEMATEL to evaluate the decision-making of municipal solid waste management in Metro Manila.

PubMed

Tseng, Ming-Lang

2009-09-01

A municipal solid waste management (MSW) expert group was consulted in order to mirror how government officials might reach an effective solution regarding municipal solid waste management in Metro Manila. A critical issue regarding this is how the expert group can better evaluate and select a favorable MSW management solution using a series of criteria. MSW management solution selection is a multiple criteria decision-making (MCDM) problem, which requires the consideration of a large number of complex criteria. A robust MCDM method should consider the interactions among these criteria. The analytic network process (ANP) is a relatively new MCDM method which can deal with all kinds of interactions systematically. The Decision Making Trial and Evaluation Laboratory (DEMATEL) not only can convert the relations between cause and effect of criteria into a structural model, but also can be used as a way to handle the inner dependences within a set of criteria. Hence, this paper applies an effective solution based on a combined ANP and DEMATEL method to assist the expert group evaluating different MSW management solutions. According to the results, the best solution is for each city to have its own type of thermal process technology and resource recovery facility before landfill rather than entering a joint venture with enterprises or going into build-operate-transfer projects in order to be able to construct thermal process technologies and resource recovery facilities.

An educational strategy for treating chronic, noncancer pain with opioids: a pilot test.

PubMed

Elhwairis, Huda; Reznich, Christopher B

2010-12-01

Chronic pain is common and can be devastating to the patient and challenging to the health care provider. Despite the importance of the topic, pain management curricula are incomplete in health professionals' training. We developed a longitudinal curriculum to teach therapy for chronic noncancer pain over four units and pilot-tested the teaching of one unit (opioids) to internal medicine residents. The educational strategies we used included didactic sessions, write-up of a management plan following a model, case discussions, and role-play group activities. We pilot-tested one unit (opioid therapy) in March 2008. We performed learner evaluations, using a pretest and posttest, a write-up plan following a model, and a learner knowledge questionnaire. Results showed significant improvement in knowledge. Residents found the sessions and educational strategy to be excellent and reported higher confidence levels in managing patients with chronic noncancer pain. This article demonstrates that multiple teaching modalities-including didactic lectures, case discussions, write-up of a management plan following a model, and role-play group activities-are effective methods of teaching internal medicine residents how to use opioids to manage chronic noncancer pain. Copyright © 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

"Making Do" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards.

PubMed

Wills, Celia E; Polivka, Barbara J; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-04-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of "making do" decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. © The Author(s) 2015.

“Making Do” Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards

PubMed Central

Wills, Celia E.; Polivka, Barbara J.; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2016-01-01

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of “making do” decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. PMID:26669605

[Implementation and (cost-)effectiveness of case management for people with dementia and their informal caregivers: results of the COMPAS study].

PubMed

van Mierlo, Lisa D; MacNeil-Vroomen, Janet; Meiland, Franka J M; Joling, Karlijn J; Bosmans, Judith E; Dröes, Rose Marie; Moll van Charante, Eric P; de Rooij, Sophia E J A; van Hout, Hein P J

2016-12-01

Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

The Role of Thoracic Medial Branch Blocks in Managing Chronic Mid and Upper Back Pain: A Randomized, Double-Blind, Active-Control Trial with a 2-Year Followup

PubMed Central

Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J. E.; Cash, Kimberly A.; Pampati, Vidyasagar; Fellows, Bert

2012-01-01

Study Design. A randomized, double-blind, active-control trial. Objective. To determine the clinical effectiveness of therapeutic thoracic facet joint nerve blocks with or without steroids in managing chronic mid back and upper back pain. Summary of Background Data. The prevalence of thoracic facet joint pain has been established as 34% to 42%. Multiple therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include medial branch blocks, radiofrequency neurotomy, and intraarticular injections. Methods. This randomized double-blind active controlled trial was performed in 100 patients with 50 patients in each group who received medial branch blocks with local anesthetic alone or local anesthetic and steroids. Outcome measures included the numeric rating scale (NRS), Oswestry Disability Index (ODI), opioid intake, and work status, at baseline, 3, 6, 12, 18, and 24 months. Results. Significant improvement with significant pain relief and functional status improvement of 50% or more were observed in 80% of the patients in Group I and 84% of the patients in Group II at 2-year followup. Conclusions. Therapeutic medial branch blocks of thoracic facets with or without steroids may provide a management option for chronic function-limiting thoracic pain of facet joint origin. PMID:22851967

An analysis of 1986 drug procurement practices in hospitals within the United States.

PubMed

Smolarek, R T; Powell, M F; Solomon, D K; Boike, S C

1989-09-01

The purpose of this study was to statistically answer a set of predefined objectives concerning pharmaceutical procurement. The key indicators were assumed to be cost per patient day and turnover rate. Of the 5,911 surveys mailed, 709 surveys were returned for a 12% response rate. The following statements were based on attempts to answer the six predetermined objectives. Pharmaceutical purchasing is controlled by pharmacy departments to the extent that comparisons to pharmaceutical purchasing by materials management departments was not possible. Prime vendor purchasing is the procurement method of choice. Competitive bidding through a group process is so popular that a valid comparison to nongroup bidding could not be accomplished with the results of this survey. Certain variables of group purchasing such as group age, contract adherence, and volume commitment, do not appear to be correlated to purchasing outcomes in this study. When comparing government to private hospitals, the private sector seems to have an advantage in managing turnover rates. Cost per patient day results were less conclusive. As single and multiple hospital systems were compared for purchasing outcomes, the results were not totally conclusive. Although, multiple hospital systems had a significantly higher turnover rate. Finally, a comparison based on the use, or lack of use, of prime vendor arrangements demonstrated interesting results. The duration of contract did not significantly affect the purchasing outcomes. Other hospital variables such as size, type, ownership, and organization, demonstrated notable trends. The importance of examining hospitals based on case mix and mission seems to be most important. Also, the ability to relate purchasing outcomes with formulary management strategies needs further study before conclusive statements can be adopted.

Review of multiple-choice-questions and group performance - A comparison of face-to-face and virtual groups with and without facilitation

PubMed Central

Kazubke, Edda; Schüttpelz-Brauns, Katrin

2010-01-01

Background: Multiple choice questions (MCQs) are often used in exams of medical education and need careful quality management for example by the application of review committees. This study investigates whether groups communicating virtually by email are similar to face-to-face groups concerning their review process performance and whether a facilitator has positive effects. Methods: 16 small groups of students were examined, which had to evaluate and correct MCQs under four different conditions. In the second part of the investigation the changed questions were given to a new random sample for the judgement of the item quality. Results: There was no significant influence of the variables “form of review committee” and “facilitation”. However, face-to-face and virtual groups clearly differed in the required treatment times. The test condition “face to face without facilitation” was generally valued most positively concerning taking over responsibility, approach to work, sense of well-being, motivation and concentration on the task. Discussion: Face-to-face and virtual groups are equally effective in the review of MCQs but differ concerning their efficiency. The application of electronic review seems to be possible but is hardly recommendable because of the long process time and technical problems. PMID:21818213

Comparative study on treatment satisfaction and health perception in children and adolescents with type 1 diabetes mellitus on multiple daily injection of insulin, insulin pump and sensor-augmented pump therapy.

PubMed

Hussain, Tara; Akle, Mariette; Nagelkerke, Nico; Deeb, Asma

2017-01-01

Diabetes management imposes considerable demands on patients. Treatment method used has an impact on treatment satisfaction. We aim to examine the relationship between treatment satisfaction and health perception with the method used for treatment of type 1 diabetes mellitus in children and adolescents. We have interviewed patients with type 1 diabetes mellitus using questionnaires to assess treatment satisfaction and health perception. Patients were divided into three groups based on treatment used: multiple daily injection, insulin pump and sensor-augmented pump therapy. Comparison of scores was done between the groups. A total of 72 patients were enrolled (36 males). Mean age (standard deviation) was 11.4 (4.4) years and duration of diabetes of 4.9 (3.5) years. Mean (standard deviation) HbA1c was 8.1 (1.2). Median (range) duration of sensor use was 17.7 (3-30) days/month. Mean scale for treatment satisfaction and health perception questions was 25.3, 29.7 and 31.7 and 60, 79.7 and 81 for the multiple daily injection, pump and sensor-augmented pump, respectively (p = 0.00). Significant difference was seen between the multiple daily injection and both other groups. Sensor-augmented pump group scored higher than the pump group. However, the difference was not statistically significant. Duration of sensor use showed no correlation with treatment satisfaction. The method used for diabetes treatment has an impact on patients' satisfaction and health perception in children and adolescents with type 1 diabetes mellitus. Insulin pump users have a higher treatment satisfaction and better health perception than those on multiple daily injection. Augmenting pump therapy with sensor use adds value to treatment satisfaction without correlation with the duration of the sensors use.

Filler migration and extensive lesions after lip augmentation: Adverse effects of polydimethylsiloxane filler.

PubMed

Abtahi-Naeini, Bahareh; Faghihi, Gita; Shahmoradi, Zabihollah; Saffaei, Ali

2018-01-07

Polydimethylsiloxane (PDMS), also called liquid silicone, belongs to a group of polymeric compounds that are commonly referred to as silicones. These filling agents have been used as injectable filler for soft tissue augmentation. There are limited experiences about management of the severe complications related to filler migration associated with PDMS injection. We present a 35-year-old female with severe erythema, edema over her cheeks and neck, and multiple irregularities following cosmetic lip augmentation with PDMS. Further studies are required for management of this complicated case of PDMS injection. © 2018 Wiley Periodicals, Inc.

Essential pediatric hypertension: defining the educational needs of primary care pediatricians.

PubMed

Cha, Stephen D; Chisolm, Deena J; Mahan, John D

2014-07-27

In order to better understand the educational needs regarding appropriate recognition, diagnosis and management of pediatric hypertension (HTN), we asked practicing pediatricians questions regarding their educational needs and comfort level on this topic. We conducted 4 focus group sessions that included 27 participants representing pediatric residents, adolescent medicine physicians, clinic based pediatricians and office based pediatricians. Each focus group session lasted for approximately an hour and 90 pages of total transcriptions were produced verbatim from audio recordings. Four reviewers read each transcript and themes were elucidated from these transcripts. Overall, 5 major themes related to educational needs and clinical concerns were found: utilization of resources to define blood pressure (BP), correct BP measurement method(s), co-morbidities, barriers to care, and experience level with HTN. Six minor themes were also identified: differences in BP measurement, accuracy of BP, recognition of HTN, practice pattern of care, education of families and patients, and differences in level of training. The focus group participants were also questioned on their preferences regarding educational methods (i.e. e-learning, small group sessions, self-study, large group presentations) and revealed varied teaching and learning preferences. There are multiple methods to approach education regarding pediatric HTN for primary care pediatricians based on provider preferences and multiple educational activities should be pursued to achieve best outcomes. Based on this data, the next direction will be to develop and deliver multiple educational methods and to evaluate the impact on practice patterns of care for children and adolescents with HTN.

2014 Update of the Canadian Rheumatology Association/spondyloarthritis research consortium of Canada treatment recommendations for the management of spondyloarthritis. Part I: principles of the management of spondyloarthritis in Canada.

PubMed

Rohekar, Sherry; Chan, Jon; Tse, Shirley M L; Haroon, Nigil; Chandran, Vinod; Bessette, Louis; Mosher, Dianne; Flanagan, Cathy; Keen, Kevin J; Adams, Karen; Mallinson, Michael; Thorne, Carter; Rahman, Proton; Gladman, Dafna D; Inman, Robert D

2015-04-01

The Canadian Rheumatology Association (CRA) and the Spondyloarthritis Research Consortium of Canada (SPARCC) have collaborated to update the recommendations for the management of spondyloarthritis (SpA). A working group was assembled and consisted of the SPARCC executive committee, rheumatologist leaders from SPARCC collaborating sites, Canadian rheumatologists from across the country with an interest in SpA (both academic and community), a rheumatology trainee with an interest in SpA, an epidemiologist/health services researcher, a member of the CRA executive, a member of the CRA therapeutics committee, and a patient representative from the Canadian Spondylitis Association. An extensive review was conducted of literature published from 2007 to 2014 involving the management of SpA. The working group created draft recommendations using multiple rounds of Web-based surveys and an in-person conference. A survey was sent to the membership of the CRA to obtain an extended review that was used to finalize the recommendations. Guidelines for the management of SpA were created. Part I focuses on the principles of management of SpA in Canada and includes 6 general management principles, 5 ethical considerations, target groups for treatment recommendations, 2 wait time recommendations, and recommendations for disease monitoring. Also included are 6 modifications for application to juvenile SpA. These recommendations were developed based on current literature and applied to a Canadian healthcare context. It is hoped that the implementation of these recommendations will promote best practices in the treatment of SpA.

An update on MS Nurse PROfessional, an ongoing project of the European Multiple Sclerosis Platform.

PubMed

Winslow, Anne

2016-12-01

Within the multidisciplinary team required to manage people with multiple sclerosis (MS) effectively, the nurse is the central component of coordinated care and support. A 2009 survey led by the European Multiple Sclerosis Platform, an umbrella organization of national MS associations, identified variance and disparity across Europe in the nursing care of MS patients. This led to development of MS Nurse PROfessional, a continuing medical education-accredited modular online learning program endorsed and approved by leading international nursing and professional groups, and people with MS, as a tool to support the evolving role of the European MS nurse. Analysis of participant experience and nurse practice to date has been overwhelmingly positive. Expansion of MS Nurse PRO is underway or planned for future.

Who Needs Statistics? | Poster

Cancer.gov

You may know the feeling. You have collected a lot of new data on an important experiment. Now you are faced with multiple groups of data, a sea of numbers, and a deadline for submitting your paper to a peer-reviewed journal. And you are not sure which data are relevant, or even the best way to present them. The statisticians at Data Management Services (DMS) know how to help.

Development of Medical Technology for Contingency Response to Marrow Toxic Agents

DTIC Science & Technology

2018-06-06

Health Physics e. Emergency Medicine f. Burn Care g. State Public Health h. Federal Public Health i. Emergency Management. 2. The group has...Preparedness 4 Project: Local Public Health Radiological Preparedness Gap Review and Tool Development Identification 1. The National Association...of County and City Health Officials (NACCHO) has held multiple conference calls with leaders within their organization to identify the areas of

A Single Group Multiple Base Line Design: Clinical Hypnosis as a Technique in the Reduction of Stress Related Symptomatology in Graduate Students

ERIC Educational Resources Information Center

Jones-Trebatoski, Kathleen

2009-01-01

The primary purpose of this study was to determine the effectiveness of a hypnosis program with graduate students as a stress management strategy This study identified components of the program that were perceived as beneficial in relieving stress. Additionally, this study determined the amount of time necessary for benefits to be realized. The…

Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change.

PubMed

Prochaska, Judith J; Fromont, Sebastien C; Delucchi, Kevin; Young-Wolff, Kelly C; Benowitz, Neal L; Hall, Stephen; Bonas, Thomas; Hall, Sharon M

2014-12-01

Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.

15 CFR 921.33 - Boundary changes, amendments to the management plan, and addition of multiple-site components.

Code of Federal Regulations, 2010 CFR

2010-01-01

... management plan, and addition of multiple-site components. 921.33 Section 921.33 Commerce and Foreign Trade... management plan, and addition of multiple-site components. (a) Changes in the boundary of a Reserve and major... management plan shall address goals and objectives for all components of the multi-site Reserve and the...

Correlations of fatty acid supplementation, aeroallergens, shampoo, and ear cleanser with multiple parameters in pruritic dogs.

PubMed

Nesbitt, Gene H; Freeman, Lisa M; Hannah, Steven S

2004-01-01

Seventy-two pruritic dogs were fed one of four diets controlled for n-6:n-3 fatty acid ratios and total dietary intake of fatty acids. Multiple parameters were evaluated, including clinical and cytological findings, aeroallergen testing, microbial sampling techniques, and effects of an anti-fungal/antibacterial shampoo and ear cleanser. Significant correlations were observed between many clinical parameters, anatomical sampling sites, and microbial counts when data from the diet groups was combined. There were no statistically significant differences between individual diets for any of the clinical parameters. The importance of total clinical management in the control of pruritus was demonstrated.

Associations Between Fatigue and Disability, Functional Mobility, Depression, and Quality of Life in People with Multiple Sclerosis

PubMed Central

Bush, Steffani; Gappmaier, Eduard

2016-01-01

Background: Fatigue is a common symptom in people with multiple sclerosis (MS), but its associations with disability, functional mobility, depression, and quality of life (QOL) remain unclear. We aimed to determine the associations between different levels of fatigue and disability, functional mobility, depression, and physical and mental QOL in people with MS. Methods: Eighty-nine individuals with MS (mean [SD] disease duration = 13.6 [9.8] years, mean [SD] Expanded Disability Status Scale [EDSS] score = 5.3 [1.5]) and no concurrent relapses were retrospectively analyzed. Participants were divided into two groups based on five-item Modified Fatigue Impact Scale (MFIS-5) scores: group LF (n = 32, MFIS-5 score ≤10 [low levels of fatigue]) and group HF (n = 57, MFIS-5 score >10 [high levels of fatigue]). Results: Sixty-four percent of the sample reported high levels of fatigue. Compared with group LF, group HF demonstrated significantly (P < .05) greater impairments in the Timed Up and Go test, Activities-specific Balance Confidence scale, and 12-item Multiple Sclerosis Walking Scale scores; depression; and QOL but not in the EDSS scores, which were not significantly different between groups. Conclusions: Fatigue was found to be a predominant symptom in the study participants. Individuals reporting higher levels of fatigue concomitantly exhibited greater impairments in functional mobility, depression, and physical and mental QOL. Disability was not found to be related to level of fatigue. These findings can be important for appropriate assessment and management of individuals with MS with fatigue. PMID:27134580

The role of the pediatric surgeon in the perinatal multidisciplinary team.

PubMed

Raboei, E H

2008-10-01

The pediatric surgeons' understanding of the etiology of many prenatally diagnosed surgical conditions has grown significantly in recent years. The impact of prenatal pediatric surgical consultation on the perinatal course has not been explored extensively. The aim of this study was to explore the pediatric surgeon's role as a team member on the management and outcome of prenatally diagnosed surgical congenital anomalies. A retrospective study was performed of all pregnant women diagnosed at our institution by antenatal ultrasound as having a fetus with congenital anomalies. The pediatric surgeon's role in decisions on the termination of pregnancy, IN UTERO intervention, or an altered mode or timing of delivery was studied. Patients were divided according to prenatal decisions into 5 groups; group one included those who had nonaggressive obstetric management, groups two and three included pregnancies where the mode or time of delivery was changed, group four consisted of patients who underwent amniocentesis for karyotype analysis and group five had a termination of pregnancy. There were 406 fetuses diagnosed with congenital anomalies out 20 995 pregnancies. The incidence of congenital anomalies was 1.93 %. The total number of surgical anomaly cases was 234/400 (58.5 %). The pediatric surgeon was the team leader for the management and counseling of parents in 184 out of 227 cases (82.4 %) in group one, two (0.85 %) and 10 (4.3 %) patients in groups 2 and 3, respectively. The pediatric surgeon was the main team member who took the decision in groups 4 and 5. Eighty-three out of 400 cases (35.5 %) had amniocentesis. Although termination of pregnancy in 26/83 (31.3 %) or an altered mode or time of delivery was the outcome for group four; this was not related to the results of the test. Twenty-six pregnancies (11 %) were terminated in group five. The pregnancy terminations included fetuses with Potter's and VATER syndrome, multiple congenital anomalies and conjoined twins. The pediatric surgeon should be a member of the perinatal multidisciplinary team. Prenatal pediatric surgical consultations have a significant impact on the perinatal management of a fetus with congenital anomalies by providing obstetric colleagues and families with valuable information into the surgical management of anomalies.

Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay.

PubMed

Spaggiari, Emmanuel; Ruas, Marie; Dreux, Sophie; Valat, Anne-Sylvie; Czerkiewicz, Isabelle; Guimiot, Fabien; Schmitz, Thomas; Delezoide, Anne-Lise; Muller, Françoise

2013-04-01

To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein. A retrospective cohort study in 658 patients with maternal serum alpha-fetoprotein ≥2.5 multiple of median, performed at routine Down syndrome screening. Maternal serum alpha-fetoprotein was assayed a second time in 341 of them. Outcomes were recorded in all cases. The group with unexplained maternal serum alpha-fetoprotein persistently ≥2.5 multiple of median was associated with more pregnancy complications 37 of 92 (40.2%) as fetal death, preeclampsia, intrauterine growth restriction, and congenital nephrotic syndrome, compared with the group with maternal serum alpha-fetoprotein that returned to a normal level 37 of 226 (16.4%) (P < .001). When maternal serum alpha-fetoprotein returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat maternal serum alpha-fetoprotein assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. Alpha-fetoprotein should be monitored in pregnancies associated with unexplained high maternal serum alpha-fetoprotein. A management strategy based on ultrasound examination, second maternal serum alpha-fetoprotein assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it. Copyright © 2013 Mosby, Inc. All rights reserved.

Pathway-based analyses.

PubMed

Kent, Jack W

2016-02-03

New technologies for acquisition of genomic data, while offering unprecedented opportunities for genetic discovery, also impose severe burdens of interpretation and penalties for multiple testing. The Pathway-based Analyses Group of the Genetic Analysis Workshop 19 (GAW19) sought reduction of multiple-testing burden through various approaches to aggregation of highdimensional data in pathways informed by prior biological knowledge. Experimental methods testedincluded the use of "synthetic pathways" (random sets of genes) to estimate power and false-positive error rate of methods applied to simulated data; data reduction via independent components analysis, single-nucleotide polymorphism (SNP)-SNP interaction, and use of gene sets to estimate genetic similarity; and general assessment of the efficacy of prior biological knowledge to reduce the dimensionality of complex genomic data. The work of this group explored several promising approaches to managing high-dimensional data, with the caveat that these methods are necessarily constrained by the quality of external bioinformatic annotation.

Arts and health as a practice of liminality: managing the spaces of transformation for social and emotional wellbeing with primary school children.

PubMed

Atkinson, Sarah; Robson, Mary

2012-11-01

Intervention to enhance wellbeing through participation in the creative arts has a transformative potential, but the spatialities to this are poorly theorised. The paper examines arts-based interventions in two primary schools in which small groups of children are taken out of their everyday classrooms to participate in weekly sessions. The paper argues that such intervention is usefully seen as a practice of liminality, a distinct time and space that needs careful management to realise a transformative potential. Such management involves negotiating multiple sources of tension to balance different modes of power, forms of art practices and permeability of the liminal time-space. Copyright © 2012 Elsevier Ltd. All rights reserved.

Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations

PubMed Central

Baumbauer, Kyle M.; Young, Erin E.; Starkweather, Angela R.; Guite, Jessica W.; Russell, Beth S.; Manworren, Renee C.

2015-01-01

Synopsis Chronic pain represents a significant health and societal concern. In the adult population chronic pain can lead to loss of productivity, earning potential, and decreased quality of life. Research has typically focused on otherwise healthy adults with chronic pain conditions; however there appear to be distinct groups with increased vulnerability for the emergence of chronic pain. These groups may be defined by developmental status and/or life circumstances that increase the risk of injury or for which treatment of pain is less effective. Within the pediatric, geriatric, and drug abuser populations, chronic pain also represents a significant health issue, which can lead to increased absenteeism during school age years, as well as decreased quality of life and increased risk of additional adverse health conditions later in life. Currently, little is known about the mechanisms that encourage the development of chronic pain in these groups, and, consequently, pediatric, geriatric, and substance abuse patients represent challenging cohorts to manage. We focus on known anatomic, physiologic, and genetic mechanisms underlying chronic pain in these populations, and highlight the need for a multimodal approach from multiple healthcare professionals for management of chronic pain in those with the most risk. PMID:26614727

Leader--member exchange, differentiation, and psychological contract fulfillment: a multilevel examination.

PubMed

Henderson, David J; Wayne, Sandy J; Shore, Lynn M; Bommer, William H; Tetrick, Lois E

2008-11-01

Prior integrations of the leader-member exchange (LMX) and psychological contract literatures have not clarified how within-group LMX differentiation influences employees' attitudes and behaviors in the employment relationship. Therefore, using a sample of 278 members and managers of 31 intact work groups at 4 manufacturing plants, the authors examined how LMX operating at the within-group level (relative LMX, or RLMX) and the group level influenced perceptions of psychological contract fulfillment and employee-level outcomes. Controlling for individual-level perceptions of LMX quality, results indicated a positive relationship between RLMX and fulfillment, which was strengthened as group-level variability in LMX quality increased. Perceptions of fulfillment mediated the relationship between RLMX and performance and sportsmanship behaviors. The importance of conceptualizing LMX as simultaneously operating at multiple levels is highlighted.

Integrating Fuel Treatments into Comprehensive Ecosystem Management

Treesearch

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

2006-01-01

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

Managing bay and estuarine ecosystems for multiple services

USGS Publications Warehouse

Needles, Lisa A.; Lester, Sarah E.; Ambrose, Richard; Andren, Anders; Beyeler, Marc; Connor, Michael S.; Eckman, James E.; Costa-Pierce, Barry A.; Gaines, Steven D.; Lafferty, Kevin D.; Lenihan, Junter S.; Parrish, Julia; Peterson, Mark S.; Scaroni, Amy E.; Weis, Judith S.; Wendt, Dean E.

2013-01-01

Managers are moving from a model of managing individual sectors, human activities, or ecosystem services to an ecosystem-based management (EBM) approach which attempts to balance the range of services provided by ecosystems. Applying EBM is often difficult due to inherent tradeoffs in managing for different services. This challenge particularly holds for estuarine systems, which have been heavily altered in most regions and are often subject to intense management interventions. Estuarine managers can often choose among a range of management tactics to enhance a particular service; although some management actions will result in strong tradeoffs, others may enhance multiple services simultaneously. Management of estuarine ecosystems could be improved by distinguishing between optimal management actions for enhancing multiple services and those that have severe tradeoffs. This requires a framework that evaluates tradeoff scenarios and identifies management actions likely to benefit multiple services. We created a management action-services matrix as a first step towards assessing tradeoffs and providing managers with a decision support tool. We found that management actions that restored or enhanced natural vegetation (e.g., salt marsh and mangroves) and some shellfish (particularly oysters and oyster reef habitat) benefited multiple services. In contrast, management actions such as desalination, salt pond creation, sand mining, and large container shipping had large net negative effects on several of the other services considered in the matrix. Our framework provides resource managers a simple way to inform EBM decisions and can also be used as a first step in more sophisticated approaches that model service delivery.

Hospital acquisitions, parenting styles and management accounting change: An institutional perspective.

PubMed

Dossi, Andrea; Lecci, Francesca; Longo, Francesco; Morelli, Marco

2017-02-01

Many healthcare scholars have applied institutional theories to the study of management accounting systems (MAS) change. However, little attention has been devoted to MAS change within groups. Kostova et al. highlight the limitations of traditional institutional frameworks in studying groups since they are characterised not only by the existence of external institutional environments but also by intra-organisational (meso-level) ones. Given this background, the research question is: how does the meso-level institutional environment affect MAS change in healthcare groups? We use a longitudinal multiple-case study design to understand the role of headquarters in shaping local MAS change. We would expect companies to adopt similar MAS. However, we argue that the relationship between external institutions and MAS change cannot be wholly understood without taking into consideration the role of headquarters. Our analysis shows how hospitals facing the same external institutional environment implement different MAS as a consequence of different parenting styles. From a scientific perspective, our article contributes to broaden traditional institutional theoretical frameworks.

Spectacle prescription in children: Understanding practical approach of Indian ophthalmologists

PubMed Central

Monga, Sumit; Dave, Paaraj

2018-01-01

Purpose: The aim of this study is to survey the management approach, regarding spectacle prescription in children, among Indian ophthalmologists. Methods: A web-based, anonymous questionnaire (multiple choice questions dealing with practical aspects of pediatric refraction), was sent to available database of Indian ophthalmologists. The survey responses (depicted in %) were compared using the amount of pediatric clientele in one's practice (Group A: <25%, Group B: 25% or more). The responses were also analyzed in relation to the published concepts from literature. Results: Two hundred and ten ophthalmologists (2.74% response rate; 48% in Group A), from all over India, responded to the survey. There were wide discrepancies in the responses (both, in and among, Groups A and B; P > 0.05, Chi-square test), as to when and how much refractive error to prescribe in children, for a given situation. Conclusion: A wide gap exists between pediatric spectacle prescription patterns of Indian ophthalmologists, as compared to the recommended pediatric ophthalmology protocols. The management approach, for certain situations concerning the pediatric refraction, was better among those with higher pediatric clientele. PMID:29676306

A rough set approach for determining weights of decision makers in group decision making.

PubMed

Yang, Qiang; Du, Ping-An; Wang, Yong; Liang, Bin

2017-01-01

This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs' decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member' decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs' evaluations and selections.

Medical and surgical management of perianal Crohn’s disease

PubMed Central

Adegbola, Samuel O.; Pisani, Anthea; Sahnan, Kapil; Tozer, Phil; Ellul, Pierre; Warusavitarne, Janindra

2018-01-01

Crohn’s disease is increasingly thought to encompass multiple possible phenotypes. Perianal manifestations account for one such phenotype and represent an independent disease modifier. In its more severe form, perianal Crohn’s disease confers a higher risk of a severe and disabling disease course, relapses, hospital admissions and operations. This, in turn, imposes a considerable burden and disability on patients. Identification of the precise manifestation is important, as management is nuanced, with both medical and surgical components, and is best undertaken in a multidisciplinary setting for both diagnosis and ongoing treatment. The introduction of biologic medication has heralded a significant addition to the management of fistulizing perianal Crohn’s disease in particular, albeit with modest results. It remains a very challenging condition to treat and further work is required to optimize management in this group of patients. PMID:29507460

Multiple Learning Tracks: For Training Multinational Managers

ERIC Educational Resources Information Center

Harvey, Michael G.; Kerin, Roger A.

1977-01-01

The problem of identifying and training college students to be effective multinational marketing managers is investigated in three parts: (1) Identification of multinational manager attributes, (2) selection of multinational managers, and (3) multiple "track" training programs. (TA)

Postoperative Pain and Flare-Ups: Comparison of Incidence Between Single and Multiple Visit Pulpectomy in Primary Molars

PubMed Central

Gowda, Subhadra Halemane Nagaraj

2017-01-01

Introduction Endodontic treatment performed in either single- or multiple visit can be followed by numerous short- and long term complications. One of the short term complications include postoperative pain and flare–ups. The ability to predict its prevalence and forewarn the patient may go some way towards enabling coping strategies and help dentist in pain management treatment decisions Aim To compare the incidence and intensity of postoperative pain and flare-ups between single- and multiple visit pulpectomy in primary molars. Also, to correlate the preoperative status of the pulp to postoperative pain and flare-ups. Materials and Methods Eighty primary molars indicated for pulpectomy were included in the study and divided into two groups. Tooth treated and preoperative status of the pulp vitality was recorded. All the conventional steps in pulpectomy were followed. Teeth in Group 1 (single visit pulpectomy) were obturated on the same visit. Teeth in Group 2 (multiple visit pulpectomy) were obturated in the subsequent appointment. The recording of postoperative pain, flare-ups, use of medication were done after 24 hours, seven days and one month. Results Four cases in both the groups reported postoperative pain (10%) at 24 hour recall, p=0.74. One flare-up (2.5%) was recorded in each group p=0.67. None of the patients reported pain at seventh day and one month recall. Postoperative pain was recorded in five non-vital teeth (13.5%) and three vital teeth (6.9%). However, it was statistically not significant p=0.53. Conclusion From the perspective of our study there was a low incidence of postoperative pain. The majority of patients in both groups reported no pain or only minimal pain within 24 hours of treatment. There were no differences between single- and multi visit treatment protocols with respect to the incidence of postoperative pain. No significant correlation could be found between pulp vitality and the incidence of postoperative pain. PMID:28511499

A Spanish Pillbox App for Elderly Patients Taking Multiple Medications: Randomized Controlled Trial

PubMed Central

Mira, José Joaquín; Navarro, Isabel; Botella, Federico; Borrás, Fernando; Orozco, Domingo; Iglesias-Alonso, Fuencisla; Pérez-Pérez, Pastora; Lorenzo, Susana; Toro, Nuria

2014-01-01

Background Nonadherence and medication errors are common among patients with complex drug regimens. Apps for smartphones and tablets are effective for improving adherence, but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology. Objective The objective of this study was to design, implement, and evaluate a medication self-management app (called ALICE) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use. Methods A single-blind randomized controlled trial was conducted with a control and an experimental group (N=99) in Spain in 2013. The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals. ALICE was designed for Android and iOS to allow for the personalization of prescriptions and medical advice, showing images of each of the medications (the packaging and the medication itself) together with alerts and multiple reminders for each alert. The randomly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months. Pre and post measures included rate of missed doses and medication errors reported by patients, scores from the 4-item Morisky Medication Adherence Scale (MMAS-4), level of independence, self-perceived health status, and biochemical test results. In the experimental group, data were collected on their previous experience with information and communication technologies, their rating of ALICE, and their perception of the level of independence they had achieved. The intergroup intervention effects were calculated by univariate linear models and ANOVA, with the pre to post intervention differences as the dependent variables. Results Data were obtained from 99 patients (48 and 51 in the control and experimental groups, respectively). Patients in the experimental group obtained better MMAS-4 scores (P<.001) and reported fewer missed doses of medication (P=.02). ALICE only helped to significantly reduce medication errors in patients with an initially higher rate of errors (P<.001). Patients with no experience with information and communication technologies reported better adherence (P<.001), fewer missed doses (P<.001), and fewer medication errors (P=.02). The mean satisfaction score for ALICE was 8.5 out of 10. In all, 45 of 51 patients (88%) felt that ALICE improved their independence in managing their medications. Conclusions The ALICE app improves adherence, helps reduce rates of forgetting and of medication errors, and increases perceived independence in managing medication. Elderly patients with no previous experience with information and communication technologies are capable of effectively using an app designed to help them take their medicine more safely. Trial Registration Clinicaltrials.gov NCT02071498; http://clinicaltrials.gov/ct2/show/NCT02071498 (Archived by WebCite at http://www.webcitation.org/6OJjdHVhD). PMID:24705022

A Spanish pillbox app for elderly patients taking multiple medications: randomized controlled trial.

PubMed

Mira, José Joaquín; Navarro, Isabel; Botella, Federico; Borrás, Fernando; Nuño-Solinís, Roberto; Orozco, Domingo; Iglesias-Alonso, Fuencisla; Pérez-Pérez, Pastora; Lorenzo, Susana; Toro, Nuria

2014-04-04

Nonadherence and medication errors are common among patients with complex drug regimens. Apps for smartphones and tablets are effective for improving adherence, but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology. The objective of this study was to design, implement, and evaluate a medication self-management app (called ALICE) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use. A single-blind randomized controlled trial was conducted with a control and an experimental group (N=99) in Spain in 2013. The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals. ALICE was designed for Android and iOS to allow for the personalization of prescriptions and medical advice, showing images of each of the medications (the packaging and the medication itself) together with alerts and multiple reminders for each alert. The randomly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months. Pre and post measures included rate of missed doses and medication errors reported by patients, scores from the 4-item Morisky Medication Adherence Scale (MMAS-4), level of independence, self-perceived health status, and biochemical test results. In the experimental group, data were collected on their previous experience with information and communication technologies, their rating of ALICE, and their perception of the level of independence they had achieved. The intergroup intervention effects were calculated by univariate linear models and ANOVA, with the pre to post intervention differences as the dependent variables. Data were obtained from 99 patients (48 and 51 in the control and experimental groups, respectively). Patients in the experimental group obtained better MMAS-4 scores (P<.001) and reported fewer missed doses of medication (P=.02). ALICE only helped to significantly reduce medication errors in patients with an initially higher rate of errors (P<.001). Patients with no experience with information and communication technologies reported better adherence (P<.001), fewer missed doses (P<.001), and fewer medication errors (P=.02). The mean satisfaction score for ALICE was 8.5 out of 10. In all, 45 of 51 patients (88%) felt that ALICE improved their independence in managing their medications. The ALICE app improves adherence, helps reduce rates of forgetting and of medication errors, and increases perceived independence in managing medication. Elderly patients with no previous experience with information and communication technologies are capable of effectively using an app designed to help them take their medicine more safely. Clinicaltrials.gov NCT02071498; http://clinicaltrials.gov/ct2/show/NCT02071498.

Activities of daily living independence in Iranian blind war survivors: a cross sectional study, 2008.

PubMed

Amini, Reza; Sahaf, Robab; Kaldi, Alireza; Haghani, Hamid; Davatgaran, Keyvan; Masoumi, Mehdi; Hayatbakhsh, Reza; Rassafiani, Mehdi

2013-07-01

Assessment of activities of daily living (ADL) can be helpful for designing individualized rehabilitation programs for disabled individuals. Measuring and comparing the basic ADL (BADL) and instrumental ADL (IADL) independence between middle aged and senior Iranian blind war survivors (IBWS) was the aim of this study. This cross-sectional study assessed BADL and IADL of 312 blind war survivors, using the Barthel Index and the Lawton-Bordy scale. Data collection was carried out in a recreational event for the blind war survivors in Mashhad, Iran, 2008. The majority of the participants were male (99%), and more than 80% had multiple injuries. None of them were independent in all BADL and IADL. Older groups were more dependent in IADL such as telephone use, drug management, financial management, and BADL such as walking on uneven surfaces, bed/chair transfer and using stairs. The functional status and activities' level differences between those aged younger than 50 years and those aged older than 50 years were significant (P<0.05). In the present study, all the IBWS were dependent in at least one ADL. Multiple physical injuries could be one of the main reasons for the dependency in this group. IBWS aged older than 50 years were considerably more dependent in their BADL and IADL than the younger group. It appears that starting the fifth decade of age in IBWS might cause some considerable decrease in their function. Training and individualized rehabilitation programs are warranted. © 2012 Japan Geriatrics Society.

The Association of CD81 Polymorphisms with Alloimmunization in Sickle Cell Disease

PubMed Central

Tatari-Calderone, Zohreh; Tamouza, Ryad; Le Bouder, Gama P.; Dewan, Ramita; Luban, Naomi L. C.; Lasserre, Jacqueline; Maury, Jacqueline; Lionnet, François; Krishnamoorthy, Rajagopal; Girot, Robert

2013-01-01

The goal of the present work was to identify the candidate genetic markers predictive of alloimmunization in sickle cell disease (SCD). Red blood cell (RBC) transfusion is indicated for acute treatment, prevention, and abrogation of some complications of SCD. A well-known consequence of multiple RBC transfusions is alloimmunization. Given that a subset of SCD patients develop multiple RBC allo-/autoantibodies, while others do not in a similar multiple transfusional setting, we investigated a possible genetic basis for alloimmunization. Biomarker(s) which predicts (predict) susceptibility to alloimmunization could identify patients at risk before the onset of a transfusion program and thus may have important implications for clinical management. In addition, such markers could shed light on the mechanism(s) underlying alloimmunization. We genotyped 27 single nucleotide polymorphisms (SNPs) in the CD81, CHRNA10, and ARHG genes in two groups of SCD patients. One group (35) of patients developed alloantibodies, and another (40) had no alloantibodies despite having received multiple transfusions. Two SNPs in the CD81 gene, that encodes molecule involved in the signal modulation of B lymphocytes, show a strong association with alloimmunization. If confirmed in prospective studies with larger cohorts, the two SNPs identified in this retrospective study could serve as predictive biomarkers for alloimmunization. PMID:23762099

Landslide: Systematic Dynamic Race Detection in Kernel Space

DTIC Science & Technology

2012-05-01

schedule_in_flight← true; CAUSE_TIMER_INTERRUPT(); end if end function Thread Scheduling Finally, the Landslide scheduler is responsible for managing ...child process vanish() simultaneously. • double_wait: Tests interactions of multiple waiters on a single child. • double_thread_fork: Tests for...conditions using Landslide. We describe them here. • Too many waiters allowed. Using the double_wait test case, Group 1 found a bug in which more threads

Building the Brain's "Air Traffic Control" System: How Early Experiences Shape the Development of Executive Function. Working Paper 11

ERIC Educational Resources Information Center

National Scientific Council on the Developing Child, 2011

2011-01-01

Being able to focus, hold, and work with information in mind, filter distractions, and switch gears is like having an air traffic control system at a busy airport to manage the arrivals and departures of dozens of planes on multiple runways. In the brain, this air traffic control mechanism is called executive functioning, a group of skills that…

Using exercises to identify Veterans Health Administration priorities for disaster response: findings from the New Madrid Earthquake training exercise.

PubMed

Gin, June L; Chan, Edward W; Brewster, Pete; Mitchell, Michael N; Ricci, Karen A; Afable, Melissa K; Dobalian, Aram

2013-01-01

Emergency managers are often charged with prioritizing the relative importance of key issues and tasks associated with disaster response. However, little work has been done to identify specific ways that the decision-making process can be improved. This exercise was conducted with 220 employees of the US Department of Veterans Affairs, who were asked to assign priority rankings to a list of possible options of the most important issues to address after a hypothetical disaster scenario impacting a Veterans Affairs Medical Center. We found that groups that were assigned to represent perspectives farther from the impacted site had less agreement in their identification of the top priorities than those assigned to the impacted facility. These findings suggest that greater geographic and administrative proximity to the impacted site may generate greater clarity and certainty about priority setting. Given the complex structure of many organizations, and the multiple levels of group decision making and coordination likely to be needed during disasters, research to better understand training needs with respect to decision making is essential to improve preparedness. Relatively simple modifications to exercises, as outlined here, could provide valuable information to better understand emergency management decision making across multiple organizational levels.

A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis

PubMed Central

Plow, Matthew; Bethoux, Francois; Mai, Kimloan; Marcus, Bess

2014-01-01

Inactivity is a prevalent problem in the population affected with multiple sclerosis (MS). Thus, there is a need to develop and test physical activity (PA) interventions that can be widely disseminated. We conducted a formative evaluation as part of a randomized controlled trial of a pamphlet-based PA intervention among 30 women with MS. Pamphlets were customized to sub-sets of participants who shared similar symptoms and barriers to PA. Mixed methods were used to examine the intervention’s influence on self-efficacy, social support, processes of change and stages of change placement, as well as explore participants’ perceived barriers, motivators and strategies for engaging in a PA program. Results indicated that the intervention group significantly improved stages of change placement (F = 16.64, P < 0.01) and social support (F = 4.08, P = 0.05) in comparison to the control group. Fatigue, pain and lack of time were the commonly cited barriers to engage in the PA program; whereas the pamphlets, phone calls and action planning were cited as motivators. Participants used fatigue management strategies, enlisted social support and modified their environment to routinely engage in the PA program. Strategies were identified to improve the PA intervention in future research. PMID:24989822

Randomized Clinical Trial of the Effectiveness of a Home-Based Advanced Practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV

PubMed Central

Hanrahan, Nancy P.; Wu, Evan; Kelly, Deena; Aiken, Linda H.; Blank, Michael B.

2011-01-01

Individuals with serious mental illness have greater risk for contracting HIV, multiple morbidities, and die 25 years younger than the general population. This high need and high cost subgroup face unique barriers to accessing required health care in the current health care system. The effectiveness of an advanced practice nurse model of care management was assessed in a four-year random controlled trial. Results are reported in this paper. In a four-year random controlled trial, a total of 238 community-dwelling individuals with HIV and serious mental illness (SMI) were randomly assigned to an intervention group (n=128) or to a control group (n=110). Over 12 months, the intervention group received care management from advanced practice psychiatric nurse, and the control group received usual care. The intervention group showed significant improvement in depression (P=.012) and the physical component of health-related quality of life (P=.03) from baseline to 12 months. The advanced practice psychiatric nurse intervention is a model of care that holds promise for a higher quality of care and outcomes for this vulnerable population. PMID:21935499

Building on common ground to address biodiversity conflicts and foster collaboration in environmental management.

PubMed

Lecuyer, Lou; White, Rehema M; Schmook, Birgit; Calmé, Sophie

2018-08-15

Conservation biology faces critical challenges that require collaborative approaches, including novel strategies to support interactions among actors in biodiversity conflicts. The goals of this study were to investigate the concept of common ground across multiple issues and to explore its practical application for the support of environmental management. We conceptually defined common ground as the areas of relevance underlying the suite of issues expressed by people regarding environmental management in a particular context. We then empirically tested this in the Calakmul region of Mexico, where the complex socio-historical context and high biodiversity have created environmental management challenges that are now being addressed by a local, multi-stakeholder management board. We conducted 26 open interviews with members of the board and a further round of quantitative prioritisation of issues raised. Using a coding process designed to reveal common ground, we categorized the issues at four levels ranging from coarse to fine (themes, topics, sub-topics and perspectives). We then analysed two levels, topics (n = 14 issues) and sub-topics (n = 51 issues). To do so, we built common ground matrices to identify and analyze common ground among actors and across issues. First, cluster and non-metrical data analyses revealed the diversity of actor positions and the lack of consistent grouping among actors by occupational activity. This demonstrated that focusing on actors' differences might be misleading, and that actors' views were not closely aligned with their roles. Second, we located issues according to their levels of common ground and importance among actors. We showed that by not focusing on single issue conflicts, the identification of common ground across multiple issues can pinpoint synergies. We then proposed a framework for collaboration that prioritizes issues of high importance with greater common ground (e.g. sustainable resource use activities), to support the development of trust and norms of reciprocity among actors, strengthening the potential for future cooperation. By adopting this approach, environmental managers could support the initial stages of collaborative conservation strategies, engaging with other actors to seek common ground, avoid the creation of polarised groups and help effectively manage biodiversity conflicts. Copyright © 2018 Elsevier Ltd. All rights reserved.

Management of postintubation tracheal stenosis: appropriate indications make outcome differences.

PubMed

Melkane, Antoine E; Matar, Nayla E; Haddad, Amine C; Nassar, Michel N; Almoutran, Homère G; Rohayem, Ziad; Daher, Mohammad; Chalouhy, Georges; Dabar, George

2010-01-01

Laryngotracheal stenosis is difficult to treat and its etiologies are multiple; nowadays, the most common ones are postintubation or posttracheostomy stenoses. To provide an algorithm for the management of postintubation laryngotracheal stenoses (PILTS) based on the experience of a tertiary care referral center. A retrospective study was conducted on all patients treated for PILTS over a 10-year period. Patients were divided into a surgically and an endoscopically treated group according to predefined criteria. The characteristics of the two groups were analyzed and the outcomes compared. Thirty-three consecutive patients were included in the study: 14 in the surgically treated group and 19 in the endoscopically treated group. Our candidates for airway surgery were healthy patients presenting with complex tracheal stenoses, subglottic involvement or associated tracheomalacia. The endoscopic candidates were chronically ill patients presenting with simple, strictly tracheal stenoses not exceeding 4 cm in length. Stents were placed if the stenosis was associated with tracheomalacia or exceeded 2 cm in total length. In the surgically treated group, 2/14 patients needed more than one procedure versus 8/19 patients in the endoscopically treated group. At the end of the intervention, 50% of the patients were decannulated in the surgically treated group versus 84.2% in the endoscopically treated group (p = 0.03). However, the decannulation rates at 6 months and the symptomatology at rest and on exertion on the last follow-up visit were comparable in the two groups. Our experience in the management of PILTS demonstrates that both surgery and endoscopy yield excellent functional outcomes if the treatment strategy is based on clear, predefined objective criteria. Copyright 2010 S. Karger AG, Basel.

Gait Characteristics in Adolescents With Multiple Sclerosis.

PubMed

Kalron, Alon; Frid, Lior; Menascu, Shay

2017-03-01

Multiple sclerosis is a progressive autoimmune disease of the central nervous system. A presentation of multiple sclerosis before age18 years has traditionally been thought to be rare. However, during the past decade, more cases have been reported. We examined gait characteristics in 24 adolescents with multiple sclerosis (12 girls, 12 boys). Mean disease duration was 20.4 (S.D. = 24.9) months and mean age was 15.5 (S.D. = 1.1) years. The mean expanded disability status scale score was 1.7 (S.D. = 0.7) indicating minimal disability. Outcomes were compared with gait and the gait variability index value of healthy age-matched adolescents. Adolescents with multiple sclerosis walked slower with a wider base of support compared with age-matched healthy control subjects. Moreover, the gait variability index was lower in the multiple sclerosis group compared with the values in the healthy adolescents: 85.4 (S.D. = 8.1) versus 96.5 (S.D. = 7.4). We present gait parameters of adolescents with multiple sclerosis. From a clinical standpoint, our data could improve management of walking dysfunction in this relatively young population. Copyright © 2016 Elsevier Inc. All rights reserved.

Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study.

PubMed

McCullagh, Ruth; Fitzgerald, Anthony P; Murphy, Raymond P; Cooke, Grace

2008-03-01

To determine if exercise benefits patients with multiple sclerosis. Randomized controlled trial. Participants exercised at home and also attended exercise classes held in a hospital physiotherapy gym. Thirty patients, diagnosed and independently mobile, were recruited in the Dublin area. For three months, classes were held twice-weekly and participants exercised independently once-weekly. The control group was monitored monthly and management remained unchanged. Measurements were taken at baseline, three and six months. The Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Impact Scale-29 (MSIS-29) and Functional Assessment of Multiple Sclerosis (FAMS) were used to measure fatigue and quality of life (QOL). Heart rate (HR) and the Borg's Rating of Perceived Exertion (RPE) were recorded during an incremental exercise test. The change from baseline scores between groups was compared using the Mann-Whitney U-test. Twenty-four participants completed the programme (n = 12 in each group). Based on the change in scores at three months, the exercise group had significantly greater improvements in exercise capacity (HR: -14 [-18.5, -2.5] versus 0.5 [-4, 5.5], P= 0.009), QOL (FAMS: 23 [9.5, 42.5] versus -3.5 [-16, 5], P=0.006) and fatigue (MFIS: -13 [-20, -3] versus 1 [-4, 4.5], P=0.02). At six months, the difference in change scores remained significant for FAMS (19 [14, 31] versus -4.5 [-25, 8], P=0.002) and MFIS (-8.5 [-19.5, -1] versus 0.5 [-2.5, 6.5], P=0.02) only. A three-month exercise programme improved participants' exercise capacity, QOL and fatigue, with the improvements in QOL and fatigue lasting beyond the programme.

What community resources do older community-dwelling adults use to manage their osteoarthritis? A formative examination

PubMed Central

Martin, Kathryn Remmes; Schoster, Britta; Woodard, Janice

2011-01-01

Community resources can influence health outcomes, yet little research has examined how older individuals use community resources for osteoarthritis (OA) management. Six focus groups were conducted with 37 community-dwelling older adult African Americans and Caucasians who self-reported OA and resided in Johnston County, North Carolina. Descriptive analyses and qualitative constant comparison methodology revealed individuals use local recreational facilities, senior centers, shopping centers, religious organizations, medical providers, pharmacies and their social network for OA management. Participants also identified environmental characteristics (e.g., sidewalk conditions, curb-cuts, handicapped parking, automatic doors) that both facilitated and hindered use of community resources for OA management. Identified resources and environmental characteristics were organized around Corbin & Strauss framework tasks: medical/behavioral, role, and emotional management. As older Americans live with multiple chronic diseases, better understanding of what community resources are used for disease management may help improve the health of community-dwelling adults, both with and without OA. PMID:23049159

JAX Colony Management System (JCMS): an extensible colony and phenotype data management system.

PubMed

Donnelly, Chuck J; McFarland, Mike; Ames, Abigail; Sundberg, Beth; Springer, Dave; Blauth, Peter; Bult, Carol J

2010-04-01

The Jackson Laboratory Colony Management System (JCMS) is a software application for managing data and information related to research mouse colonies, associated biospecimens, and experimental protocols. JCMS runs directly on computers that run one of the PC Windows operating systems, but can be accessed via web browser interfaces from any computer running a Windows, Macintosh, or Linux operating system. JCMS can be configured for a single user or multiple users in small- to medium-size work groups. The target audience for JCMS includes laboratory technicians, animal colony managers, and principal investigators. The application provides operational support for colony management and experimental workflows, sample and data tracking through transaction-based data entry forms, and date-driven work reports. Flexible query forms allow researchers to retrieve database records based on user-defined criteria. Recent advances in handheld computers with integrated barcode readers, middleware technologies, web browsers, and wireless networks add to the utility of JCMS by allowing real-time access to the database from any networked computer.

Key principles of community-based natural resource management: a synthesis and interpretation of identified effective approaches for managing the commons.

PubMed

Gruber, James S

2010-01-01

This article examines recent research on approaches to community-based environmental and natural resource management and reviews the commonalities and differences between these interdisciplinary and multistakeholder initiatives. To identify the most effective characteristics of Community-based natural resource management (CBNRM), I collected a multiplicity of perspectives from research teams and then grouped findings into a matrix of organizational principles and key characteristics. The matrix was initially vetted (or "field tested") by applying numerous case studies that were previously submitted to the World Bank International Workshop on CBNRM. These practitioner case studies were then compared and contrasted with the findings of the research teams. It is hoped that the developed matrix may be useful to researchers in further focusing research, understanding core characteristics of effective and sustainable CBNRM, providing practitioners with a framework for developing new CBNRM initiatives for managing the commons, and providing a potential resource for academic institutions during their evaluation of their practitioner-focused environmental management and leadership curriculum.

Effect of aerobic interval training on serum IL-10, TNFα, and adipokines levels in women with multiple sclerosis: possible relations with fatigue and quality of life.

PubMed

Mokhtarzade, Motahare; Ranjbar, Rouholah; Majdinasab, Nastaran; Patel, Darpan; Molanouri Shamsi, Mehdieh

2017-08-01

Multiple sclerosis is associated with immune system dysfunction and chronic inflammation; however, possible relations between immunologic and metabolic factors and some psychological indexes such as fatigue and quality of life, especially in relation to exercise training, have not yet been investigated. The present study was designed to investigate the effect of aerobic interval training on interleukin-10/tumor necrosis factor ratio and adipokine (leptin and adiponectin) concentrations in women with multiple sclerosis. Furthermore, the relationship between these factors with fatigue and quality of life were assessed. Forty women with multiple sclerosis (Expanded Disability Status Scale ≤3) were randomized into either a non-exercising control or training group. The training group performed 8-weeks of upper and lower limb aerobic interval training. Serum concentrations of tumor necrosis factorα, interleukin-10, leptin, and adiponectin were measured before and after the 8-week intervention. Moreover, antropometric measures and measures for fatigue and quality of life were determined at the onset of and after exercise training. The results revealed that leptin and tumor necrosis factorα levels significantly decreased subsequent to the aerobic interval training. Although blood adiponectin levels considerably increased in the training group, interleukin-10 and interleukin-10/tumor necrosis factorα ratio underwent no substantial change after the exercise training. In addition, the aerobic interval training was associated with improvement in fatigue, quality of life, and maximal oxygen consumption. Our findings suggested that aerobic interval training can be an effective strategy for managing the immune system at least by its significant impact on inflammatory cytokines and adipokines levels in women with multiple sclerosis. Additionally, this positive impact improved fatigue and adipose tissue indicators.

The Utility of a Syndemic Framework in Understanding Chronic Disease Management Among HIV-Infected and Type 2 Diabetic Men Who Have Sex with Men.

PubMed

Byg, Blaire; Bazzi, Angela Robertson; Funk, Danielle; James, Bonface; Potter, Jennifer

2016-12-01

Syndemic theory posits that epidemics of multiple physical and psychosocial problems co-occur among disadvantaged groups due to adverse social conditions. Although sexual minority populations are often stigmatized and vulnerable to multiple health problems, the syndemic perspective has been underutilized in understanding chronic disease. To assess the potential utility of this perspective in understanding the management of co-occurring HIV and Type 2 diabetes, we used linear regression to examine glycemic control (A1c) among men who have sex with men (MSM) with both HIV and Type 2 diabetes (n = 88). Bivariable linear regression explored potential syndemic correlates of inadequate glycemic control. Compared to those with adequate glycemic control (A1c ≤ 7.5 %), more men with inadequate glycemic control (A1c > 7.5 %) had hypertension (70 vs. 46 %, p = 0.034), high triglycerides (93 vs. 61 %, p = 0.002), depression (67 vs. 39 %, p = 0.018), current substance abuse (15 vs. 2 %, p = 0.014), and detectable levels of HIV (i.e., viral load ≥75 copies per ml blood; 30 vs. 10 %, p = 0.019). In multivariable regression controlling for age, the factors that were independently associated with higher A1c were high triglycerides, substance use, and detectable HIV viral load, suggesting that chronic disease management among MSM is complex and challenging for patients and providers. Findings also suggest that syndemic theory can be a clarifying lens for understanding chronic disease management among sexual minority stigmatized populations. Interventions targeting single conditions may be inadequate when multiple conditions co-occur; thus, research using a syndemic framework may be helpful in identifying intervention strategies that target multiple co-occurring conditions.

Innovation management based on proactive engagement of customers: A case study on LEGO Group. Part I: Innovation Management at Lego Group

NASA Astrophysics Data System (ADS)

Rusu, G.; Avasilcăi, S.

2015-11-01

Customers' proactive engagement in the innovation process represents a business priority for companies which adopt the open innovation business model. In such a context, it is of outmost importance for companies to use the online environment and social media, in order to create an interactive and open dialogue with customers and other important external stakeholders, achieving to gather creative solutions and innovative ideas by involving them in the process of co-creating value. Thus, the current paper is based on a case study approach, which aims to highlight the open innovation business model of the LEGO Group, one of the most successful and active company in engaging customers in submitting ideas and creative solutions for developing new products and new technologies, through online platforms. The study then proceeds to analyze the innovation management at LEGO Group, emphasizing the most important elements regarding the management team, the success and failures, the evolution of the LEGO products focusing on the innovation efforts of the company, its mission, vision, and values, emphasizing the innovation terms which guide the actions and objectives of the LEGO Group. Also, the research based on the case study approach, outlines the most important policies and strategies of the company, the organizational structure consisting of flat structures which facilitate the orientation of the team management on the innovation process and the proactive involvement of consumers and other external stakeholders in product development, highlighting also the most important activities developed by the management team in exploring the new opportunities which may occur on the market, involving customers in sharing their ideas at festivals, participating to discussions of adult fans on web-based platforms and establishing partnerships with the external stakeholders in order to create value. Moreover, the paper is focused on identifying the company's concerns regarding the competitive strategies, new technologies developed for sustainable development and innovation, emphasizing also the concerns of the LEGO Group for a long-term orientation strategy which implies developing innovative products, made by ecological materials, reducing the negative impact on the environment. In addition, the company aims to foster innovation maintaining a clear vision, multiple contacts with the internal and external environment, and the flat structures which enable the communication between innovative management teams and top management team. Consequently, the study provides the insights regarding the innovation management of the LEGO Group, emphasizing the role of engaging customers and other external stakeholders in the co-creation of value.

Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial

PubMed Central

Carey, Mariko; Sanson-Fisher, Rob; Oldmeadow, Christopher; Mansfield, Elise; Walsh, Justin

2016-01-01

Introduction General practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is needed which addresses multiple health needs simultaneously, and encourages patient self-management to address health risks. The aim of this cluster randomised controlled trial is to test the effectiveness of a patient feedback intervention in improving patient self-management of health needs related to smoking, risky alcohol consumption and underscreening for cancers at 1 month follow-up. Methods and analysis Adult general practice patients will be invited to participate in a baseline survey to assess cancer risk factors, screening needs and depression. A total of 360 participants identified by the baseline survey as having at least one health need (a self-reported cancer risk factor, underscreening for cancer, or an elevated depression score) will be randomised to an intervention or control group. Participants in the intervention group will receive tailored printed feedback summarising their identified health needs and recommended self-management actions to address these. All participants will be invited to complete a telephone interview 1 month following recruitment to assess self-management actions taken in relation to health needs identified in the baseline survey. Control group participants will receive tailored printed feedback on their identified health needs after their follow-up interview. A logistic regression model, with group allocation as the main predictor, will be used to assess the impact of the intervention on self-management actions. Ethical considerations and dissemination Participants identified as being at risk of depression will be advised to speak with their doctor. Results will be disseminated via publication in peer-reviewed journals. The study has been approved by the University of Newcastle Human Research Ethics Committee. Trial registration number ACTRN12616001443482. PMID:27864255

Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

PubMed

Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

2017-03-09

Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet. ClinicalTrials.gov NCT01430741.

Smartphone self-monitoring to support self-management among people living with HIV: Perceived benefits and theory of change from a mixed-methods, randomized pilot study

PubMed Central

Swendeman, Dallas; Ramanathan, Nithya; Baetscher, Laura; Medich, Melissa; Scheffler, Aaron; Comulada, W. Scott; Estrin, Deborah

2015-01-01

BACKGROUND Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). METHODS PLH (n=50), primarily African-American and Latino, were recruited from two AIDS services organizations and randomly assigned to daily smartphone (n=34) or bi-weekly web-survey only (n=16) self-monitoring for six weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine bi-weekly, open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. RESULTS Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, non-judgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than bi-weekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared to bi-weekly web-survey only participants. CONCLUSION Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption and sustainability. PMID:25867783

Identifying common pressure pathways from a complex network of human activities to support ecosystem-based management.

PubMed

Knights, Antony M; Koss, Rebecca S; Robinson, Leonie A

2013-06-01

The marine environment is heavily exploited, but unintentional consequences cause wide-ranging negative effects to its characteristics. Linkage frameworks (e.g., DPSIR [driver-pressure-state-impact-response]) are commonly used to describe an interaction between human activities and ecological characteristics of the ecosystem, but as each linkage is viewed independently, the diversity of pressures that affect those characteristics may not be identified or managed effectively. Here we demonstrate an approach for using linkages to build a simple network to capture the complex relationships arising from multiple sectors and their activities. Using data-analysis tools common to ecology, we show how linkages can be placed into mechanistically similar groups. Management measures can be combined into fewer and more simplified measures that target groups of pressures rather than individual pressures, which is likely to increase compliance and the success of the measure while reducing the cost of enforcement. Given that conservation objectives (regional priorities) can vary, we also demonstrate by way of a case study example from the Marine Strategy Framework Directive, how management priorities might change, and illustrate how the approach can be used to identify sectors for control that best support the conservation objectives.

Essential pediatric hypertension: defining the educational needs of primary care pediatricians

PubMed Central

2014-01-01

Background In order to better understand the educational needs regarding appropriate recognition, diagnosis and management of pediatric hypertension (HTN), we asked practicing pediatricians questions regarding their educational needs and comfort level on this topic. Methods We conducted 4 focus group sessions that included 27 participants representing pediatric residents, adolescent medicine physicians, clinic based pediatricians and office based pediatricians. Each focus group session lasted for approximately an hour and 90 pages of total transcriptions were produced verbatim from audio recordings. Results Four reviewers read each transcript and themes were elucidated from these transcripts. Overall, 5 major themes related to educational needs and clinical concerns were found: utilization of resources to define blood pressure (BP), correct BP measurement method(s), co-morbidities, barriers to care, and experience level with HTN. Six minor themes were also identified: differences in BP measurement, accuracy of BP, recognition of HTN, practice pattern of care, education of families and patients, and differences in level of training. The focus group participants were also questioned on their preferences regarding educational methods (i.e. e-learning, small group sessions, self-study, large group presentations) and revealed varied teaching and learning preferences. Conclusions There are multiple methods to approach education regarding pediatric HTN for primary care pediatricians based on provider preferences and multiple educational activities should be pursued to achieve best outcomes. Based on this data, the next direction will be to develop and deliver multiple educational methods and to evaluate the impact on practice patterns of care for children and adolescents with HTN. PMID:25063988

UK guidance on the management of personal dosimetry systems for healthcare staff working at multiple organizations.

PubMed

Rogers, Andy; Chapple, Claire-Louise; Murray, Maria; Platton, David; Saunderson, John

2017-11-01

There has been concern expressed by the UK regulator, the Health & Safety Executive, regarding the management of occupation dose for healthcare radiation workers who work across multiple organizations. In response to this concern, the British Institute of Radiology led a working group of relevant professional bodies to develop guidance in this area. The guidance addresses issues of general system management that would apply to all personal dosimetry systems, regardless of whether or not the workers within that system work across organizational boundaries, along with exploring efficient strategies to comply with legislation where those workers do indeed work across organizational boundaries. For those specific instances, the guidance discusses both system requirements to enable organizations to co-operate (Ionising Radiation Regulations 1999 Regulation 15), as well as specific instances of staff exposure. This is broken down into three categories-low, medium and high risk. A suggested approach to each is given to guide employers and their radiation advisers in adopting sensible strategies for the monitoring of their staff and the subsequent sharing of dosimetry data to ensure overall compliance with both dose limits and optimization requirements.

Future of management of multiple sclerosis in the middle East: a consensus view from specialists in ten countries.

PubMed

Aljumah, Mohammed; Alroughani, Raed; Alsharoqi, I; Bohlega, Saeed A; Dahdaleh, Maurice; Deleu, Dirk; Esmat, Khaled; Khalifa, Ahmad; Sahraian, Mohammad A; Szólics, Miklós; Altahan, Abdulrahman; Yamout, Bassem I; Rieckmann, Peter; Daif, Abdulkader

2013-01-01

The prevalence of multiple sclerosis (MS) is now considered to be medium-to-high in the Middle East and is rising, particularly among women. While the characteristics of the disease and the response of patients to disease-modifying therapies are generally comparable between the Middle East and other areas, significant barriers to achieving optimal care for MS exist in these developing nations. A group of physicians involved in the management of MS in ten Middle Eastern countries met to consider the future of MS care in the region, using a structured process to reach a consensus. Six key priorities were identified: early diagnosis and management of MS, the provision of multidisciplinary MS centres, patient engagement and better communication with stakeholders, regulatory body education and reimbursement, a commitment to research, and more therapy options with better benefit-to-risk ratios. The experts distilled these priorities into a single vision statement: "Optimization of patient-centred multidisciplinary strategies to improve the quality of life of people with MS." These core principles will contribute to the development of a broader consensus on the future of care for MS in the Middle East.

Fundamentals in the management of multiple myeloma.

PubMed

Fadilah, S A W

2010-09-01

Progress in our understanding of multiple myeloma and its treatment has resulted in a more tailored approach to patient management, with different therapeutics regimens for different patient populations. The decision to initiate therapy depends primarily on the presence of symptoms which has to balance the chance of tumor clearance and against the risks of treatment related mortality. Selection of appropriate initial treatment should be based primarily on patient's characteristics (biologic age, co-morbidities), the disease characteristics (tumor burden and genetic risk profile) and the expected toxicity profile of the different regimens. When treatment begins, in younger transplant eligible patients the goal is to achieve high quality responses with intensive therapies as the quality of response appears to be important surrogates for long-term outcome. In the majority of myeloma patients in whom intensive treatment is not an option due to advanced age and co-morbidities, treatment should emphasize on optimal disease control to obtain symptomatic relief and to maintain a satisfactory quality of life. The introduction of novel agents has substantially changed the treatment paradigm of this otherwise incurable disease. The utilization of these drugs has moved from relapse setting to the front line setting and has benefited all patient groups. Because of these rapid developments and many treatment options we need good quality clinical studies to guide clinical practice in the management of patients with multiple myeloma. This review presents an update on current concepts of diagnosis and treatment of patients with multiple myeloma and provides recommendations on tailored therapies with particular reference to the local practice. The information presented herein may be used by the health care providers caring for myeloma patients as a guideline to counsel patients to understand their disease and the treatment better.

Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis.

PubMed

Uchida, K; Nishimura, T; Takesada, H; Morioka, T; Hagawa, N; Yamamoto, T; Kaga, S; Terada, T; Shinyama, N; Yamamoto, H; Mizobata, Y

2017-08-01

The purpose of this study was to assess the effects of recent surgical rib fixation and establish its indications not only for flail chest but also for multiple rib fractures. Between 2007 and 2015, 187 patients were diagnosed as having multiple rib fractures in our institution. After the propensity score matching was performed, ten patients who had performed surgical rib fixation and ten patients who had treated with non-operative management were included. Categorical variables were analyzed with Fischer's exact test and non-parametric numerical data were compared using the Mann-Whitney U test. Wilcoxon signed-rank test was performed for comparison of pre- and postoperative variables. All statistical data are presented as median (25-75 % interquartile range [IQR]) or number. The surgically treated patients extubated significantly earlier than non-operative management patients (5.5 [1-8] vs 9 [7-12] days: p = 0.019). The duration of continuous intravenous narcotic agents infusion days (4.5 [3-6] vs 12 [9-14] days: p = 0.002) and the duration of intensive care unit stay (6.5 [3-9] vs 12 [8-14] days: p = 0.008) were also significantly shorter in surgically treated patients. Under the same ventilating conditions, the postoperative values of tidal volume and respiratory rate improved significantly compared to those values measured just before the surgery. The incidence of pneumonia as a complication was significantly higher in non-operative management group (p = 0.05). From the viewpoints of early respiratory stabilization and intensive care unit disposition without any complications, surgical rib fixation is a sufficiently acceptable procedure not only for flail chest but also for repair of severe multiple rib fractures.

Assessment and rehabilitation of driver skills: subjective experiences of people with multiple sclerosis and health professionals.

PubMed

Archer, Cherie; Morris, Libby; George, Stacey

2014-01-01

It is acknowledged in the literature that the physical and cognitive effects of the degenerative neurological condition of multiple sclerosis can impact upon driver safety. The aim of this study was to identify the experiences and needs of people with multiple sclerosis in relation to driver assessment and rehabilitation. Focus group discussions were conducted with people with multiple sclerosis (MS) who were: currently driving; no longer licensed or no longer driving and health professionals. The four themes that emerged from the data were: (1) from self-management to formal assessment - a journey of uncertainty and emotional dilemmas; (2) lost independence with grieving and adjustment by self and family; (3) alternative transport is challenging and unsatisfactory; (4) gaps in information and services exist. The results of this study highlight the need for ongoing support in relation to driving for people with MS, ranging from support for self-management, driving assessment and retraining, and preparation for loss of license. Standardised information needs to be developed and health professionals and licensing authorities require knowledge and skills to ensure driver assessment and rehabilitation processes and resources can better meet the needs of people with MS. There is a need for health professionals to examine driving in people with MS in a holistic manner taking into account the context for the person and the supports available. Self-management and self-assessment emerged as a preferred approach for the participants in this study, indicating that health professionals may need to engage with the process. Tools to support self-assessment of driving abilities for people with MS require further research. Indicators for review and formal assessment of driving abilities is needed. Alternative forms of transport require further investigation and improvement for people with MS.

Salmon and steelhead in the White Salmon River after the removal of Condit Dam–Planning efforts and recolonization results

USGS Publications Warehouse

Allen, Brady; Engle, Rod O; Zendt, Joseph S; Shrier, Frank C; Wilson, Jeremy T; Connolly, Patrick J.

2016-01-01

Condit Dam, at river kilometer 5.3 on the White Salmon River, Washington, was breached in 2011 and completely removed in 2012. This action opened habitat to migratory fish for the first time in 100 years. The White Salmon Working Group was formed to create plans for fish salvage in preparation for fish recolonization and to prescribe the actions necessary to restore anadromous salmonid populations in the White Salmon River after Condit Dam removal. Studies conducted by work group members and others served to inform management decisions. Management options for individual species were considered, including natural recolonization, introduction of a neighboring stock, hatchery supplementation, and monitoring natural recolonization for some time period to assess the need for hatchery supplementation. Monitoring to date indicates that multiple species and stocks of anadromous salmonids are finding and spawning in the now accessible and recovering habitat.

Multiple myeloma in the very elderly patient: challenges and solutions

PubMed Central

Willan, John; Eyre, Toby A; Sharpley, Faye; Watson, Caroline; King, Andrew J; Ramasamy, Karthik

2016-01-01

Diagnosis and management of myeloma in the very elderly patient is challenging. Treatment options have vastly improved for elderly myeloma patients but still require the clinician to personalize therapy. In this paper, we offer evidence-based, pragmatic advice on how to overcome six of the main challenges likely to arise: 1) diagnosis of myeloma in this age group, 2) assessment of the need for treatment, and the fitness for combination chemotherapy, 3) provision of the best quality of supportive care, 4) choice of combination chemotherapy in those fit enough for it, 5) treatment of relapsed myeloma, and 6) provision of end of life care. With an increased burden of comorbidities and a reduced resilience to treatment and its associated toxicities, the management of myeloma in this age group requires a different approach to that in younger patients to maximize both quality and length of life. PMID:27143866

Moving Toward Space Internetworking via DTN: Its Operational Challenges, Benefits, and Management

NASA Technical Reports Server (NTRS)

Barkley, Erik; Burleigh, Scott; Gladden, Roy; Malhotra, Shan; Shames, Peter

2010-01-01

The international space community has begun to recognize that the established model for management of communications with spacecraft - commanded data transmission over individual pair-wise contacts - is operationally unwieldy and will not scale in support of increasingly complex and sophisticated missions such as NASA's Constellation project. Accordingly, the international Inter-Agency Operations Advisory Group (IOAG) ichartered a Space Internetworking Strategy Group (SISG), which released its initial recommendations in a November 2008 report. The report includes a recommendation that the space flight community adopt Delay-Tolerant Networking (DTN) to address the problem of interoperability and communication scaling, especially in mission environments where there are multiple spacecraft operating in concert. This paper explores some of the issues that must be addressed in implementing, deploying, and operating DTN as part of a multi-mission, multi-agency space internetwork as well as benefits and future operational scenarios afforded by DTN-based space internetworking.

Plasma cell quantification in bone marrow by computer-assisted image analysis.

PubMed

Went, P; Mayer, S; Oberholzer, M; Dirnhofer, S

2006-09-01

Minor and major criteria for the diagnosis of multiple meloma according to the definition of the WHO classification include different categories of the bone marrow plasma cell count: a shift from the 10-30% group to the > 30% group equals a shift from a minor to a major criterium, while the < 10% group does not contribute to the diagnosis. Plasma cell fraction in the bone marrow is therefore critical for the classification and optimal clinical management of patients with plasma cell dyscrasias. The aim of this study was (i) to establish a digital image analysis system able to quantify bone marrow plasma cells and (ii) to evaluate two quantification techniques in bone marrow trephines i.e. computer-assisted digital image analysis and conventional light-microscopic evaluation. The results were compared regarding inter-observer variation of the obtained results. Eighty-seven patients, 28 with multiple myeloma, 29 with monoclonal gammopathy of undetermined significance, and 30 with reactive plasmocytosis were included in the study. Plasma cells in H&E- and CD138-stained slides were quantified by two investigators using light-microscopic estimation and computer-assisted digital analysis. The sets of results were correlated with rank correlation coefficients. Patients were categorized according to WHO criteria addressing the plasma cell content of the bone marrow (group 1: 0-10%, group 2: 11-30%, group 3: > 30%), and the results compared by kappa statistics. The degree of agreement in CD138-stained slides was higher for results obtained using the computer-assisted image analysis system compared to light microscopic evaluation (corr.coeff. = 0.782), as was seen in the intra- (corr.coeff. = 0.960) and inter-individual results correlations (corr.coeff. = 0.899). Inter-observer agreement for categorized results (SM/PW: kappa 0.833) was in a high range. Computer-assisted image analysis demonstrated a higher reproducibility of bone marrow plasma cell quantification. This might be of critical importance for diagnosis, clinical management and prognostics when plasma cell numbers are low, which makes exact quantifications difficult.

Feedback to Managers: A Review and Comparison of Multi-Rater Instruments for Management Development. Third Edition.

ERIC Educational Resources Information Center

Leslie, Jean Brittain; Fleenor, John W.

This volume describes 24 publicly available multiple-perspective management-assessment instruments that relate self-view to the views of others on multiple management and leadership domains. Each instrument also includes an assessment-for-development focus that scales managers along a continuum of psychometric properties, and "best…

Cultural and Family Challenges to Managing Type 2 Diabetes in Immigrant Chinese Americans

PubMed Central

Chesla, Catherine A.; Chun, Kevin M.; Kwan, Christine M.L.

2009-01-01

OBJECTIVE Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. RESEARCH DESIGN AND METHODS This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples. RESULTS Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. CONCLUSIONS Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted. PMID:19628812

Cultural and family challenges to managing type 2 diabetes in immigrant Chinese Americans.

PubMed

Chesla, Catherine A; Chun, Kevin M; Kwan, Christine M L

2009-10-01

Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples. Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted.

Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis.

PubMed

Thomas, Peter W; Thomas, Sarah; Kersten, Paula; Jones, Rosemary; Nock, Alison; Slingsby, Vicky; Green, Colin; Baker, Roger; Galvin, Kate; Hillier, Charles

2010-06-16

Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Current Controlled Trials ISRCTN76517470.

Evaluating the effect of the new incentive system for high-risk pressure ulcer patients on wound healing and cost-effectiveness: a cohort study.

PubMed

Sanada, Hiromi; Nakagami, Gojiro; Mizokami, Yuko; Minami, Yukiko; Yamamoto, Aya; Oe, Makoto; Kaitani, Toshiko; Iizaka, Shinji

2010-03-01

To evaluate the effectiveness and cost-effectiveness of new incentive system for pressure ulcer management, which focused on skilled nurse staffing in terms of rate of healing and medical costs. A prospective cohort study included two types of groups: 39 institutions, which introduced the new incentive system, and 20 non-introduced groups (control). Sixty-seven patients suffering from severe pressure ulcers in the introduced group and 38 patients in the non-introduced group were included. Wound healing and medical costs were monitored weekly for three weeks by their skilled nurses in charge. Healing status and related medical costs. The introduced group showed significantly higher rate of healing compared with the control group at each weekly assessment. Multiple regression analysis revealed that the introduction of the new incentive system was independently associated with the faster healing rate (beta=3.44, P<.001). The budget impact analysis demonstrated that introducing this system could reduce cost of treating severe pressure ulcers by 1.776 billion yen per year. The new incentive system for the management of pressure ulcers, which focused on staffing with skilled nurses can improve healing rate with reduced medical cost. Copyright 2009 Elsevier Ltd. All rights reserved.

Generalist care managers for the treatment of depressed medicaid patients in North Carolina: a pilot study.

PubMed

Landis, Suzanne E; Gaynes, Bradley N; Morrissey, Joseph P; Vinson, Nina; Ellis, Alan R; Domino, Marisa E

2007-03-05

In most states, mental illness costs are an increasing share of Medicaid expenditures. Specialized depression care managers (CM) have consistently demonstrated improvements in patient outcomes relative to usual primary care (UC), but are costly and may not be fully utilized in smaller practices. A generalist care manager (GCM) could manage multiple chronic conditions and be more accepted and cost-effective than the specialist depression CM. We designed a pilot program to demonstrate the feasibility of training/deploying GCMs into primary care settings. We randomized depressed adult Medicaid patients in 2 primary care practices in Western North Carolina to a GCM intervention or to UC. GCMs, already providing services in diabetes and asthma in both study arms, were further trained to provide depression services including self-management, decision support, use of information systems, and care management. The following data were analyzed: baseline, 3- and 6-month Patient Health Questionnaire (PHQ9) scores; baseline and 6-month Short Form (SF) 12 scores; Medicaid claims data; questionnaire on patients' perceptions of treatment; GCM case notes; physician and office staff time study; and physician and office staff focus group discussions. Forty-five patients were enrolled, the majority with preexisting depression. Both groups improved; the GCM group did not demonstrate better clinical and functional outcomes than the UC group. Patients in the GCM group were more likely to have prescriptions of correct dosing by chart data. GCMs most often addressed comorbid conditions (36%), then social issues (27%) and appointment reminders (14%). GCMs recorded an average of 46 interactions per patient in the GCM arm. Focus group data demonstrated that physicians valued using GCMs. A time study documented that staff required no more time interacting with GCMs, whereas physicians spent an average of 4 minutes more per week. GCMs can be trained in care of depression and other chronic illnesses, are acceptable to practices and patients, and result in physicians prescribing guideline concordant care. GCMs appear to be a feasible intervention for community medical practices and to warrant a larger scale trial to test their appropriateness for Medicaid programs nationally.

Re-defining the characteristics of environmental volunteering: Creating a typology of community-scale green infrastructure.

PubMed

Jerome, Gemma; Mell, Ian; Shaw, Dave

2017-10-01

One way to engage people with green infrastructure (GI) is as environmental volunteers. Previous studies explored the nature of such groups/projects in terms of the benefits they deliver such as their impact on levels of social capital within a pre-defined community. However, existing literature contributes little to our understanding of the composition, characteristics and mechanisms used to form and maintain these groups. As such, it is difficult to establish the influencing factors determining the capacity of a group to sustain its provision over time. This paper serves to offer a more nuanced understanding of local-scale environmental stewardship by outlining the diversity of volunteer-led GI activities observed at the community-scale. Evidence presented from a desk-based examination of observable activity within The Mersey area Forest in North-West England represents a re-conceptualisation of existing definitions of Community-Scale GI (CSGI). Using thematic criteria, the paper clusters characteristics into key classification affecting group dynamics, composition and objectives. Initial findings identified the following categories as being significant descriptors for community-scale green infrastructure: status, location, timeframe, membership, activity focus, governance, resources and recognition, and communications. Thus, we classify four distinct types of group engaged in voluntary activity contributing to local level GI creation and long-term management: 'Formal Group (Active), Formal Group (Inactive), Formal Project and Informal Group. Creating a nuanced typology of CSGI provides further opportunities to analysis the creation and long-term management of GI at a site, neighbourhood and city-scale. In turn, this contributes to our understanding of how multiple actors remain engaged in the decision-making processes of GI management and maintenance. Copyright © 2017. Published by Elsevier Inc.

Impact of network aided platforms as educational tools on academic performance and attitude of pharmacology students.

PubMed

Khan, Aftab Ahmed; Siddiqui, Adel Zia; Mohsin, Syed Fareed; Momani, Mohammed Mahmoud Al; Mirza, Eraj Humayun

2017-01-01

This cross-sectional study aimed to examine the impact of learning management system and WhatsApp application as educational tools on students' academic achievement and attitude. The sample population was the students of six medical colleges of Riyadh, Saudi Arabia attending Medical Pharmacology's semester course in Bachelor of Medicine, Bachelor of Surgery (MBBS) program from September 2016 to January 2017. An exploratory approach was adopted based on a comparison between students exposed to only in-class lectures (Group-N), in-class lectures together with WhatsApp platform to disseminate the lecture slides (Group-W) and students group with in-class lectures facility blended with Learning Management System (LMS) and WhatsApp platform (Group-WL). The students' grades were assessed using unified multiple choice questions at the end of the semester. Data were analyzed using descriptive statistics and Pearson correlation (p<0.01). Using learning management system (LMS) and/or WhatsApp messenger tool showed a significant positive correlation in improving students' grades. Additionally, use of WhatsApp enhances students' in-class attendance though statistically insignificant. The results are pivotal for a paradigm shift of in-class lectures and discussion to mobile learning (M-learning). M-learning through WhatsApp may be as an alternative, innovative, and collaborative tool in achieving the required goals in medical education.

Impact of network aided platforms as educational tools on academic performance and attitude of pharmacology students

PubMed Central

Khan, Aftab Ahmed; Siddiqui, Adel Zia; Mohsin, Syed Fareed; Momani, Mohammed Mahmoud Al; Mirza, Eraj Humayun

2017-01-01

Objective: This cross-sectional study aimed to examine the impact of learning management system and WhatsApp application as educational tools on students’ academic achievement and attitude. Methods: The sample population was the students of six medical colleges of Riyadh, Saudi Arabia attending Medical Pharmacology’s semester course in Bachelor of Medicine, Bachelor of Surgery (MBBS) program from September 2016 to January 2017. An exploratory approach was adopted based on a comparison between students exposed to only in-class lectures (Group-N), in-class lectures together with WhatsApp platform to disseminate the lecture slides (Group-W) and students group with in-class lectures facility blended with Learning Management System (LMS) and WhatsApp platform (Group-WL). The students’ grades were assessed using unified multiple choice questions at the end of the semester. Data were analyzed using descriptive statistics and Pearson correlation (p<0.01). Results: Using learning management system (LMS) and/or WhatsApp messenger tool showed a significant positive correlation in improving students’ grades. Additionally, use of WhatsApp enhances students’ in-class attendance though statistically insignificant. Conclusion: The results are pivotal for a paradigm shift of in-class lectures and discussion to mobile learning (M-learning). M-learning through WhatsApp may be as an alternative, innovative, and collaborative tool in achieving the required goals in medical education. PMID:29492081

Complex interventions can increase osteoporosis investigations and treatment: a systematic review and meta-analysis.

PubMed

Kastner, M; Perrier, L; Munce, S E P; Adhihetty, C C; Lau, A; Hamid, J; Treister, V; Chan, J; Lai, Y; Straus, S E

2018-01-01

Osteoporosis is affecting over 200 million people worldwide. Despite available guidelines, care for these patients remains sub-optimal. We developed an osteoporosis tool to address the multiple dimensions of chronic disease management. Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment, so we are revising this tool to include multiple chronic conditions including an update of evidence about osteoporosis. Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis. We searched bibliometric databases for randomized controlled trials (RCTs) in any language evaluating osteoporosis disease management interventions in adults at risk for osteoporosis. Reviewer pairs independently screened citations and full-text articles, extracted data, and assessed risk of bias. Analysis included random effects meta-analysis. Primary outcomes were osteoporosis investigations and treatment, and fragility fractures. Fifty-five RCTs and one companion report were included in the analysis representing 165,703 patients. Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications, and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations. No significant impact was found for any type of intervention to reduce fracture. Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment. Patient education appears to be an important component in osteoporosis disease management.

The greater snow goose Anser caerulescens atlanticus: Managing an overabundant population.

PubMed

Lefebvre, Josée; Gauthier, Gilles; Giroux, Jean-François; Reed, Austin; Reed, Eric T; Bélanger, Luc

2017-03-01

Between the early 1900s and the 1990s, the greater snow goose Anser caerulescens atlanticus population grew from 3000 individuals to more than 700 000. Because of concerns about Arctic degradation of natural habitats through overgrazing, a working group recommended the stabilization of the population. Declared overabundant in 1998, special management actions were then implemented in Canada and the United States. Meanwhile, a cost-benefit socioeconomic analysis was performed to set a target population size. Discussions aiming towards attaining a common vision were undertaken with stakeholders at multiple levels. The implemented measures have had varying success; but population size has been generally stable since 1999. To be effective and meet social acceptance, management actions must have a scientific basis, result from a consensus among stakeholders, and include an efficient monitoring programme. In this paper, historical changes in population size and management decisions along with past and current challenges encountered are discussed.

Healthcare managers' decision making: findings of a small scale exploratory study.

PubMed

Macdonald, Jackie; Bath, Peter A; Booth, Andrew

2008-12-01

Managers who work in publicly funded healthcare organizations are an understudied group. Some of the influences on their decisions may be unique to healthcare. This study considers how to integrate research knowledge effectively into healthcare managers' decision making, and how to manage and integrate information that will include community data. This first phase in a two-phase mixed methods research study used a qualitative, multiple case studies design. Nineteen semi-structured interviews were undertaken using the critical incident technique. Interview transcripts were analysed using the NatCen Framework. One theme represented ;information and decisions'. Cases were determined to involve complex multi-level, multi-situational decisions with participants in practical rather than ceremonial work roles. Most considered organizational knowledge in the first two decision phases and external knowledge, including research, in the third phase. All participants engaged in satisficing to some degree.

Transition of occupational health issues associated with stabilization and decommissioning of the nuclear reactors in the Fukushima Daiichi Nuclear Power Plant through 2013.

PubMed

Mori, Koji; Tateishi, Seiichiro; Kubo, Tatsuhiko; Okazaki, Ryuji; Suzuki, Katsunori; Kobayashi, Yuichi; Hiraoka, Koh; Hayashi, Takeshi; Takeda, Masaru; Kiyomoto, Yoshifumi; Kawashita, Futoshi; Yoshikawa, Toru; Sakai, Kazuhiro

2014-11-01

To clarify the occupational health (OH) issues that arose, what actions were taken, and the OH performances during the disaster involving the Fukushima Daiichi Nuclear Power Plant and thus improve the OH management system with respect to long-term decommissioning work and preparation for future disasters. We used information in advisory reports to the Tokyo Electric Power Company by an OH expert group, observation through support activities, and data officially released by the Tokyo Electric Power Company. Occupational health issues transitioned as work progressed and seasons changed. They were categorized into OH management system establishment, radiation exposure control, heat illness prevention, infectious disease prevention and control, and fitness for workers' duties. Occupational health management systems involving OH experts should be implemented to manage multiple health risks with several conflicts and trade-offs after a disaster.

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

USGS Publications Warehouse

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

2017-01-01

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

A qualitative investigation of lay perspectives of diagnosis and self-management strategies employed by people with progressive multiple sclerosis.

PubMed

Frost, Julia; Grose, Jane; Britten, Nicky

2017-05-01

This article explores how people with progressive multiple sclerosis give meaning to their experiences. It builds upon the self-management literature, which has captured the tension between the desire for retaining normalcy and the increasing burden of self-management associated with chronic disease progression. This repeat interview study is empirically grounded in 28 interviews with 14 people with progressive multiple sclerosis. We identified gender differences in diagnosis-seeking which impacted subsequent sense-making. Male respondents found a diagnosis of multiple sclerosis difficult to come to terms with, and an enduring sense of loss or anger could inhibit further sense-making. A diagnosis of multiple sclerosis was more difficult to obtain for women respondents, and any sense of certainty that diagnosis provided framed their subsequent sense-making strategies. The complex sequelae of multiple sclerosis require that self-management strategies are both contextual and timely, although even the most accomplished self-managers can lose their sense of self with neurodegeneration. Disease progression can be associated with suicidal ideation, suggesting the need for greater dialogue to ensure that people with multiple sclerosis are adequately supported to fulfil their quality of life at all stages of neurodegeneration. These lay perspectives emphasise the articulation of affect rather than the rendering of a medical diagnosis, although diagnosis may provide a degree of certainty in the short term. The ethos of self-management ensures people attempt to retain their sense of 'normality' and existent social roles for as long as possible, but this ethos can negate both one's ability to self-manage and the management of self.

Healthcare utilization in women after abdominal surgery for ovarian cancer.

PubMed

McCorkle, Ruth; Jeon, Sangchoon; Ercolano, Elizabeth; Schwartz, Peter

2011-01-01

Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments. The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer. A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms. There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours. Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.

Efficacy of Social Media Adoption on Client Growth for Independent Management Consultants

DTIC Science & Technology

2017-02-01

design , a linear multiple regression with three predictor variables and one dependent variable per testing were used. Under those circumstances...regression test was used to compare the social media adoption of two groups on a single measure to determine if there was a statistical difference...number and types of social media platforms used and their influence on client growth was examined in this research design that used a descriptive

Association between pregnancy-associated plasma protein-A levels in the first trimester and gestational diabetes mellitus in Chinese women.

PubMed

Cheuk, Q Ky; Lo, T K; Wong, S F; Lee, C P

2016-02-01

Several studies have shown that women with pre-existing diabetes mellitus have significantly lower pregnancy-associated plasma protein-A levels than those without. This study aimed to evaluate whether first-trimester pregnancy-associated plasma protein-A multiple of median is associated with gestational diabetes mellitus in Chinese pregnant women. This prospectively collected case series was conducted in a regional hospital in Hong Kong. All consecutive Chinese women with a singleton pregnancy who attended the hospital for their first antenatal visit (before 14 weeks' gestation) from April to July 2014 were included. Pregnancy-associated plasma protein-A multiple of median was compared between the gestational diabetic (especially for early-onset gestational diabetes) and non-diabetic groups. The correlation between pregnancy-associated plasma protein-A level and glycosylated haemoglobin level in women with gestational diabetes was also examined. Of the 520 women recruited, gestational diabetes was diagnosed in 169 (32.5%). Among them, 43 (25.4%) had an early diagnosis, and 167 (98.8%) with the disease were managed by diet alone. The gestational diabetic group did not differ significantly to the non-diabetic group in pregnancy-associated plasma protein-A (0.97 vs 0.99, P=0.40) or free β-human chorionic gonadotrophin multiple of median (1.05 vs 1.02, P=0.29). Compared with the non-gestational diabetic group, women with early diagnosis of gestational diabetes had a non-significant reduction in pregnancy-associated plasma protein-A multiple of median (median, interquartile range: 0.86, 0.57-1.23 vs 0.99, 0.67-1.44; P=0.11). Pregnancy-associated plasma protein-A and glycosylated haemoglobin levels were not correlated in women with gestational diabetes (r=0.027; P=0.74). Chinese women with non-insulin-dependent gestational diabetes did not exhibit significant changes to pregnancy-associated plasma protein-A multiple of median nor a correlation between pregnancy-associated plasma protein-A with glycosylated haemoglobin levels. Pregnancy-associated plasma protein-A multiple of median was not predictive of non-insulin-dependent gestational diabetes or early onset of gestational diabetes. There was a high prevalence of gestational diabetes in the Chinese population.

Acquisition and management of continuous data streams for crop water management

USDA-ARS?s Scientific Manuscript database

Wireless sensor network systems for decision support in crop water management offer many advantages including larger spatial coverage and multiple types of data input. However, collection and management of multiple and continuous data streams for near real-time post analysis can be problematic. Thi...

Incremental Benefit of a Home Visit Following Discharge for Patients with Multiple Chronic Conditions Receiving Transitional Care

PubMed Central

Jackson, Carlos; Kasper, Elizabeth W.; Williams, Christianna

2016-01-01

Abstract Transitional care management is effective at reducing hospital readmissions among patients with multiple chronic conditions, but evidence is lacking on the relative benefit of the home visit as a component of transitional care. The sample included non-dual Medicaid recipients with multiple chronic conditions enrolled in Community Care of North Carolina (CCNC), with a hospital discharge between July 2010 and December 2012. Using claims data and care management records, this study retrospectively examined whether home visits reduced the odds of 30-day readmission compared to less intensive transitional care support, using multivariate logistic regression to control for demographic and clinical characteristics. Additionally, the researchers examined group differences within clinical risk strata on inpatient admissions and total cost of care in the 6 months following hospital discharge. Of 35,174 discharges receiving transitional care from a CCNC care manager, 21% (N = 7468) included a home visit. In multivariate analysis, home visits significantly reduced the odds of readmission within 30 days (odds ratio = 0.52, 95% confidence interval 0.48–0.57). At the 6-month follow-up, home visits were associated with fewer inpatient admissions within 4 of 6 clinical risk strata, and lower total costs of care for highest risk patients (average per member per month cost difference $970; P < 0.01). For complex chronic patients, home visits reduced the likelihood of a 30-day readmission by almost half compared to less intensive forms of nurse-led transitional care support. Higher risk patients experienced the greatest benefit in terms of number of inpatient admissions and total cost of care in the 6 months following discharge. (Population Health Management 2016;19:163–170) PMID:26431255

[Modern concepts of trauma care and multiple trauma management in oral and maxillofacial region].

PubMed

Tan, Yinghui

2015-06-01

Multiple trauma management requires the application of modem trauma care theories. Optimal treatment results can be achieved by reinforcing cooperation and stipulating a treatment plan together with other disciplines. Based on modem theories in trauma care and our understanding of the theoretical points, this paper analyzes the injury assessment strategies and methods in oral and maxillofacial multiple trauma management. Moreover, this paper discusses operating time and other influencing factors as well as proposed definitive surgical timing and indications in comprehensive management of oral and maxillofacial multiple trauma patients associated with injuries in other body parts. We hope that this paper can help stomatological physicians deepen their understanding of modem trauma care theories and improve their capacity and results in the treatment of oral and maxillofacial multiple trauma.

Multicultural identity integration and well-being: a qualitative exploration of variations in narrative coherence and multicultural identification

PubMed Central

Yampolsky, Maya A.; Amiot, Catherine E.; de la Sablonnière, Roxane

2013-01-01

Understanding the experiences of multicultural individuals is vital in our diverse populations. Multicultural people often need to navigate the different norms and values associated with their multiple cultural identities. Recent research on multicultural identification has focused on how individuals with multiple cultural groups manage these different identities within the self, and how this process predicts well-being. The current study built on this research by using a qualitative method to examine the process of configuring one's identities within the self. The present study employed three of the four different multiple identity configurations in Amiot et al. (2007) cognitive-developmental model of social identity integration: categorization, where people identify with one of their cultural groups over others; compartmentalization, where individuals maintain multiple, separate identities within themselves; and integration, where people link their multiple cultural identities. Life narratives were used to investigate the relationship between each of these configurations and well-being, as indicated by narrative coherence. It was expected that individuals with integrated cultural identities would report greater narrative coherence than individuals who compartmentalized and categorized their cultural identities. For all twenty-two participants, identity integration was significantly and positively related to narrative coherence, while compartmentalization was significantly and negatively related to narrative coherence. ANOVAs revealed that integrated and categorized participants reported significantly greater narrative coherence than compartmentalized participants. These findings are discussed in light of previous research on multicultural identity integration. PMID:23504407

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

PubMed

Sanjeevi, V; Shahabudeen, P

2015-12-01

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

Canadian residents' perceived manager training needs.

PubMed

Stergiopoulos, Vicky; Lieff, Susan; Razack, Saleem; Lee, A Curtis; Maniate, Jerry M; Hyde, Stacey; Taber, Sarah; Frank, Jason R

2010-01-01

Despite widespread endorsement for administrative training during residency, teaching and learning in this area remains intermittent and limited in most programmes. To inform the development of a Manager Train-the-Trainer program for faculty, the Royal College of Physicians and Surgeons of Canada undertook a survey of perceived Manager training needs among postgraduate trainees. A representative sample of Canadian specialty residents received a web-based questionnaire in 2009 assessing their perceived deficiencies in 13 Manager knowledge and 11 Manager skill domains, as determined by gap scores (GSs). GSs were defined as the difference between residents' perceived current and desired level of knowledge or skill in selected Manager domains. Residents' educational preferences for furthering their Manager knowledge and skills were also elicited. Among the 549 residents who were emailed the survey, 199 (36.2%) responded. Residents reported significant gaps in most knowledge and skills domains examined. Residents' preferred educational methods for learning Manager knowledge and skills included workshops, web-based formats and interactive small groups. The results of this national survey, highlighting significant perceived gaps in multiple Manager knowledge and skills domains, may inform the development of Manager curricula and faculty development activities to address deficiencies in training in this important area.

Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG).

PubMed

2018-04-01

Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.

Reduced-intensity conditioning allogeneic SCT as salvage treatment for relapsed multiple myeloma.

PubMed

de Lavallade, H; El-Cheikh, J; Faucher, C; Fürst, S; Stoppa, A-M; Coso, D; Bouabdallah, R; Chabannon, C; Gastaut, J-A; Blaise, D; Mohty, M

2008-06-01

The aim of this retrospective analysis was to assess the benefit of reduced-intensity conditioning allo SCT (RIC allo-SCT) in a cohort of 32 relapsed multiple myeloma (MM) patients. A total of 19 patients had an HLA-identical sibling donor ('donor' group), while 13 patients had no donor ('no-donor' group). There were no significant differences between these two groups as for prognosis risk factors. Eighteen patients from the 'donor' group could actually proceed to RIC allo-SCT. With a median follow-up of 36 (range, 21-60) months, six patients died from transplant-related toxicity (cumulative incidence, 33% (95% CI, 11-55%)). Only 4 patients from the 18 transplanted patients (22%; 95% CI, 7-48%) progressed after RIC allo-SCT, as compared to 12 (86%; 95% CI, 56-98%; P=0.0003) among the nontransplanted patients. In an 'intention-to-treat' analysis, the Kaplan-Meier estimate of PFS was significantly higher in the 'donor' group as compared to the 'no-donor' group (P=0.01; 46 versus 8% at 3 years). There was no difference in terms of overall survival. However, in multivariate analysis, actual performance of RIC allo-SCT was associated with better PFS (relative risk, 0.35; 95% CI, 0.15-0.82; P=0.01). These data suggest a potential benefit for RIC allo-SCT in the management of relapsed MM warranting further prospective investigations.

MASTR-MS: a web-based collaborative laboratory information management system (LIMS) for metabolomics.

PubMed

Hunter, Adam; Dayalan, Saravanan; De Souza, David; Power, Brad; Lorrimar, Rodney; Szabo, Tamas; Nguyen, Thu; O'Callaghan, Sean; Hack, Jeremy; Pyke, James; Nahid, Amsha; Barrero, Roberto; Roessner, Ute; Likic, Vladimir; Tull, Dedreia; Bacic, Antony; McConville, Malcolm; Bellgard, Matthew

2017-01-01

An increasing number of research laboratories and core analytical facilities around the world are developing high throughput metabolomic analytical and data processing pipelines that are capable of handling hundreds to thousands of individual samples per year, often over multiple projects, collaborations and sample types. At present, there are no Laboratory Information Management Systems (LIMS) that are specifically tailored for metabolomics laboratories that are capable of tracking samples and associated metadata from the beginning to the end of an experiment, including data processing and archiving, and which are also suitable for use in large institutional core facilities or multi-laboratory consortia as well as single laboratory environments. Here we present MASTR-MS, a downloadable and installable LIMS solution that can be deployed either within a single laboratory or used to link workflows across a multisite network. It comprises a Node Management System that can be used to link and manage projects across one or multiple collaborating laboratories; a User Management System which defines different user groups and privileges of users; a Quote Management System where client quotes are managed; a Project Management System in which metadata is stored and all aspects of project management, including experimental setup, sample tracking and instrument analysis, are defined, and a Data Management System that allows the automatic capture and storage of raw and processed data from the analytical instruments to the LIMS. MASTR-MS is a comprehensive LIMS solution specifically designed for metabolomics. It captures the entire lifecycle of a sample starting from project and experiment design to sample analysis, data capture and storage. It acts as an electronic notebook, facilitating project management within a single laboratory or a multi-node collaborative environment. This software is being developed in close consultation with members of the metabolomics research community. It is freely available under the GNU GPL v3 licence and can be accessed from, https://muccg.github.io/mastr-ms/.

43 CFR 3900.40 - Multiple use development of leased or licensed lands.

Code of Federal Regulations, 2013 CFR

2013-10-01

... (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) OIL SHALE MANAGEMENT-GENERAL Oil Shale Management-Introduction § 3900.40 Multiple use development of leased or licensed... production of deposits of oil shale does not preclude the BLM from issuing other exploration licenses or...

43 CFR 3900.40 - Multiple use development of leased or licensed lands.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR RANGE MANAGEMENT (4000) OIL SHALE MANAGEMENT-GENERAL Oil Shale Management-Introduction § 3900.40 Multiple use development of leased or licensed... production of deposits of oil shale does not preclude the BLM from issuing other exploration licenses or...

43 CFR 3900.40 - Multiple use development of leased or licensed lands.

Code of Federal Regulations, 2014 CFR

2014-10-01

... (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) OIL SHALE MANAGEMENT-GENERAL Oil Shale Management-Introduction § 3900.40 Multiple use development of leased or licensed... production of deposits of oil shale does not preclude the BLM from issuing other exploration licenses or...

43 CFR 3900.40 - Multiple use development of leased or licensed lands.

Code of Federal Regulations, 2012 CFR

2012-10-01

... (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) OIL SHALE MANAGEMENT-GENERAL Oil Shale Management-Introduction § 3900.40 Multiple use development of leased or licensed... production of deposits of oil shale does not preclude the BLM from issuing other exploration licenses or...

A pilot mixed-methods evaluation of MS INFoRm: a self-directed fatigue management resource for individuals with multiple sclerosis.

PubMed

Akbar, Nadine; Turpin, Karen; Petrin, Julie; Smyth, Penny; Finlayson, Marcia

2018-06-01

Fatigue management interventions for individuals with multiple sclerosis (MS) often feature structured programmes requiring repeated, in-person attendance that is not possible for all individuals. We sought to determine whether MS INFoRm, a self-directed fatigue management resource for individuals with MS, was worth further, more rigorous evaluation. Our indicators of worthiness were actual use of the resource by participants over 3 months, reductions in fatigue impact and increases in self-efficacy, and participant reports of changes in fatigue management knowledge and behaviours. This was a single-group, mixed-methods, before-after pilot study in individuals with MS reporting mild to moderate fatigue. Thirty-five participants were provided with MS INFoRm by a USB flash drive to use at home for 3 months, on their own volition. Twenty-three participants completed all standardized questionnaires, semi-structured interviews and study process measures. Participants reported actively using MS INFoRm over the 3-month study period (median total time spent using MS INFoRm=315 min) as well as significantly lower overall fatigue impact (Modified Fatigue Impact Scale: t=2.6, P=0.01), increased knowledge of MS fatigue (z=-2.8, P=0.01) and greater confidence in managing MS fatigue (z=-3.3, P=0.001). Individuals with significant reductions in fatigue impact also reported behavioural changes including tracking fatigue, better communication with others, greater awareness, improved quality of life and being more proactive. This study provides evidence that further rigorous evaluation of MS INFoRm, a self-directed resource for managing fatigue, is worth pursuing.

Physical function and pain after surgical or conservative management of multiple rib fractures - a follow-up study.

PubMed

Fagevik Olsén, Monika; Slobo, Margareta; Klarin, Lena; Caragounis, Eva-Corina; Pazooki, David; Granhed, Hans

2016-10-28

There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients. A consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures. The results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p < 0.01) and less deterioration in two items in Disability Rating Index (sitting and standing bent over a sink) (p < 0.05). It is questionable whether the control group is representative since the majority of patients were invited but refused to participate in the follow-up. In addition, this study is too small to make a definitive conclusion if surgery is better than conservative treatment. But we see some indications, such as a tendency for decreased pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery. Patients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients. FoU i Sverige (R&D in Sweden), No 106121.

A rational approach to long-term care: comparing the independent living model with agency-based care for persons with high spinal cord injuries.

PubMed

Mattson-Prince, J

1997-05-01

Two groups of individuals with high level tetraplegia (C1-4) were compared with respect to the model of personal care assistance used. The study was undertaken to determine whether a finite population with severe disability had differences in health status, costs and perceived quality of life, relative to whether they used agencies for their care, or hired, trained and reimbursed care givers independently. A survey, which included demographics as well as portions of RAND-36, LSI-A, PIP, PASI and CHART was used. Telephone interviews were held with 29 individuals who received their care through an agency and 42 who managed care independently. Chi square, 't'-tests, and multiple regression analysis were used to control for potentially confounding group differences. The self-managed group demonstrated significantly better health outcomes, with fewer re-hospitalizations for preventable complications. They experienced better life satisfaction and significantly lower costs. Although those who used an independent model of care-giving received significantly more hours of paid assistance, the average annual cost of care was significantly lower for each individual. In addition to reducing the financial burden on the individual and society, self-managed care seemed to diminish the emotional burden borne by these individuals.

Intergroup Cooperation in Common Pool Resource Dilemmas.

PubMed

Sadowski, Jathan; Spierre, Susan G; Selinger, Evan; Seager, Thomas P; Adams, Elizabeth A; Berardy, Andrew

2015-10-01

Fundamental problems of environmental sustainability, including climate change and fisheries management, require collective action on a scale that transcends the political and cultural boundaries of the nation-state. Rational, self-interested neoclassical economic theories of human behavior predict tragedy in the absence of third party enforcement of agreements and practical difficulties that prevent privatization. Evolutionary biology offers a theory of cooperation, but more often than not in a context of discrimination against other groups. That is, in-group boundaries are necessarily defined by those excluded as members of out-groups. However, in some settings human's exhibit behavior that is inconsistent with both rational economic and group driven cooperation of evolutionary biological theory. This paper reports the results of a non-cooperative game-theoretic exercise that models a tragedy of the commons problem in which groups of players may advance their own positions only at the expense of other groups. Students enrolled from multiple universities and assigned to different multi-university identity groups participated in experiments that repeatedly resulted in cooperative outcomes despite intergroup conflicts and expressions of group identity. We offer three possible explanations: (1) students were cooperative because they were in an academic setting; (2) students may have viewed their instructors as the out-group; or (3) the emergence of a small number of influential, ethical leaders is sufficient to ensure cooperation amongst the larger groups. From our data and analysis, we draw out lessons that may help to inform approaches for institutional design and policy negotiations, particularly in climate change management.

Insider Threat and Information Security Management

NASA Astrophysics Data System (ADS)

Coles-Kemp, Lizzie; Theoharidou, Marianthi

The notion of insider has multiple facets. An organization needs to identify which ones to respond to. The selection, implementetion and maintenance of information security countermeasures requires a complex combination of organisational policies, functions and processes, which form Information Security Management. This chapter examines the role of current information security management practices in addressing the insider threat. Most approaches focus on frameworks for regulating insider behaviour and do not allow for the various cultural responses to the regulatory and compliance framework. Such responses are not only determined by enforcement of policies and awareness programs, but also by various psychological and organisational factors at an individual or group level. Crime theories offer techniques that focus on such cultural responses and can be used to enhance the information security management design. The chapter examines the applicability of several crime theories and concludes that they can contribute in providing additional controls and redesign of information security management processes better suited to responding to the insider threat.

An SSH key management system: easing the pain of managing key/user/account associations

NASA Astrophysics Data System (ADS)

Arkhipkin, D.; Betts, W.; Lauret, J.; Shiryaev, A.

2008-07-01

Cyber security requirements for secure access to computing facilities often call for access controls via gatekeepers and the use of two-factor authentication. Using SSH keys to satisfy the two factor authentication requirement has introduced a potentially challenging task of managing the keys and their associations with individual users and user accounts. Approaches for a facility with the simple model of one remote user corresponding to one local user would not work at facilities that require a many-to-many mapping between users and accounts on multiple systems. We will present an SSH key management system we developed, tested and deployed to address the many-to-many dilemma in the environment of the STAR experiment. We will explain its use in an online computing context and explain how it makes possible the management and tracing of group account access spread over many sub-system components (data acquisition, slow controls, trigger, detector instrumentation, etc.) without the use of shared passwords for remote logins.

Management of behavioural and psychological symptoms of dementia by an aroma-massage with acupressure treatment protocol: A randomised clinical trial.

PubMed

Fung, Jo Kamen Ka-Man; Tsang, Hector Wing-Hong

2018-05-01

This study evaluates the clinical effectiveness of a multicomponent aroma-massage with an acupressure treatment protocol and compared it to cognitive training for the management of behavioural and psychological symptoms of dementia. Pharmacological interventions have been unsatisfactory in managing behavioural and psychological symptoms of dementia; thus, complementary and alternative medicine has been extensively researched to identify an adjunct safe and cost-effective intervention. This randomised clinical trial utilised a three-arm parallel group design. Cognitive training was used as a conventional intervention to manage behavioural and psychological symptoms of dementia, whereas exercise was considered "treatment as usual" in this study; both were used as comparisons with the experimental protocol. There were three treatment groups: Group 1: aroma-massage with acupressure + exercise, Group 2: cognitive training + exercise and Group 3: aroma-massage with acupressure + cognitive training. Sixty older adults were recruited and randomly assigned to the three groups (20 each). Using the 29-item Chinese Version of the Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, Mini-mental State Examination and Barthel Index-20, the outcome measures were assessed at preintervention, postintervention and the 3-month follow-up to assess behaviour, Activities of Daily Living, cognition, and behavioural and psychological symptoms of dementia severity and distress. Multiple comparisons performed through repeated measures were analysed to detect between-group differences and within-subject differences, as well as the interaction effects between groups and times. The Group 1 and 3 participants showed a significant reduction in the severity and distress caused by behavioural and psychological symptoms of dementia, whereas Group 2 did not demonstrate similar effects. This clinical study suggests that aroma-massage with acupressure is as effective as cognitive training and can enhance cognitive training in reducing the severity and distress of behavioural and psychological symptoms of dementia. Aroma-massage with acupressure may serve as an adjunct therapy to reduce behavioural and psychological symptoms of dementia. This therapy is safe, cost-effective and can be implemented by caregivers and family members who are not professionally trained. © 2017 John Wiley & Sons Ltd.

The Effect of Integration of Self-Management Web Platforms on Health Status in Chronic Obstructive Pulmonary Disease Management in Primary Care (e-Vita Study): Interrupted Time Series Design

PubMed Central

Verdijk, Noortje A; Kasteleyn, Marise J; Harmans, Lara M; Talboom, Irvin JSH; Looijmans-van den Akker, Ingrid; van Geloven, Nan; Numans, Mattijs E; Chavannes, Niels H

2017-01-01

Background Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves quality of life for COPD patients and can reduce hospitalization. Self-management of COPD through eHealth is an effective method to improve IDM and clinical outcomes. Objectives The objective of this implementation study was to investigate the effect of 3 chronic obstructive pulmonary disease eHealth programs applied in primary care on health status. The e-Vita COPD study compares different levels of integration of Web-based self-management platforms in IDM in 3 primary care settings. Patient health status is examined using the Clinical COPD Questionnaire (CCQ). Methods The parallel cohort design includes 3 levels of integration in IDM (groups 1, 2, 3) and randomization of 2 levels of personal assistance for patients (group A, high assistance, group B, low assistance). Interrupted time series (ITS) design was used to collect CCQ data at multiple time points before and after intervention, and multilevel linear regression modeling was used to analyze CCQ data. Results Of the 702 invited patients, 215 (30.6%) registered to a platform. Of these, 82 participated in group 1 (high integration IDM), 36 in group 1A (high assistance), and 46 in group 1B (low assistance); 96 participated in group 2 (medium integration IDM), 44 in group 2A (high assistance) and 52 in group 2B (low assistance); also, 37 participated in group 3 (no integration IDM). In the total group, no significant difference was found in change in CCQ trend (P=.334) before (–0.47% per month) and after the intervention (–0.084% per month). Also, no significant difference was found in CCQ changes before versus after the intervention between the groups with high versus low personal assistance. In all subgroups, there was no significant change in the CCQ trend before and after the intervention (group 1A, P=.237; 1B, P=.991; 2A, P=.120; 2B, P=.166; 3, P=.945). Conclusions The e-Vita eHealth-supported COPD programs had no beneficial impact on the health status of COPD patients. Also, no differences were found between the patient groups receiving different levels of personal assistance. Trial Registration Netherlands Trial Registry NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6sbM5PayG) PMID:28814380

LSN MS guidelines for the management of multiple sclerosis.

PubMed

Shatila, A R; Koussa, S; Jabbour, R; Mourad, A; Aouad, A; Sabbagh, G; Kallab, K; Hilal, R; Khalifeh, R; Gebeily, S; Tourbah, A

2013-12-01

The prevalence of multiple sclerosis (MS) in Lebanon is unknown, as there are no available or reliable epidemiological studies to date. The circumstances of Middle East countries are different from those of Europe and North America in terms of differential diagnoses and disease management. The aim of the conference is to establish guidelines for diagnosis, treatment, follow-up and management of patients with MS in Lebanon. Another objective is to discuss and participate in research projects based on epidemiology, clinical trials and more fundamental aspects of the disease in the future. Under the authority of the Lebanese Society of Neurology (LSN), a group of neurologists took the initiative to participate in this LSN MS committee with the purpose of establishing a consensus for the management of patients with MS, and under the supervision of a Coordinator (A.T.) designed by the LSN board. Diagnostic and therapeutic, follow-up and research recommendations were proposed with special emphasis on the specific needs and circumstances of Lebanon. The experts highlighted the importance of considering particular needs, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, and cost-effective control of treatment efficacy, as well as global assessment of disability. The experts established guidelines concerning diagnosis, treatment, and follow-up of patients with MS in Lebanon. Furthermore, they recommended some clinical and fundamental research projects. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Constellation Mission Operation Working Group: ESMO Maneuver Planning Process Review

NASA Technical Reports Server (NTRS)

Moyer, Eric

2015-01-01

The Earth Science Mission Operation (ESMO) Project created an Independent Review Board to review our Conjunction Risk evaluation process and Maneuver Planning Process to identify improvements that safely manages mission conjunction risks, maintains ground track science requirements, and minimizes overall hours expended on High Interest Events (HIE). The Review Board is evaluating the current maneuver process which requires support by multiple groups. In the past year, there have been several changes to the processes although many prior and new concerns exist. This presentation will discuss maneuver process reviews and Board comments, ESMO assessment and path foward, ESMO future plans, recent changes and concerns.

Continuous Subcutaneous Insulin Infusion versus Multiple Daily Injections of Insulin for the Management of Type 1 Diabetes Mellitus in Pregnancy: Association with Neonatal Chemical Hypoglycemia.

PubMed

Sargent, James A; Roeder, Hilary A; Ward, Kristy K; Moore, Thomas R; Ramos, Gladys A

2015-12-01

We hypothesized that patients with type 1 diabetes mellitus (T1DM) who were managed during their pregnancy with a continuous subcutaneous insulin infusion (CSII) would have a lower incidence of neonatal hypoglycemia (NH) than patients managed with multiple daily injections (MDI) of insulin. This was a retrospective cohort of 95 women with T1DM who delivered singleton, term neonates between 2007 and 2014. The primary outcome was incidence of NH (capillary plasma glucose ≤ 45 mg/dL) in the first 24 hours after birth. The incidence of NH was 66.0% (62/95). The NH rate was significantly higher in women managed with CSII versus MDI (62 vs. 38%, p = 0.024). Neonates with NH had a higher birth weight (3,867 ± 658 vs. 3,414 ± 619 g, p = 0.002). When analyzing intrapartum glucose management, mothers of neonates with NH had significantly less time managed on an insulin infusion (median interquartile range 7 [3.5-30.5] vs. 17.5 [2.0-17.5] hours, p = 0.014). In multivariable analysis, only maternal body mass index (BMI) (p = 0.035) and time on an insulin infusion (p = 0.043) were significantly associated with NH. In our population of patients with T1DM, CSII was more prevalent in the NH group; however, when controlling for other factors, intrapartum glucose management and early maternal BMI were the only variables associated with NH. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medicaid and the politics of groups: recipients, providers, and policy making.

PubMed

Kronebusch, K

1997-06-01

There is a substantial heterogeneity of interests within the Medicaid program. Its major beneficiary groups include the elderly, people with disabilities, children in low-income families, and adults receiving Aid to Families with Dependent Children. Providers who deliver medical services to these recipients represent another set of potential claimants. These groups are likely to be treated differently by the politics that affect the design and management of the Medicaid program. The Medicaid recipient groups vary in several important dimensions: First, the groups differ politically, a dimension that includes their political participation, their relationships to parties and electoral coalitions, the images they present to other political actors, and the legacy of public policies that affect them. Second, the groups have different medical and social needs. Third, the groups differ with respect to economic constraints, including the political economy of labor markets and of government spending programs, and they have differing relationships to the various types of medical providers. The medical providers are themselves political actors with a variety of characteristics that create political advantages relative to recipients, although there is also diversity among providers. The politics of the Medicaid program involves more than simply technical decisions about eligibility, coverage of medical services, reimbursement, and the implementation of managed care initiatives. Instead the differences between the program's multiple claimants are an important element of current Medicaid politics and the likely path of future reforms.

Stories and metaphors in the sensemaking of multiple primary health care organizational identities.

PubMed

Rodríguez, Charo; Bélanger, Emmanuelle

2014-03-04

The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.

Nurse managers' strategies for feeling less drained by their work: an action research and reflection project for developing emotional intelligence.

PubMed

Taylor, Bev; Roberts, Sue; Smyth, Therese; Tulloch, Moira

2015-10-01

To raise nurse managers' critical awareness of practice problems; uncover practice constraints and improve work effectiveness. Nurse management requires skills and knowledge, underscored by emotional intelligence. The research improved participants' practice and personal insights. Purposive sampling targeted nurse managers interested in improving their practice. Three experienced female nurse managers met fortnightly in a group, for 1 hour, for 10 meetings. The methods included: writing and sharing de-identified journal reflections; critically analysing practice stories; identifying a thematic concern; generating action strategies; and instituting and revising the action plan. Phase One resulted in the identification of the issue of 'being drained by the intensity of nurse managers' work'. The participants adopted five strategies: debriefing problematic situations; deflecting multiple requests; diffusing issues; naming dysfunctional behaviours; and regrouping. In Phase Two, participants implemented and revised the action plan strategies, which resulted in them feeling less drained by their work. Strategies can lessen nurse managers' sense of personal depletion. However, strategies cannot guarantee success every time because the emotional intelligence is integral to nurse management. Action research and reflection assist nurse managers to improve their practice and develop their emotional intelligence. © 2014 John Wiley & Sons Ltd.

Management of thinned Emory oak coppice for multiple resource benefits

Treesearch

D. Catlow Shipek; Peter F. Ffolliott

2005-01-01

Managers are increasingly moving toward an ecosystem-based, multiple-use approach in managing Emory oak woodlands in the Southwestern United States. Often of particular interest is managing the coppice that evolves from earlier fuelwood harvesting activities. Emory oak (Quercus emoryi) is a prolific sprouting species and, as a consequence, post-...

Managing Multiple Tasks in Complex, Dynamic Environments

NASA Technical Reports Server (NTRS)

Freed, Michael; Null, Cynthia H. (Technical Monitor)

1998-01-01

Sketchy planners are designed to achieve goals in realistically complex, time-pressured, and uncertain task environments. However, the ability to manage multiple, potentially interacting tasks in such environments requires extensions to the functionality these systems typically provide. This paper identifies a number of factors affecting how interacting tasks should be prioritized, interrupted, and resumed, and then describes a sketchy planner called APEX that takes account of these factors when managing multiple tasks.

Management and Outcomes Among Chinese Hospitalized Patients With Established Cardiovascular Disease or Multiple Risk Factors.

PubMed

Yang, Jingang; Yang, Yuejin; Gu, Hongqiu; Li, Wei; Hu, Dayi

2016-02-01

We assessed the management and outcomes among hospitalized patients with coronary artery disease (CAD), stroke, peripheral artery disease (PAD), or with multiple (≥ 2) cardiovascular (CV) risk factors (multiple risk factors [MRFs]). We retrospectively studied 3732 hospitalized patients of either CV disease or ≥ 2 risk factors for atherothrombosis from October 2004 to January 2005. Outcomes included CV death, myocardial infarction (MI), stroke, and hospitalization for atherothrombotic events. About one-third had disease involving ≥ 1 vascular bed. Medication was more intense in patients with CAD than in others. The lowest use of statins and antiplatelet treatment was in the PAD-only group. Patients with PAD experienced a higher CV mortality (5.1%) than the patients with CAD (3.73%) or stroke (4.1%), P < .001. Cardiovascular death ranged from 1.2% for patients with MRFs, 2.8% for patients with 1-bed disease, 4.7% for patients with 2-bed disease to 6.4% for patients with 3-bed disease (P for trend <.001). For hospitalized patients with established atherosclerotic arterial disease, a substantial increase in CV event rates occurs with increasing numbers of affected arterial beds. Patients with PAD were at an especially high risk. © The Author(s) 2015.

Pelvic pain: a pathway for care developed for both men and women by the British Pain Society.

PubMed

Baranowski, A P; Lee, J; Price, C; Hughes, J

2014-03-01

This paper aims to explain the key points and highlight some of the controversies in the development of the British Pain Society's pelvic pain patient pathway map. Many clinicians lack experience and confidence with this group of patients, and this issue is highlighted. Additionally, the difficulties of classification and definitions in this area are discussed in detail. These are historical causes of disagreement among specialists which can lead to confused clinical care. This group of patients have multiple issues that cross many professional boundaries; they are best managed by the co-ordinated involvement of multiple teams. Patients suffer from significant distress and disability that often needs specialist assessment and intervention (interdisciplinary). This suggests that an integrated approach is required across the historic boundaries of primary and secondary care. A variety of interventions, including opioids and neuromodulation are recommended in the pathway and the controversies surrounding these inclusions are aired in detail.

Multiple myeloma: Diagnosis and management issues in patients with pre-existing chronic kidney disease.

PubMed

Vadlamudi, Srilatha; Annapareddy, Siva Nagendra Reddy

2016-01-01

Multiple myeloma is one of the most common malignancies encountered in clinical practice. Renal involvement in myeloma is a well-recognized entity. Although rare, another special situation that a nephrologist can encounter is myeloma occurring in a patient with preexisting chronic kidney disease (CKD) due to other etiologies. Anemia, bone pains and hypercalcemia, which commonly indicate the diagnosis of myeloma in the general population, are not useful in the presence of CKD. The sensitivity and specificity of serum free light chain assay is decreased in the presence of renal failure. Chemotherapy-related adverse effects are high compared with that in patients without CKD; this is attributed to the decreased clearance of drugs and the additive effect of chemotherapy-related adverse effects to the complications of CKD. Autologous and allogenic bone marrow transplantation can be attempted in this group of patients with non-myeloablative-conditioning regimens. Combined bone marrow and renal transplantation remains a viable option in this group of patients to increase life expectancy and quality of life.

A rough set approach for determining weights of decision makers in group decision making

PubMed Central

Yang, Qiang; Du, Ping-an; Wang, Yong; Liang, Bin

2017-01-01

This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs’ decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member’ decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs’ evaluations and selections. PMID:28234974

Management of substance use disorder in schizophrenia patients: current guidelines.

PubMed

Drake, Robert E

2007-10-01

Substance use disorder is the most frequent and clinically significant comorbidity among schizophrenia patients today. All schizophrenia patients should be assessed and monitored carefully regarding their substance use. Those with any regular use of alcohol or other drugs should be considered at risk for multiple adverse effects. As therapies for co-occurring substance use disorders have evolved over the past 20 years, medication management, psychosocial interventions, and rehabilitation models have increasingly emphasized the integration of mental health and substance abuse treatments, attention to group and residential interventions, matching interventions to stage of treatment, comprehensiveness, and long-term perspectives on recovery. Clinicians should understand the implications of each of these principles of care.

Comparing and contrasting knowledge of pressure ulcer assessment, prevention and management in people with spinal cord injury among nursing staff working in two metropolitan spinal units and rehabilitation medicine training specialists in a three-way comparison.

PubMed

Gupta, N; Loong, B; Leong, G

2012-02-01

To assess for differences in knowledge of pressure ulcer (PU) prevention and management among nurses working in two metropolitan spinal cord injury (SCI) units, and between nurses and rehabilitation registrars (doctors). There is anecdotal evidence of wide variation in PU management. An understanding of current knowledge is fundamental to evidence-based practice implementation. This was a prospective survey, using a multiple choice question format developed with nurse wound specialists. A total of 10 questions assessed PU prevention and 10 assessed management. It was distributed to nurses working at the spinal units and rehabilitation registrars. The results from the groups were analysed for similarities and differences using one- and two-way analysis of variance (ANOVA) tests and tests for significance of specific linear combinations of group means. The response rate was 79% (19/24) and 71% (20/ 28) from the two SCI units, and 46% (13/28) from doctors. Doctors performed better than nurses on prevention questions (P<0.005) but worse on management (P<0.05). There was a significant difference in management knowledge (P<0.001) between nurses working in the two units but not in prevention knowledge (P<0.5) and interestingly years of experience did not correlate with performance (P<0.2 for prevention and P<0.5 for management questions). Rehabilitation registrars score better in prevention questions, but poorer in management questions, which reflects academic rather than experiential knowledge. There are also differences in management knowledge among nurses, based on work area rather than years of experience. Although knowledge does not necessarily reflect practice, this calls for better standardisation and implementation of wound management pathways.

hEIDI: An Intuitive Application Tool To Organize and Treat Large-Scale Proteomics Data.

PubMed

Hesse, Anne-Marie; Dupierris, Véronique; Adam, Claire; Court, Magali; Barthe, Damien; Emadali, Anouk; Masselon, Christophe; Ferro, Myriam; Bruley, Christophe

2016-10-07

Advances in high-throughput proteomics have led to a rapid increase in the number, size, and complexity of the associated data sets. Managing and extracting reliable information from such large series of data sets require the use of dedicated software organized in a consistent pipeline to reduce, validate, exploit, and ultimately export data. The compilation of multiple mass-spectrometry-based identification and quantification results obtained in the context of a large-scale project represents a real challenge for developers of bioinformatics solutions. In response to this challenge, we developed a dedicated software suite called hEIDI to manage and combine both identifications and semiquantitative data related to multiple LC-MS/MS analyses. This paper describes how, through a user-friendly interface, hEIDI can be used to compile analyses and retrieve lists of nonredundant protein groups. Moreover, hEIDI allows direct comparison of series of analyses, on the basis of protein groups, while ensuring consistent protein inference and also computing spectral counts. hEIDI ensures that validated results are compliant with MIAPE guidelines as all information related to samples and results is stored in appropriate databases. Thanks to the database structure, validated results generated within hEIDI can be easily exported in the PRIDE XML format for subsequent publication. hEIDI can be downloaded from http://biodev.extra.cea.fr/docs/heidi .

A formative evaluation of customized pamphlets to promote physical activity and symptom self-management in women with multiple sclerosis.

PubMed

Plow, Matthew; Bethoux, Francois; Mai, Kimloan; Marcus, Bess

2014-10-01

Inactivity is a prevalent problem in the population affected with multiple sclerosis (MS). Thus, there is a need to develop and test physical activity (PA) interventions that can be widely disseminated. We conducted a formative evaluation as part of a randomized controlled trial of a pamphlet-based PA intervention among 30 women with MS. Pamphlets were customized to sub-sets of participants who shared similar symptoms and barriers to PA. Mixed methods were used to examine the intervention's influence on self-efficacy, social support, processes of change and stages of change placement, as well as explore participants' perceived barriers, motivators and strategies for engaging in a PA program. Results indicated that the intervention group significantly improved stages of change placement (F = 16.64, P < 0.01) and social support (F = 4.08, P = 0.05) in comparison to the control group. Fatigue, pain and lack of time were the commonly cited barriers to engage in the PA program; whereas the pamphlets, phone calls and action planning were cited as motivators. Participants used fatigue management strategies, enlisted social support and modified their environment to routinely engage in the PA program. Strategies were identified to improve the PA intervention in future research. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A comparison of two methods of teaching. Computer managed instruction and keypad questions versus traditional classroom lecture.

PubMed

Halloran, L

1995-01-01

Computers increasingly are being integrated into nursing education. One method of integration is through computer managed instruction (CMI). Recently, technology has become available that allows the integration of keypad questions into CMI. This brings a new type of interactivity between students and teachers into the classroom. The purpose of this study was to evaluate differences in achievement between a control group taught by traditional classroom lecture (TCL) and an experimental group taught using CMI and keypad questions. Both control and experimental groups consisted of convenience samples of junior nursing students in a baccalaureate program taking a medical/surgical nursing course. Achievement was measured by three instructor-developed multiple choice examinations. Findings demonstrated that although the experimental group demonstrated increasingly higher test scores as the semester progressed, no statistical difference was found in achievement between the two groups. One reason for this may be phenomenon of vampire video. Initially, the method of presentation overshadowed the content. As students became desensitized to the method, they were able to focus and absorb more content. This study suggests that CMI and keypads are a viable teaching option for nursing education. It is equal to TCL in student achievement and provides a new level of interaction in the classroom setting.

Managing Neuropsychological Impairment in Multiple Sclerosis

PubMed Central

Lau, Stephanie; Penner, Iris; Heesen, Christoph; Moritz, Steffen

2015-01-01

Background: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system of potential autoimmune origin that is frequently associated with psychological disorders and cognitive deficits, as well as with fatigue, stress, and psychosocial burden. These factors often cause decreased quality of life, social withdrawal, and unemployment. We describe the development of a cognitive-behavioral group intervention based on the concept of metacognition and evaluation of the feasibility and acceptance of the program as a rehabilitation tool. Methods: Metacognitive Training in MS (MaTiMS) consists of six modules, each 90 minutes in duration. We tested acceptance and design of the program in six focus groups (entire sample, n = 27). Framework analysis of transcripts was used to identify key topics and categories. Program modules were revised in accordance with appropriate recommendations of focus group members. We subsequently evaluated MaTiMS in two groups (n = 5, n = 6) in a rehabilitation center. Neuropsychological functioning as well as coping self-efficacy, depression, stress, perceived cognitive deficit, fatigue, and quality of life were assessed. Acceptance of MaTiMS from the patient perspective was also studied. Results: The modules were highly accepted by patients. Pre-post assessments showed significant improvements in the Coping Self Efficacy Scale (P = .007), the Würzburger Fatigue Inventory for MS Score (P = .028), and the Hamburg Quality of Life Questionnaire in Multiple Sclerosis Mood subscale (P = .046). Conclusions: These preliminary results suggest that MaTiMS represents a feasible psychological group training program that may foster improvements in self-efficacy, fatigue, and mood. The next step will be an evaluation of the program in a randomized controlled trial. PMID:26052258

Langerhans cell histiocytosis of skull: a retrospective study of 18 cases.

PubMed

Zhang, Xiang-Heng; Zhang, Ji; Chen, Zheng-He; Sai, Ke; Chen, Yin-Sheng; Wang, Jian; Ke, Chao; Guo, Chen-Chen; Chen, Zhong-Ping; Mou, Yong-Gao

2017-04-01

The present study presents 18 cases of Chinese patients harboring a Langerhans cell histiocytosis (LCH) of the skull. Eighteen consecutive patients were diagnosed as LCH of the skull and confirmed pathologically between March 2002 and February 2014. In the present study, the patients of LCH without skull involvement were excluded. According to disease extent at diagnosis, the 18 LCH patients with skull involvement were divided into three groups: (I) unifocal-monosystem group, including ten cases with solitary skull lesion; (II) multifocal-monosystem group, including two cases with multiple bone lesions and no extra-skeletal involvement; (III) multisystem group, including six cases with LCH lesions involving both skeletal and extra-skeletal system. In unifocal-monosystem group, excision of the skull lesion was performed in eight of ten cases, a low dosage of local radiotherapy and a purposeful observation was accept by the remaining two cases of this group after biopsy respectively. In multifocal-monosystem group, both of the two cases were received chemotherapy. In multi-system group, all the six cases were managed with systemic chemotherapy, after their diagnoses of LCH were confirmed. The mean age at the time of diagnosis was 9.4 years. There was a male predominance in this disease male/female ratio was 3.5:1. In our cases, a skull mass with or without tenderness was the most common chief complaint (13 cases, 72.2%), and frontal bone was the most frequent affected locations of skull (6 cases, 33.3%). In unifocal-monosystem group, nine of ten remained free from LCH, the remain one lesion recurred 22 months after his surgical excision. In multifocal-monosystem group, a complete response (CR) was obtained in one of them, and a stable disease (SD) of multiple osseous lesions was obtained in another one. In the multi-system group, a CR in four cases and a partial response (PR) in one case were obtained, and a progressive disease (PD) was observed in the remaining one. The unifocal-monosystem of LCH of the skull is a clinicopathological entity with a good outcome, and resection, irradiation or purposeful observation are also can be been utilized as the choice of treatment. For the multifocal bone lesions and multisystem lesions of LCH, chemotherapy is an effective treatment as a systemic therapy. There is no enough publication literature to determine guidelines or indications for managing this disease.

Ethnic and language disparities in diabetes care among California residents.

PubMed

Choi, Sarah; Lee, Jung-Ah; Rush, Elizabeth

2011-01-01

We examined ethnic and language disparities in diabetes care and management among California residents with type 2 diabetes based on ethnicity and English-language proficiency. Data were drawn from the 2007 California Health Interview Survey with a total of 3,531 Asian, Latino, and Caucasian adults with diabetes. Latino and Asian groups were subdivided by their limited English proficiency (LEP) level. Population-weighted regression analyses were conducted to examine group differences, controlling for socioeconomic and clinical variables. Latino English Proficient (EP) and Latino LEP respondents received fewer hemoglobin A1c checks (EP: b = -0.11, P < .05; LEP: b = -0.27, P < .01) than Caucasians. Latino and Asian LEP respondents checked their glucose less frequently than Caucasians (Latino LEP: b = -0.49, P < .05; Asian LEP: b = -0.79, P < .01). Asian LEP respondents were less likely to receive feet checks than Caucasians (Asian LEP: b = -.52, P < .001). Asian LEP respondents received significantly fewer feet checks than Asian EP respondents (P < .05). Ethnic disparities in disease management exist among California residents. However, beyond ethnicity, English proficiency should be taken into account when examining diabetes management among minority groups. Diabetic Californians who belong to ethnic minorities and speak limited English, particularly Asians, are less likely to receive the standard of care for diabetes than English proficient Caucasians. From a policy perspective, care should be taken to ensure that adequate information about diabetes management is available in multiple languages for patients with limited English skills.

A web-based approach to managing stress and mood disorders in the workforce.

PubMed

Billings, Douglas W; Cook, Royer F; Hendrickson, April; Dove, David C

2008-08-01

To evaluate the effectiveness of a web-based multimedia health promotion program for the workplace, designed to help reduce stress and to prevent depression, anxiety, and substance abuse. Using a randomized controlled trial design, 309 working adults were randomly assigned to the web-based condition or to a wait-list control condition. All participants were assessed on multiple self-reported outcomes at pretest and posttest. Relative to controls, the web-based group reduced their stress, increased their knowledge of depression and anxiety, developed more positive attitudes toward treatment, and adopted a more healthy approach to alcohol consumption. We found that a brief and easily adaptable web-based stress management program can simultaneously reduce worker stress and address stigmatized behavioral health problems by embedding this prevention material into a more positive stress management framework.

Customized laboratory information management system for a clinical and research leukemia cytogenetics laboratory.

PubMed

Bakshi, Sonal R; Shukla, Shilin N; Shah, Pankaj M

2009-01-01

We developed a Microsoft Access-based laboratory management system to facilitate database management of leukemia patients referred for cytogenetic tests in regards to karyotyping and fluorescence in situ hybridization (FISH). The database is custom-made for entry of patient data, clinical details, sample details, cytogenetics test results, and data mining for various ongoing research areas. A number of clinical research laboratoryrelated tasks are carried out faster using specific "queries." The tasks include tracking clinical progression of a particular patient for multiple visits, treatment response, morphological and cytogenetics response, survival time, automatic grouping of patient inclusion criteria in a research project, tracking various processing steps of samples, turn-around time, and revenue generated. Since 2005 we have collected of over 5,000 samples. The database is easily updated and is being adapted for various data maintenance and mining needs.

Assessing risk from a stakeholder perspective

NASA Technical Reports Server (NTRS)

Cooper, L. P.

2003-01-01

Planetary exploration missions are subject to a vast array of interpretations of 'success' based on the concerns of multiple stakeholder groups. While project risk management generally focuses on issues of cost/schedule constraints or reliability issues, a broader interpretation of 'risk' as it applies to stakeholders such as sponsors (e.g., NASA), the public at large, the scientific community, the home organization, and the project team itself can provide important insights into the full spectrum of risk that needs to be managed. This paper presents a stakeholder view of risk which is divided into failure, not-a-failure, success, and stunning-success zones. Using the Mars Pathfinder mission as an example, an alternative interpretation of the risks to that mission is presented from the view of key stakeholders. The implications of the stakeholder perspective to project risk management are addressed.

Change Management in Dental Education: A Professional Learning Community.

PubMed

Palatta, Anthony M

2018-06-01

Professional learning communities (PLCs) are defined as "a group of people sharing and critically interrogating their practice in an ongoing, reflective, collaborative, inclusive, learning-oriented, growth-promoting way." PLCs have been found to be an effective change management strategy in business and education when confronted by rapid change. The American Dental Education Association's Commission on Change and Innovation in Dental Education new national program-ADEA CCI 2.0-includes the development of a PLC. By employing an "engage and learn" model PLC centered on continuous quality improvement and systems thinking, dental faculty can identify internal and external barriers to change that could lead to innovative solutions to complex issues. This article argues that a PLC is a viable change management strategy to counteract the effect of multiple external forces impacting dental education and thus to develop future-ready faculty.

Workplace Participatory Occupational Health/Health Promotion Program

PubMed Central

Zhang, Yuan; Flum, Marian; Kotejoshyer, Rajashree; Fleishman, Jane; Henning, Robert; Punnett, Laura

2018-01-01

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers’ and employees’ perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational health/health promotion program. PMID:26977705

Characteristics of patients with non-variceal upper gastrointestinal bleeding taking antithrombotic agents.

PubMed

Yamaguchi, Daisuke; Sakata, Yasuhisa; Tsuruoka, Nanae; Shimoda, Ryo; Higuchi, Toru; Sakata, Hiroyuki; Fujimoto, Kazuma; Iwakiri, Ryuichi

2015-01-01

The present study aimed to clarify the features and management of non-variceal upper gastrointestinal bleeding (UGIB) in Japanese patients taking antithrombotic agents. We retrospectively investigated the medical records of 560 patients who underwent emergency endoscopy for UGIB from 2002 to 2013. The patients were divided into two groups: group A, antithrombotic agent use; and group NA, no antithrombotic agent use. We compared clinical characteristics, comorbidities, and causes of UGIB between the groups. We also investigated management with antithrombotics. Of 560 patients with UGIB, 27.5% were taking antithrombotics, and this proportion gradually increased during the study period. Mean hemoglobin levels on admission were significantly lower in group A (8.0 ± 1.7 g/dL) than in group NA (8.9 ± 2.9 g/dL) (P < 0.001). Patients in group A developed more gastric ulcers and multiple ulcers than did patients in group NA. Incidence of Forrest Ia-type bleeding was lower in group A than in group NA (P < 0.001), and the rate of endoscopic hemostasis was significantly higher in group A (98.7%) than in group NA (94.3%) (P = 0.022). After the release of the 2012 Japan Gastroenterological Endoscopy Society guidelines, the antithrombotic agent cessation periods were significantly shortened (P < 0.001). Among patients with UGIB, those taking antithrombotics exhibited more severe clinical signs. However spurting hemorrhage was rare. Antithrombotics may be resumed early after endoscopic hemostasis. © 2014 The Authors. Digestive Endoscopy © 2014 Japan Gastroenterological Endoscopy Society.

Development and implementation of a balanced scorecard in an academic hospitalist group.

PubMed

Hwa, Michael; Sharpe, Bradley A; Wachter, Robert M

2013-03-01

Academic hospitalist groups (AHGs) are often expected to excel in multiple domains: quality improvement, patient safety, education, research, administration, and clinical care. To be successful, AHGs must develop strategies to balance their energies, resources, and performance. The balanced scorecard (BSC) is a strategic management system that enables organizations to translate their mission and vision into specific objectives and metrics across multiple domains. To date, no hospitalist group has reported on BSC implementation. We set out to develop a BSC as part of a strategic planning initiative. Based on a needs assessment of the University of California, San Francisco, Division of Hospital Medicine, mission and vision statements were developed. We engaged representative faculty to develop strategic objectives and determine performance metrics across 4 BSC perspectives. There were 41 metrics identified, and 16 were chosen for the initial BSC. It allowed us to achieve several goals: 1) present a broad view of performance, 2) create transparency and accountability, 3) communicate goals and engage faculty, and 4) ensure we use data to guide strategic decisions. Several lessons were learned, including the need to build faculty consensus, establish metrics with reliable measureable data, and the power of the BSC to drive goals across the division. We successfully developed and implemented a BSC in an AHG as part of a strategic planning initiative. The BSC has been instrumental in allowing us to achieve balanced success in multiple domains. Academic groups should consider employing the BSC as it allows for a data-driven strategic planning and assessment process. Copyright © 2013 Society of Hospital Medicine.

Multiple trauma in children: critical care overview.

PubMed

Wetzel, Randall C; Burns, R Cartland

2002-11-01

Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

Impact of Pilates Exercise in Multiple Sclerosis: A Randomized Controlled Trial.

PubMed

Duff, Whitney R D; Andrushko, Justin W; Renshaw, Doug W; Chilibeck, Philip D; Farthing, Jonathan P; Danielson, Jana; Evans, Charity D

2018-01-01

Pilates is a series of exercises based on whole-body movement and may improve mobility in people with multiple sclerosis (MS). The purpose of this study was to determine the effect of Pilates on walking performance in people with MS. 30 individuals with MS who were not restricted to a wheelchair or scooter (Patient-Determined Disease Steps scale score <7) were randomized to receive Pilates (twice weekly) and massage therapy (once weekly) or once-weekly massage therapy only (control group). The Pilates was delivered in a group setting (five to ten participants per session). The primary outcome was change in walking performance (6-Minute Walk Test) after 12 weeks. Secondary outcomes included functional ability (Timed Up and Go test), balance (Fullerton Advanced Balance Scale), flexibility (sit and reach test), body composition (dual-energy X-ray absorptiometry), core endurance (plank-hold test), and muscle strength and voluntary activation (quadriceps). Intention-to-treat analysis was performed using a two-factor repeated-measures analysis of variance. Walking distance increased by a mean (SD) of 52.4 (40.2) m in the Pilates group versus 15.0 (34.1) m in the control group (group × time, P = .01). Mean (SD) time to complete the Timed Up and Go test decreased by 1.5 (2.8) seconds in the Pilates group versus an increase of 0.3 (0.9) seconds in the control group (group × time, P = .03). There were no other significant differences between groups over time. Pilates improved walking performance and functional ability in persons with MS and is a viable exercise option to help manage the disease.

Assessment and management of acute pain in the older person with cognitive impairment: A qualitative study.

PubMed

Fry, Margaret; Chenoweth, Lynn; Arendts, Glenn

2016-01-01

Older Australians experience health disparities in pain management compared to other groups. This article is focused on understanding the emergency nurses' perceptions of pain and pain management for older persons with cognitive impairment and presenting with a long bone fracture. This article is part of a larger study focusing on emergency nurses' pain management practices for older Australians with cognitive impairment. The aim of the study was to understand emergency nurses' perceptions of the management of pain for older persons with cognitive impairment and presenting with a long bone fracture. This is part of a larger multicentre programme of research exploring pain management in older persons with cognitive impairment and who are experiencing pain from a long bone fracture. This study had a qualitative research design, with data collected through focus group interviews and a thematic method of analysis. The study is framed by a constructivist's paradigm, which enabled multiple realities to surface and be interpreted. Eighty emergency nurses participated, with 67 (84%) females and 13 (16%) males, in 16 focus groups across four emergency departments. Nurses had an average of 12.5 years as a Registered Nurse (SD ± 10.06) and 8.6 years (SD ± 8.64) emergency experience. Five themes emerged from data analysis and included: 1) Belief in championing pain management; 2) Pain management and the ageing processes; 3) Lack of pain assessment tools for the cognitively impaired older person; 4) Delivering analgesia--a balancing act; and 5) Policy barriers to nurse initiated pain management. This study makes clear the challenges clinicians' face in managing pain in older patients presenting to emergency departments. More specifically, older persons with cognitive impairment face substantially greater obstacles in receiving effective pain relief given the lack of any standardised pain assessment screening tool within emergency departments. To improve pain management practices emergency clinicians need to test the utility of behavioural pain assessment tools for cognitively impaired older persons within the emergency context. Copyright © 2015 Elsevier Ltd. All rights reserved.

Challenges of self-management when living with multiple chronic conditions

PubMed Central

Liddy, Clare; Blazkho, Valerie; Mill, Karina

2014-01-01

Abstract Objective To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management. Data sources On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception. Study selection Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States. Synthesis Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people’s ability to self-manage their multiple chronic conditions. Conclusion This study provides a unique view into patients’ perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients’ perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations. PMID:25642490

Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study.

PubMed

Jakopovic, D; Falk, A-C; Lindström, V

2015-07-01

Pain management is described to be insufficient for patients suffering from a hip fracture, and the management for this vulnerable group of patients may be challenging due to their medical history (multiple comorbidities) and polypharmacy. Previous research has mainly focused on fast tracks aiming to reduce time to surgery. But the research on how pain management is handled for these patients in the prehospital context has been sparse. Therefore, the purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture. A descriptive and qualitative design with Critical Incident Technique was used for collecting data. Moreover, a qualitative content analysis was used for analysing the collected data. Twenty-two participants communicated their experiences and 51 incidents were analysed. The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to individualize the pain relief for patients with a suspected hip fracture through a variety of interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

A distributed data base management facility for the CAD/CAM environment

NASA Technical Reports Server (NTRS)

Balza, R. M.; Beaudet, R. W.; Johnson, H. R.

1984-01-01

Current/PAD research in the area of distributed data base management considers facilities for supporting CAD/CAM data management in a heterogeneous network of computers encompassing multiple data base managers supporting a variety of data models. These facilities include coordinated execution of multiple DBMSs to provide for administration of and access to data distributed across them.

Multiple use management preferences by visitors with differing leisure identity salience

Treesearch

Ingrid E. Schneider; Patricia B. Winter

1998-01-01

Multiple use area management is of particular interest to both outdoor and urban planners due to an increase in and diversity of users. These areas pose special management challenges due to the diverse and potential conflicting interests involved. Diverse users are frequently excluded from management decisions, however. Further, when visitor input is solicited, it is...

Distributed Electrical Energy Systems: Needs, Concepts, Approaches and Vision (in Chinese)

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

Zhang, Yingchen; Zhang, Jun; Gao, Wenzhong

Intelligent distributed electrical energy systems (IDEES) are featured by vast system components, diversifled component types, and difficulties in operation and management, which results in that the traditional centralized power system management approach no longer flts the operation. Thus, it is believed that the blockchain technology is one of the important feasible technical paths for building future large-scale distributed electrical energy systems. An IDEES is inherently with both social and technical characteristics, as a result, a distributed electrical energy system needs to be divided into multiple layers, and at each layer, a blockchain is utilized to model and manage its logicmore » and physical functionalities. The blockchains at difierent layers coordinate with each other and achieve successful operation of the IDEES. Speciflcally, the multi-layer blockchains, named 'blockchain group', consist of distributed data access and service blockchain, intelligent property management blockchain, power system analysis blockchain, intelligent contract operation blockchain, and intelligent electricity trading blockchain. It is expected that the blockchain group can be self-organized into a complex, autonomous and distributed IDEES. In this complex system, frequent and in-depth interactions and computing will derive intelligence, and it is expected that such intelligence can bring stable, reliable and efficient electrical energy production, transmission and consumption.« less

Eliciting Provider and Patient Perspectives on New Obesity Management Services in a Team-Based Primary Care Organization.

PubMed

Royall, Dawna; Brauer, Paula; Atta-Konadu, Edwoba; Dwyer, John J M; Edwards, A Michelle; Hussey, Tracy; Kates, Nick

2017-09-01

Both providers and patients may have important insights to inform the development of obesity prevention and management services in Canadian primary care settings. In this formative study, insights for new obesity management services were sought from both providers and patients in 1 progressive citywide organization (150 physicians, team services, separate offices). Seven focus groups with interprofessional health providers (n = 56) and 4 focus groups with patients (n = 34) were conducted. Two clinical vignettes (adult, child) were used to focus discussion. Four analysts coded for descriptive content and interpretative themes on possible tools and care processes using NVivo. Participants identified numerous strategies for care processes, most of which could be categorized into 1 or more of 11 themes: 6 directed at clinical care of patients (raising awareness, screening, clinical care, skill building, ongoing support, and social/peer support) and 5 directed at the organization (coordination/collaboration, creating awareness among health professionals, adding new expertise to the team, marketing, and lobbying/advocacy). The approach was successful in generating an extensive list of diverse activities to be considered for implementation studies. Both patients and providers identified that multiple strategies and systems approaches will be needed to address obesity management in primary care.

Testing Group Mean Differences of Latent Variables in Multilevel Data Using Multiple-Group Multilevel CFA and Multilevel MIMIC Modeling.

PubMed

Kim, Eun Sook; Cao, Chunhua

2015-01-01

Considering that group comparisons are common in social science, we examined two latent group mean testing methods when groups of interest were either at the between or within level of multilevel data: multiple-group multilevel confirmatory factor analysis (MG ML CFA) and multilevel multiple-indicators multiple-causes modeling (ML MIMIC). The performance of these methods were investigated through three Monte Carlo studies. In Studies 1 and 2, either factor variances or residual variances were manipulated to be heterogeneous between groups. In Study 3, which focused on within-level multiple-group analysis, six different model specifications were considered depending on how to model the intra-class group correlation (i.e., correlation between random effect factors for groups within cluster). The results of simulations generally supported the adequacy of MG ML CFA and ML MIMIC for multiple-group analysis with multilevel data. The two methods did not show any notable difference in the latent group mean testing across three studies. Finally, a demonstration with real data and guidelines in selecting an appropriate approach to multilevel multiple-group analysis are provided.

Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months.

PubMed

Sorbi, M J; Kleiboer, A M; van Silfhout, H G; Vink, G; Passchier, J

2015-06-01

This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N = 195) versus waitlist control (WLC; N = 173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes). An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle. At T2, attack frequency had improved significantly in oBT (-23%, ES = 0.66) but also in WLC (-19%; ES = 0.52). Self-efficacy, internal and external control in migraine management--and triptan use--improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent. oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

DEVELOPING THE NEXT GENERATION OF WATERSHED RISK ASSESSMENT AND MANAGEMENT MODELS: WHERE DO WE GO FROM HERE?

EPA Science Inventory

Wise management decisions to protect ecological resources require an understanding of how the resource is affcted by multiple stressors at multiple scales and how it responds to the change(s) effected by the management action.

Impact of self-reported multiple chemical sensitivity on everyday life: a qualitative study.

PubMed

Skovbjerg, Sine; Brorson, Stig; Rasmussen, Alice; Johansen, Jeanne Duus; Elberling, Jesper

2009-08-01

Multiple chemical sensitivity (MCS) is a descriptive term covering symptoms attributed to exposure to common airborne chemicals. There are no internationally accepted criteria, but it has been suggested that MCS is a chronic and disabling condition. However, details of the impact of MCS on everyday life are limited. To describe the impact of MCS on everyday life, strategies for managing the condition, and experiences with healthcare management. A focus group study was conducted, including two interviews with a sample of six women and six men between 27 and 78 years of age, a duration of MCS of at least 1 year, and with different occupational conditions. MCS may severely influence different aspects of everyday life, including lifestyle, social relations, and occupational conditions. Avoiding common airborne chemicals was the most prevalent coping strategy, which implied creating a chemical-free living space and limiting social activities. Experiences with healthcare management were overall reported as negative in terms of not receiving acknowledgement of the reported symptoms. MCS may have serious implications for daily functioning. Further research on individual consequences and the social and psychological factors that may be associated with MCS is needed in order to add to our understanding of this condition and to the provision of more satisfactory healthcare.

The environment as a driver of immune and endocrine responses in dolphins (Tursiops truncatus)

PubMed Central

Fair, Patricia A.; Schaefer, Adam M.; Houser, Dorian S.; Bossart, Gregory D.; Romano, Tracy A.; Champagne, Cory D.; Stott, Jeffrey L.; Rice, Charles D.; White, Natasha; Reif, John S.

2017-01-01

Immune and endocrine responses play a critical role in allowing animals to adjust to environmental perturbations. We measured immune and endocrine related markers in multiple samples from individuals from two managed-care care dolphin groups (n = 82 samples from 17 dolphins and single samples collected from two wild dolphin populations: Indian River Lagoon, (IRL) FL (n = 26); and Charleston, (CHS) SC (n = 19). The immune systems of wild dolphins were more upregulated than those of managed-care-dolphins as shown by higher concentrations of IgG and increases in lysozyme, NK cell function, pathogen antibody titers and leukocyte cytokine transcript levels. Collectively, managed-care care dolphins had significantly lower levels of transcripts encoding pro-inflammatory cytokine TNF, anti-viral MX1 and INFα and regulatory IL-10. IL-2Rα and CD69, markers of lymphocyte activation, were both lower in managed-care care dolphins. IL-4, a cytokine associated with TH2 activity, was lower in managed-care care dolphins compared to the free-ranging dolphins. Differences in immune parameters appear to reflect the environmental conditions under which these four dolphin populations live which vary widely in temperature, nutrition, veterinary care, pathogen/contaminant exposures, etc. Many of the differences found were consistent with reduced pathogenic antigenic stimulation in managed-care care dolphins compared to wild dolphins. Managed-care care dolphins had relatively low TH2 lymphocyte activity and fewer circulating eosinophils compared to wild dolphins. Both of these immunologic parameters are associated with exposure to helminth parasites which is uncommon in managed-care care dolphins. Less consistent trends were observed in a suite of hormones but significant differences were found for cortisol, ACTH, total T4, free T3, and epinephrine. While the underlying mechanisms are likely multiple and complex, the marked differences observed in the immune and endocrine systems of wild and managed-care care dolphins appear to be shaped by their environment. PMID:28467830

The environment as a driver of immune and endocrine responses in dolphins (Tursiops truncatus).

PubMed

Fair, Patricia A; Schaefer, Adam M; Houser, Dorian S; Bossart, Gregory D; Romano, Tracy A; Champagne, Cory D; Stott, Jeffrey L; Rice, Charles D; White, Natasha; Reif, John S

2017-01-01

Immune and endocrine responses play a critical role in allowing animals to adjust to environmental perturbations. We measured immune and endocrine related markers in multiple samples from individuals from two managed-care care dolphin groups (n = 82 samples from 17 dolphins and single samples collected from two wild dolphin populations: Indian River Lagoon, (IRL) FL (n = 26); and Charleston, (CHS) SC (n = 19). The immune systems of wild dolphins were more upregulated than those of managed-care-dolphins as shown by higher concentrations of IgG and increases in lysozyme, NK cell function, pathogen antibody titers and leukocyte cytokine transcript levels. Collectively, managed-care care dolphins had significantly lower levels of transcripts encoding pro-inflammatory cytokine TNF, anti-viral MX1 and INFα and regulatory IL-10. IL-2Rα and CD69, markers of lymphocyte activation, were both lower in managed-care care dolphins. IL-4, a cytokine associated with TH2 activity, was lower in managed-care care dolphins compared to the free-ranging dolphins. Differences in immune parameters appear to reflect the environmental conditions under which these four dolphin populations live which vary widely in temperature, nutrition, veterinary care, pathogen/contaminant exposures, etc. Many of the differences found were consistent with reduced pathogenic antigenic stimulation in managed-care care dolphins compared to wild dolphins. Managed-care care dolphins had relatively low TH2 lymphocyte activity and fewer circulating eosinophils compared to wild dolphins. Both of these immunologic parameters are associated with exposure to helminth parasites which is uncommon in managed-care care dolphins. Less consistent trends were observed in a suite of hormones but significant differences were found for cortisol, ACTH, total T4, free T3, and epinephrine. While the underlying mechanisms are likely multiple and complex, the marked differences observed in the immune and endocrine systems of wild and managed-care care dolphins appear to be shaped by their environment.

Operating the EOSDIS at the land processes DAAC managing expectations, requirements, and performance across agencies, missions, instruments, systems, and user communities

USGS Publications Warehouse

Kalvelage, T.A.; ,

2002-01-01

NASA developed the Earth Observing System (EOS) during the 1990'S. At the Land Processes Distributed Active Archive Center (LP DAAC), located at the USGS EROS Data Center, the EOS Data and Information System (EOSDIS) is required to support heritage missions as well as Landsat 7, Terra, and Aqua. The original system concept of the early 1990'S changed as each community had its say - first the managers, then engineers, scientists, developers, operators, and then finally the general public. The systems at the LP DAAC - particularly the largest single system, the EOSDIS Core System (ECS) - are changing as experience accumulates, technology changes, and each user group gains influence. The LP DAAC has adapted as contingencies were planned for, requirements and therefore plans were modified, and expectations changed faster than requirements could hope to be satisfied. Although not responsible for Quality Assurance of the science data, the LP DAAC works to ensure the data are accessible and useable by influencing systems, capabilities, and data formats where possible, and providing tools and user support as necessary. While supporting multiple missions and instruments, the LP DAAC also works with and learns from multiple management and oversight groups as they review mission requirements, system capabilities, and the overall operation of the LP DAAC. Stakeholders, including the Land Science community, are consulted regularly to ensure that the LP DAAC remains cognizant and responsive to the evolving needs of the user community. Today, the systems do not look or function as originally planned, but they do work, and they allow customers to search and order of an impressive amount of diverse data.

An occupancy-based quantification of the highly imperiled status of desert fishes of the southwestern United States.

PubMed

Budy, Phaedra; Conner, Mary M; Salant, Nira L; Macfarlane, William W

2015-08-01

Desert fishes are some of the most imperiled vertebrates worldwide due to their low economic worth and because they compete with humans for water. An ecological complex of fishes, 2 suckers (Catostomus latipinnis, Catostomus discobolus) and a chub (Gila robusta) (collectively managed as the so-called three species) are endemic to the U.S. Colorado River Basin, are affected by multiple stressors, and have allegedly declined dramatically. We built a series of occupancy models to determine relationships between trends in occupancy, local extinction, and local colonization rates, identify potential limiting factors, and evaluate the suitability of managing the 3 species collectively. For a historical period (1889-2011), top performing models (AICc) included a positive time trend in local extinction probability and a negative trend in local colonization probability. As flood frequency decreased post-development local extinction probability increased. By the end of the time series, 47% (95% CI 34-61) and 15% (95% CI 6-33) of sites remained occupied by the suckers and the chub, respectively, and models with the 2 species of sucker as one group and the chub as the other performed best. For a contemporary period (2001-2011), top performing (based on AICc ) models included peak annual discharge. As peak discharge increased, local extinction probability decreased and local colonization probability increased. For the contemporary period, results of models that split all 3 species into separate groups were similar to results of models that combined the 2 suckers but not the chub. Collectively, these results confirmed that declines in these fishes were strongly associated with water development and that relative to their historic distribution all 3 species have declined dramatically. Further, the chub was distinct in that it declined the most dramatically and therefore may need to be managed separately. Our modeling approach may be useful in other situations in which targeted data are sparse and conservation status and best management approach for multiple species are uncertain. © 2015 Society for Conservation Biology.

An interactive health communication application for supporting parents managing childhood long-term conditions: outcomes of a randomized controlled feasibility trial.

PubMed

Swallow, Veronica M; Knafl, Kathleen; Santacroce, Sheila; Campbell, Malcolm; Hall, Andrew G; Smith, Trish; Carolan, Ian

2014-12-03

Families living with chronic or long-term conditions such as chronic kidney disease (CKD), stages 3-5, face multiple challenges and respond to these challenges in various ways. Some families adapt well while others struggle, and family response to a condition is closely related to outcome. With families and professionals, we developed a novel condition-specific interactive health communication app to improve parents' management ability-the online parent information and support (OPIS) program. OPIS consists of a comprehensive mix of clinical caregiving and psychosocial information and support. The purpose of this study was to (1) assess feasibility of a future full-scale randomized controlled trial (RCT) of OPIS in terms of recruitment and retention, data collection procedures, and psychometric performance of the study measures in the target population, and (2) investigate trends in change in outcome measures in a small-scale RCT in parents of children with CKD stages 3-5. Parents were recruited from a pediatric nephrology clinic and randomly assigned to one of two treatment groups: usual support for home-based clinical caregiving (control) or usual support plus password-protected access to OPIS for 20 weeks (intervention). Both groups completed study measures at study entry and exit. We assessed feasibility descriptively in terms of recruitment and retention rates overall; assessed recruitment, retention, and uptake of the intervention between groups; and compared family condition management, empowerment to deliver care, and fathers' involvement between groups. We recruited 55 parents of 39 children (42% of eligible families). Of those, about three-quarters of intervention group parents (19/26, 73%) and control group parents (22/29, 76%) were retained through completion of 20-week data collection. The overall retention rate was 41/55 (75%). The 41 parents completing the trial were asked to respond to the same 10 questionnaire scales at both baseline and 20 weeks later; 10 scores were missing at baseline and nine were missing at 20 weeks. Site user statistics provided evidence that all intervention group parents accessed OPIS. Analysis found that intervention group parents showed a greater improvement in perceived competence to manage their child's condition compared to control group parents: adjusted mean Family Management Measure (FaMM) Condition Management Ability Scale intervention group 44.5 versus control group 41.9, difference 2.6, 95% CI -1.6 to 6.7. Differences between the groups in the FaMM Family Life Difficulty Scale (39.9 vs 36.3, difference 3.7, 95% CI -4.9 to 12.2) appeared to agree with a qualitative observation that OPIS helped parents achieve understanding and maintain awareness of the impact of their child's condition. A full-scale RCT of the effectiveness of OPIS is feasible. OPIS has the potential to beneficially affect self-reported outcomes, including parents' perceived competence to manage home-based clinical care for children with CKD stage 3-5. Our design and methodology can be transferred to the management of other childhood conditions. International Standard Randomized Controlled Trial Number (ISRCTN): 84283190; http://www.controlled-trials.com/ISRCTN84283190 (Archived by WebCite at http://www.webcitation.org/6TuPdrXTF).

Informed multi-objective decision-making in environmental management using Pareto optimality

Treesearch

Maureen C. Kennedy; E. David Ford; Peter Singleton; Mark Finney; James K. Agee

2008-01-01

Effective decisionmaking in environmental management requires the consideration of multiple objectives that may conflict. Common optimization methods use weights on the multiple objectives to aggregate them into a single value, neglecting valuable insight into the relationships among the objectives in the management problem.

Multi-agent cooperation pursuit based on an extension of AALAADIN organisational model

NASA Astrophysics Data System (ADS)

Souidi, Mohammed El Habib; Songhao, Piao; Guo, Li; Lin, Chang

2016-11-01

An approach of cooperative pursuit for multiple mobile targets based on multi-agents system is discussed. In this kind of problem the pursuit process is divided into two kinds of tasks. The first one (coalition problem) is designed to solve the problem of the pursuit team formation. To achieve this mission, we used an innovative method based on a dynamic organisation and reorganisation of the pursuers' groups. We introduce our coalition strategy extended from the organisational agent, group, role model by assigning an access mechanism to the groups inspired by fuzzy logic principles. The second task (motion problem) is the treatment of the pursuers' motion strategy. To manage this problem we applied the principles of the Markov decision process. Simulation results show the feasibility and validity of the given proposal.

Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study.

PubMed

Cheng, Tao; Xia, Rong-Gang; Dong, Shi-Kui; Yan, Xiao-Yu; Luo, Cong-Feng

2017-12-18

Intramedullary nailing (IMN) is a popular method in the management of femoral shaft fractures (FSFs). However, whether the association of IMN with pulmonary fat emboli can compromise the pulmonary and nervous systems is debatable. The purpose of this study is to compare IMN with the locked dual plating (LDP) method by assessing the clinical outcomes of FSF patients with head or chest injury. A total of 126 FSF patients were included in this study between January 2010 and July 2016 and divided into LDP and IMN groups. Patient demographic characteristics, operative time, blood loss, Harris Hip Score, Lysholm Knee Score, radiological outcomes, and systemic complications were collected and compared between the two treatment groups. Patients were followed up for at least 12 months. The LDP group performed better than IMN in terms of operative time, estimated blood loss amount, and malunion rate. Differences in function scores, fracture union rate, overall pulmonary complication rate, and in-hospital mortality between the two groups were not significant. Average radiographic union time was significantly longer in the LDP group (36.3 weeks) than in the IMN group (32.5 weeks). One case of fixation failure occurred postoperatively in the LDP group, whereas one case of fracture nonunion took place in the IMN group. Our findings suggest that dual-plating fixation is a promising method for FSFs with multiple injuries. However, the retrospective nature of this study necessitates high-quality trials to be performed to assess the clinical efficiency of dual plating.

The effect of a novel minimally invasive strategy for infected necrotizing pancreatitis.

PubMed

Tong, Zhihui; Shen, Xiao; Ke, Lu; Li, Gang; Zhou, Jing; Pan, Yiyuan; Li, Baiqiang; Yang, Dongliang; Li, Weiqin; Li, Jieshou

2017-11-01

Step-up approach consisting of multiple minimally invasive techniques has gradually become the mainstream for managing infected pancreatic necrosis (IPN). In the present study, we aimed to compare the safety and efficacy of a novel four-step approach and the conventional approach in managing IPN. According to the treatment strategy, consecutive patients fulfilling the inclusion criteria were put into two time intervals to conduct a before-and-after comparison: the conventional group (2010-2011) and the novel four-step group (2012-2013). The conventional group was essentially open necrosectomy for any patient who failed percutaneous drainage of infected necrosis. And the novel drainage approach consisted of four different steps including percutaneous drainage, negative pressure irrigation, endoscopic necrosectomy and open necrosectomy in sequence. The primary endpoint was major complications (new-onset organ failure, sepsis or local complications, etc.). Secondary endpoints included mortality during hospitalization, need of emergency surgery, duration of organ failure and sepsis, etc. Of the 229 recruited patients, 92 were treated with the conventional approach and the remaining 137 were managed with the novel four-step approach. New-onset major complications occurred in 72 patients (78.3%) in the two-step group and 75 patients (54.7%) in the four-step group (p < 0.001). For other important endpoints, although there was no statistical difference in mortality between the two groups (p = 0.403), significantly fewer patients in the four-step group required emergency surgery when compared with the conventional group [14.6% (20/137) vs. 45.6% (42/92), p < 0.001]. In addition, stratified analysis revealed that the four-step approach group presented significantly lower incidence of new-onset organ failure and other major complications in patients with the most severe type of AP. Comparing with the conventional approach, the novel four-step approach significantly reduced the rate of new-onset major complications and requirement of emergency operations in treating IPN, especially in those with the most severe type of acute pancreatitis.

Understanding the Stress Management Needs and Preferences of Latinas Undergoing Chemotherapy.

PubMed

Martinez Tyson, Dinorah Dina; Jacobsen, Paul; Meade, Cathy D

2016-12-01

This exploratory study provides insights into everyday realities, concerns, and cultural perspectives of Latinas undergoing chemotherapy, and elicits information on stress management and information needs. Informed by a community-based participatory research approach using qualitative methods, we conducted ten interviews with providers, and two focus groups (n = 13) and 20 in-depth interviews with Latinas recently diagnosed with breast cancer. Providers and Latina patients acknowledged multiple physical and emotional stressors associated with cancer treatment, viewed a positive aspect of the cancer experience to include connection with God and enhanced spirituality, saw family as a motivating factor for recovery, and expressed a need to draw on existing coping strategies. Findings show considerable overlap between providers and Latina cancer patients' perceptions of stressors during chemotherapy. However, a few notable differences in perceptions of stress management needs during this treatment period emerged. While Latina cancer patients mentioned similar social/structural stressors (e.g., economic problems, lack of information) they tended to emphasize more of the interpersonal stressors related to family communication and relationships (e.g., providing and caring for family, distance from family), and intrapersonal stressors such as fear, changes in physical appearance, and side effects of chemotherapy. Our study illustrates the importance of including multiple perspectives. The information gained by including both providers and patient perspectives yielded a more complete understanding of the stress management needs of Latinas undergoing chemotherapy. Findings suggest that stress management educational interventions should aim to develop self-care skills, be culturally relevant and language-specific, and build upon stress-reducing strategies Latinas may already employ.

From conventional drainage to sustainable stormwater management: Beyond the technical challenges.

PubMed

Goulden, Shula; Portman, Michelle E; Carmon, Naomi; Alon-Mozes, Tal

2018-08-01

Countries and cities are increasingly recognizing the value of adopting Sustainable Stormwater Management (SSWM) goals and measures. SSWM serves multiple hydrological, ecological, social and economic goals and can replace substantial parts of conventional drainage infrastructure. Following international experience in the socio-technical nature of transitions in stormwater management, this research investigates how socio-institutional factors enable the transition from conventional to sustainable stormwater management over time. The research is based on analysing available relevant documents, semi-structured interviews and focus groups, all in a single country case study (Israel). We found significant changes in professional awareness and discourse, some advances in professional standards of work and changes to the regulative system, supporting infiltration practices in particular. We concluded that the three-pillared socio-institutional framework, composed of cultural-cognitive, normative and regulative changes, was insightful for mapping factors supporting transition from conventional drainage to SSWM. Elements within the three pillars can work simultaneously and synergistically to achieve widespread change. At the same time, while SSWM always strives to achieve multiple goals, the order of priority of the various goals may differ from place to place and may change over time. Thus the transition process across the socio-institutional pillars should be renewed if and when the priority of goals changes. The urban and regional planning system can play a crucial role in enhancing the transition process from conventional to sustainable stormwater management. These conclusions may be relevant to other localities and countries that are struggling with such transitions to sustainability. Copyright © 2018 Elsevier Ltd. All rights reserved.

Therapeutics for multiple sclerosis symptoms.

PubMed

Ben-Zacharia, Aliza Bitton

2011-01-01

Symptoms management in multiple sclerosis is an integral part of its care. Accurate assessment and addressing the different symptoms provides increased quality of life among patients with multiple sclerosis. Multiple sclerosis symptoms may be identified as primary, secondary, or tertiary symptoms. Primary symptoms, such as weakness, sensory loss, and ataxia, are directly related to demyelination and axonal loss. Secondary symptoms, such as urinary tract infections as a result of urinary retention, are a result of the primary symptoms. Tertiary symptoms, such as reactive depression or social isolation, are a result of the social and psychological consequences of the disease. Common multiple sclerosis symptoms include fatigue and weakness; decreased balance, spasticity and gait problems; depression and cognitive issues; bladder, bowel, and sexual deficits; visual and sensory loss; and neuropathic pain. Less-common symptoms include dysarthria and dysphagia, vertigo, and tremors. Rare symptoms in multiple sclerosis include seizures, hearing loss, and paralysis. Symptom management includes nonpharmacological methods, such as rehabilitation and psychosocial support, and pharmacological methods, ie, medications and surgical procedures. The keys to symptom management are awareness, knowledge, and coordination of care. Symptoms have to be recognized and management needs to be individualized. Multiple sclerosis therapeutics include nonpharmacological strategies that consist of lifestyle modifications, rehabilitation, social support, counseling, and pharmacological agents or surgical procedures. The goal is vigilant management to improve quality of life and promote realistic expectations and hope. © 2011 Mount Sinai School of Medicine.

Contracting Officer's Technical Representatives

NASA Technical Reports Server (NTRS)

Brisbin, Steve

1997-01-01

The Breakout Session is a traditional conference instrument used by the NASA Occupational Health Program (OHP) as a method to convene people with common interests. Typically these sessions provide discussion of current topics of high priority and currency and allow multiple views and opinions to be shared and evaluated by all participants. Since the Contracting Officer's Technical Representatives (COTRs) occupy the technical focus of support contract management, this particular group, attended by 20 representatives, addressed issues and topics at the forefront of operational concerns.

Acute management and outcome of multiple trauma patients with pelvic disruptions

PubMed Central

2012-01-01

Introduction Data on prehospital and trauma-room fluid management of multiple trauma patients with pelvic disruptions are rarely reported. Present trauma algorithms recommend early hemorrhage control and massive fluid resuscitation. By matching the German Pelvic Injury Register (PIR) with the TraumaRegister DGU (TR) for the first time, we attempt to assess the initial fluid management for different Tile/OTA types of pelvic-ring fractures. Special attention was given to the patient's posttraumatic course, particularly intensive care unit (ICU) data and patient outcome. Methods A specific match code was applied to identify certain patients with pelvic disruptions from both PIR and TR anonymous trauma databases, admitted between 2004 and 2009. From the resulting intersection set, a retrospective analysis was done of prehospital and trauma-room data, length of ICU stay, days of ventilation, incidence of multiple organ dysfunction syndrome (MODS), sepsis, and mortality. Results In total, 402 patients were identified. Mean ISS was 25.9 points, and the mean of patients with ISS ≥16 was 85.6%. The fracture distribution was as follows: 19.7% type A, 29.4% type B, 36.6% type C, and 14.3% isolated acetabular and/or sacrum fractures. The type B/C, compared with type A fractures, were related to constantly worse vital signs that necessitated a higher volume of fluid and blood administration in the prehospital and/or the trauma-room setting. This group of B/C fractures were also related to a significantly higher presence of concomitant injuries and related to increased ISS. This was related to increased ventilation and ICU stay, increased rate of MODS, sepsis, and increased rate of mortality, at least for the type C fractures. Approximately 80% of the dead had sustained type B/C fractures. Conclusions The present study confirms the actuality of traditional trauma algorithms with initial massive fluid resuscitation in the recent therapy of multiple trauma patients with pelvic disruptions. Low-volume resuscitation seems not yet to be accepted in practice in managing this special patient entity. Mechanically unstable pelvic-ring fractures type B/C (according to the Tile/OTA classification) form a distinct entity that must be considered notably in future trauma algorithms. PMID:22913820

Perceptions of Adolescents with Overweight and Obesity for the Development of User-Centered Design Self-Management Tools within the Context of the Chronic Care Model: A Qualitative Study.

PubMed

Knoblock-Hahn, Amy L; Wray, Ricardo; LeRouge, Cynthia M

2016-06-01

The Chronic Care Model (CCM) is helpful to illustrate multiple levels of influence in the management of chronic disease, such as overweight and obesity in adolescents. Unfortunately, various constraints create gaps in the management process activities performed within the CCM. Consumer health technologies (CHT) may serve as a linkage between adolescents with overweight or obesity, their parents, and their pediatricians. To conduct formative research to qualitatively identify views of adolescents with overweight and obesity on use of consumer health technologies to manage weight loss across chronic care management settings. As part of a multi-perspective qualitative study, 10 focus groups were conducted with adolescents with overweight and obesity. Forty-eight adolescents (15 male, 33 female) aged 12 to 17 years who were current participants of an intensive lifestyle change camp in the summer of 2012 participated in focus groups. All adolescents were classified as overweight (21%) or obese (79%) according to body mass index (BMI) for age charts published by the Centers for Disease Control and Prevention. All focus groups were recorded, transcribed verbatim, and checked for accuracy. Predefined and open coding were used to analyze transcripts for emerging themes. Adolescents perceive CHT, with its functional requirements of assistance with restaurant food selection, teaching cooking skills, and providing encouragement and motivation, to be helpful with overweight and obesity self-management. Desired features to carry out these functional requirements included avatars, self-monitoring capabilities, social networking, and rewards. Our findings largely agree with previously reported parental perceptions of the benefit of CHT for adolescent overweight and obesity self-management and strengthen support for the design and implementation of CHT within the CCM. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Multiple Group Membership and Well-Being: Is There Always Strength in Numbers?

PubMed Central

Sønderlund, Anders L.; Morton, Thomas A.; Ryan, Michelle K.

2017-01-01

A growing body of research points to the value of multiple group memberships for individual well-being. However, much of this work considers group memberships very broadly and in terms of number alone. We conducted two correlational studies exploring how the relationship between multiple group membership and well-being is shaped by (a) the complexity of those groups within the overall self-concept (i.e., social identity complexity: SIC), and (b) the perceived value and visibility of individual group memberships to others (i.e., stigma). Study 1 (N = 112) found a positive relationship between multiple group membership and well-being, but only for individuals high in SIC. This effect was mediated by perceived identity expression and access to social support. Study 2 (N = 104) also found that multiple group memberships indirectly contributed to well-being via perceived identity expression and social support, as well as identity compatibility and perceived social inclusion. But, in this study the relationship between multiple group memberships and well-being outcomes was moderated by the perceived value and visibility of group memberships to others. Specifically, possessing multiple, devalued and visible group memberships compromised well-being relative to multiple valued group memberships, or devalued group memberships that were invisible. Together, these studies suggest that the benefits of multiple group membership depend on factors beyond their number. Specifically, the features of group memberships, individually and in combination, and the way in which these guide self-expression and social action, determine whether these are a benefit or burden for individual well-being. PMID:28680414

Randomized, controlled, two-arm, interventional, multicenter study on risk-adapted damage control orthopedic surgery of femur shaft fractures in multiple-trauma patients.

PubMed

Rixen, Dieter; Steinhausen, Eva; Sauerland, Stefan; Lefering, Rolf; Maegele, Marc G; Bouillon, Bertil; Grass, Guido; Neugebauer, Edmund A M

2016-01-25

Long bone fractures, particularly of the femur, are common in multiple-trauma patients, but their optimal management has not yet been determined. Although a trend exists toward the concept of "damage control orthopedics" (DCO), current literature is inconclusive. Thus, a need exists for a more specific controlled clinical study. The primary objective of this study was to clarify whether a risk-adapted procedure for treating femoral fractures, as opposed to an early definitive treatment strategy, leads to an improved outcome (morbidity and mortality). The study was designed as a randomized controlled multicenter study. Multiple-trauma patients with femur shaft fractures and a calculated probability of death of 20 to 60 % were randomized to either temporary fracture fixation with external fixation and defined secondary definitive treatment (DCO) or primary reamed nailing (early total care). The primary objective was to reduce the extent of organ failure as measured by the maximum sepsis-related organ failure assessment (SOFA) score. Thirty-four patients were randomized to two groups of 17 patients each. Both groups were comparable regarding sex, age, injury severity score, Glasgow Coma Scale, prothrombin time, base excess, calculated probability of death, and other physiologic variables. The maximum SOFA score was comparable (nonsignificant) between the groups. Regarding the secondary endpoints, the patients with external fixation required a significantly longer ventilation period (p = 0.049) and stayed on the intensive care significantly longer (p = 0.037), whereas the in-hospital length of stay was balanced for both groups. Unfortunately, the study had to be terminated prior to reaching the anticipated sample size because of unexpected low patient recruitment. Thus, the results of this randomized study reflect the ambivalence in the literature. No advantage of the damage control concept could be detected in the treatment of femur fractures in multiple-trauma patients. The necessity for scientific evaluation of this clinically relevant question remains. Current Controlled Trials ISRCTN10321620 Date assigned: 9 February 2007.

The impact of HMO competition on private health insurance premiums, 1985-1992.

PubMed

Wickizer, T M; Feldstein, P J

1995-01-01

A critical unresolved health policy question is whether competition stimulated by managed care organizations can slow the rate of growth in health care expenditures. We analyzed the competitive effects of health maintenance organizations (HMOs) on the growth in fee-for-service indemnity insurance premiums over the period 1985-1992 using premium data on 95 groups that had policies with a single, large, private insurance carrier. We used multiple regressions to estimate the effect of HMO market penetration on insurance premium growth rates. HMO penetration had a statistically significant (p < .015) negative effect on the rate of growth in indemnity insurance premiums. For an average group located in a market whose HMO penetration rate increased by 25% (e.g., from 10% to 12.5%), the real rate of growth in premiums would be approximately 5.9% instead of 7.0%. Our findings indicate that competitive strategies, relying on managed care, have significant potential to reduce health insurance premium growth rates, thereby resulting in substantial cost savings over time.

Multiple Attempts for Online Assessments in an Operations Management Course: An Exploration

ERIC Educational Resources Information Center

Orchard, Ryan K.

2016-01-01

In learning management systems, tools for online homework assessments include a number of alternatives for the assessment settings, including the ability to permit students to attempt an assessment multiple times, with options for how the multiple attempts are administered. A specific implementation of online assessments in an introductory…

Who can provide diabetes self-management support in primary care? Findings from a randomized controlled trial.

PubMed

Siminerio, Linda; Ruppert, Kristine M; Gabbay, Robert A

2013-01-01

The purpose of this comparative effectiveness study is to compare diabetes self-management support (DSMS) approaches and determine who can be most effective in helping patients maintain/improve clinical outcomes, self-care behaviors, distress, and satisfaction following diabetes self-management education (DSME) delivered in primary care. After receiving DSME, 141 participants were randomized to receive DSMS delivered by a trained supporter: educator, peer, practice staff, or usual education during a 6-month follow-up period. DSMS groups were compared to determine which supporter helped participants to maintain/improve A1C, blood pressure, lipids, weight, self-care, and distress. DSMS satisfaction was also examined. There was a significant improvement in A1C, empowerment, aspects of self-care, and distress following DSME at 6 weeks. Those in the educator DSMS group best sustained improved A1C while those in the other DSMS groups maintained glycemic improvements but began to show trends toward worsening. No significant differences or clear trends were seen in other clinical, behavioral, or psychosocial outcomes. The Program Reinforcement Impacts Self-Management (PRISM) study demonstrates that following DSME, participants maintained improved glycemia, lipid, weight, and self-care behaviors and reductions in distress throughout the delivery of DSMS interventions regardless of DSMS supporter. All of the participants reported satisfaction with DSMS. These findings reaffirm the critical role of educators but suggest that others may serve as DSMS supporters. Results suggest that DSME delivered in primary care is effective and multiple DSMS agents are reasonable. As patient-centered self-management approaches are being explored in primary care, delivery of DSME and DSMS becomes paramount.

EMPOWER-support of patient empowerment by an intelligent self-management pathway for patients: study protocol.

PubMed

Mantwill, Sarah; Fiordelli, Maddalena; Ludolph, Ramona; Schulz, Peter J

2015-03-20

Diabetes education together with patient empowerment has shown to be key to effective self-management behavior. When delivered through information and communication technologies (ICT), this solution has shown to lead to better health outcomes. However, the potential of ICT and their integration into the healthcare environment have not yet been fully exploited. ICT should be in particular used to facilitate communication and information exchange between patient and healthcare providers. In addition, systems should include components facilitating behavior change using empowerment approaches such as goal-setting. Funded by the European Commission (FP7-ICT-2011-288209) a web/mobile based platform (EMPOWER) has been developed, which aims at supporting self-management activities of diabetes patients and their treating physicians in Germany and Turkey. The platform semantically integrates multiple information sources, such as electronic and personal health records (EHR/PHR). Patients can register patterns of daily living, record blood glucose levels, design disease management plans and set long- and short-term goals. The project actively involves the treating physician, who has the possibility to set recommendations for the patient and to monitor his/her progress on the platform. In the test-phase of EMPOWER, patients will be assigned to an intervention group and a control group. Data will be collected at baseline and three months after the intervention started. In addition, qualitative interviews will be conducted to collect extra information on usability and usefulness. Outcome measures include amongst others the Problem Areas in Diabetes questionnaire (PAID), the Summary of Diabetes Self-Care Activities and scales evaluating doctor-patient interaction. Physiological parameters, such as physical activity or blood glucose levels will be collected via the platform. Further, log files and number of logins will serve as independent variables. The interplay between multiple sources, including EHR, patients' own registered information and physicians' recommendations on one platform can have important practice implications. It might not only improve self-management activities in diabetes patients but it will also facilitate physician's work, and ultimately the physician patient relationship. The trial has been registered with Deutsches Register Klinischer Studien (German register of clinical trials) under DRKS00007699 on January 30, 2015.

The management of diagnosed heart failure in older people in primary care.

PubMed

Jones, Nicholas R; Hobbs, F D Richard; Taylor, Clare J

2017-12-01

Heart failure (HF) is a common condition affecting predominantly older people. Symptoms include breathlessness and fatigue, and can significantly reduce quality of life. HF rarely occurs in isolation, with most patients having several co-existing diseases requiring multiple medications. There is a large evidence base for treatment of HF with reduced ejection fraction, or HFrEF; however, many of the trials did not include older people with multimorbidity so their findings should be applied to this group with some caution. The evidence for treatment of HF with preserved ejection fraction, or HFpEF, is much less well established in all age groups. Older people with HF are usually managed in primary care with input from specialist HF teams when needed. General practitioners are trained to take a generalist approach, which allows them to deliver holistic, person-centred care. The wider multidisciplinary team is also important during the patient's HF journey, with a particular need to consider palliative care towards the end of life. This article summarises the important aspects of HF management in older people from the perspective of primary care. Copyright © 2017 Elsevier B.V. All rights reserved.

Text messaging to support off-campus clinical nursing facilitators: a descriptive survey.

PubMed

Howard, Christine; Fox, Amanda R; Coyer, Fiona

2014-06-01

Managing large student cohorts can be a challenge for university academics, coordinating these units. Bachelor of Nursing programmes have the added challenge of managing multiple groups of students and clinical facilitators whilst completing clinical placement. Clear, time efficient and effective communication between coordinating academics and clinical facilitators is needed to ensure consistency between student and teaching groups and prompt management of emerging issues. This study used a descriptive survey to explore the use of text messaging via a mobile phone, sent from coordinating academics to off-campus clinical facilitators, as an approach to providing direction and support. The response rate was 47.8% (n=22). Correlations were found between the approachability of the coordinating academic and clinical facilitator perception that, a) the coordinating academic understood issues on clinical placement (r=0.785, p<0.001), and b) being part of the teaching team (r=0.768, p<0.001). Analysis of responses to qualitative questions revealed three themes: connection, approachability and collaboration. This study demonstrates that use of regular text messages improves communication between coordinating academics and clinical facilitators. Findings suggest improved connection, approachability and collaboration between the coordinating academic and clinical facilitation staff. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effect of multiple chronic diseases on health care expenditures in childhood.

PubMed

Zhong, Wenjun; Finnie, Dawn M; Shah, Nilay D; Wagie, Amy E; St Sauver, Jennifer L; Jacobson, Debra J; Naessens, James M

2015-01-01

To examine multiple chronic conditions and related health care expenditures in children. Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims. The most prevalent chronic conditions were asthma/chronic obstructive pulmonary disease (12%), allergic rhinitis (11%), and behavior problems (9%). The most costly conditions were congenital anomalies, asthma/chronic obstructive pulmonary disease, and behavior problems ($9602, $4335, and $5378 annual cost per child, respectively). Annual health care expenditures increased substantially with the number of chronic conditions, and a small proportion of children with multiple chronic conditions accounted for a large proportion of health care costs. In addition, those with multiple chronic conditions were more likely to persist in the top 10th percentile spender group in year-to-year spending. Children with multiple chronic conditions accounted for a large proportion of health care expenditures. These children were also likely to persist as high spenders in the 4-year time frame. Further research into effective ways to manage the health care delivery for children with multiple chronic conditions is needed. © The Author(s) 2014.

Medical equipment management strategies.

PubMed

Wang, Binseng; Furst, Emanuel; Cohen, Ted; Keil, Ode R; Ridgway, Malcolm; Stiefel, Robert

2006-01-01

Clinical engineering professionals need to continually review and improve their management strategies in order to keep up with improvements in equipment technology, as well as with increasing expectations of health care organizations. In the last 20 years, management strategies have evolved from the initial obsession with electrical safety to flexible criteria that fit the individual institution's needs. Few hospitals, however, are taking full advantage of the paradigm shift offered by the evolution of joint Commission standards. The focus should be on risks caused by equipment failure, rather than on equipment with highest maintenance demands. Furthermore, it is not enough to consider risks posed by individual pieces of equipment to individual patients. It is critical to anticipate the impact of an equipment failure on larger groups of patients, especially when dealing with one of a kind, sophisticated pieces of equipment that are required to provide timely and accurate diagnoses for immediate therapeutic decisions or surgical interventions. A strategy for incorporating multiple criteria to formulate appropriate management strategies is provided in this article.

Gold nanostructure materials in diabetes management

NASA Astrophysics Data System (ADS)

Si, Satyabrata; Pal, Arttatrana; Mohanta, Jagdeep; Sagar Satapathy, Smith

2017-04-01

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia, and is now one of the most non-communicable diseases globally and can be lethal if not properly controlled. Prolonged exposure to chronic hyperglycemia, without proper management, can lead to various vascular complications and represents the main cause of morbidity and mortality in diabetes patients. Studies have indicated that major long-term complications of diabetes arise from persistent oxidative-nitrosative stress and dysregulation in multiple metabolic pathways. Presently, the main focus for diabetes management is to optimize the available techniques to ensure adequate blood sugar level, blood pressure and lipid profile, thereby minimizing the diabetes complications. In this regard, nanomedicine utilizing gold nanostructures has great potential and seems to be a promising option. The present review highlights the basic concepts and up-to-date literature survey of gold nanostructure materials in management of diabetes in several ways, which include sensing, imaging, drug delivery and therapy. The work can be of interest to various researchers working on basic and applied sciences including nanosciences.

Advancing nursing leadership: a model for program implementation and measurement.

PubMed

Omoike, Osei; Stratton, Karen M; Brooks, Beth A; Ohlson, Susan; Storfjell, Judy Lloyd

2011-01-01

Despite the abundant literature documenting the need for nurse management education and career development, only recently have professional standards been targeted for this group. Competency standards for nurse leaders repeatedly identify systems-level concepts including finance and budget, communication skills, strategic management, human resources management, change management, and computer technology skills. However, educational initiatives to meet these standards are still at the early stages and most nurse leaders continue to acquire knowledge and experience through "on-the-job" training. This article will illustrate the need for partnerships and collaboration between academia and hospitals to advance nursing leadership to the next century. In addition, a tool to measure the impact of a graduate certificate program in nursing administration on nurse leader competencies is presented. Overall, the certificate program has been successful in multiple ways; it has "graduated" almost 80 nurse leaders, improved participant competence in their role at the systems level, as well as providing an impetus for completion of a graduate degree post program.

Variables contributing to an excellent customer service management profile within the regulated electric utility industry: A comparison of self-concept with customer satisfaction for customer service management

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

Johnson, L.E.

1991-01-01

This research sought to address the relationship between self-concept and customer satisfaction: can customer satisfaction with a major electric utility be explained in terms of the self-reported, self-concept of the utility's managers The population to which the results of this study were generalized consisted of customer service managers in public electric utilities across the United States. In order to represent this population, a sample was selected consisting of customer service managers at a midwestern electric utility based in a large metropolitan area. Participants in this study were managers of four direct customer contact service organizations within six geographic division organizations.more » The methodology included comparisons of these four customer contact service organizations on twelve independent, self-concept variables and six customer satisfaction dependent variables using Analysis of Variance (ANOVA), Scheffe' tests, Chi-Square, and Stepwise multiple regression. The groups were found not to be significantly different and knowledge of the self-concept scores for managers will not increase the ability to predict customer satisfaction over no knowledge of self-concept scores.« less

Duplicative medications in patients who visit multiple medical institutions among the insured of a corporate health insurance society in Japan.

PubMed

Kinoshita, Hiroki; Kobayashi, Yasuki; Fukuda, Takashi

2008-01-01

The objective of this paper is to describe the frequency of duplicative medication use and to estimate the drug cost associated with duplicative medications in patients who visit multiple medical institutions in Japan. The subjects of this study were insurants of a corporate health insurance society. We examined claims of insurants who received prescriptions from multiple medical institutions in April 2002. We examined characteristics of insurants who received duplicative medications and calculated the cost of duplicated drugs. 8.8% received drugs with the same mechanism of action for overlapping administration periods. In terms of comparison among three age groups, 0-19 years old, 20-69 years old, and 70 years old or older, the percentage was higher in 0-19-year-old patients than in the other age groups. The cost of duplicated drugs was found to be 0.7% or 0.5% of the total drug cost, when calculated with higher-priced drugs and lower-priced drugs, respectively. This study suggests that pediatric and teenage patients as well as elderly patients require prudent management of medication to avoid duplicative medications and that at least an estimated 5.2-7.2 billion yen may be saved if duplicative medications can be completely eliminated nationwide.

Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

PubMed

Sánchez-Carrillo, C I

1989-01-01

Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries, psychological trauma, and survival.

Developing a national dental education research strategy: priorities, barriers and enablers.

PubMed

Ajjawi, Rola; Barton, Karen L; Dennis, Ashley A; Rees, Charlotte E

2017-03-29

This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. Scotland. In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology. This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation. 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/.

Shot Group Statistics for Small Arms Applications

DTIC Science & Technology

2017-06-01

standard deviation. Analysis is presented as applied to one , n-round shot group and then is extended to treat multiple, n-round shot groups. A...dispersion measure for multiple, n-round shot groups can be constructed by selecting one of the dispersion measures listed above, measuring the dispersion of...as applied to one , n-round shot group and then is extended to treat multiple, n-round shot groups. A dispersion measure for multiple, n- round shot

Why are there gaps in our management of those with high cardiovascular risk?

PubMed

Doolan-Noble, Fiona; Tracey, Jocelyn; Mann, Stewart

2012-03-01

Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector.

Assessing ecological integrity using multiscale information from Bureau of Land Management Assessment and Monitoring Programs [Chapter 4

Treesearch

Sarah K. Carter; Natasha B. Carr; Curtis H. Flather; Erica Fleishman; Matthias Leu; Barry R. Noon; David J. A. Wood

2016-01-01

The Bureau of Land Management manages 246 million surface acres (100 million hectares) across the United States for multiple uses and sustained yield. Ensuring protection of ecological systems in the context of multiple, and often conflicting, resource uses and values is a challenge. Ecological integrity and land health are terms used by the Bureau of Land Management...

The Effect of Integration of Self-Management Web Platforms on Health Status in Chronic Obstructive Pulmonary Disease Management in Primary Care (e-Vita Study): Interrupted Time Series Design.

PubMed

Talboom-Kamp, Esther Pwa; Verdijk, Noortje A; Kasteleyn, Marise J; Harmans, Lara M; Talboom, Irvin Jsh; Looijmans-van den Akker, Ingrid; van Geloven, Nan; Numans, Mattijs E; Chavannes, Niels H

2017-08-16

Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves quality of life for COPD patients and can reduce hospitalization. Self-management of COPD through eHealth is an effective method to improve IDM and clinical outcomes. The objective of this implementation study was to investigate the effect of 3 chronic obstructive pulmonary disease eHealth programs applied in primary care on health status. The e-Vita COPD study compares different levels of integration of Web-based self-management platforms in IDM in 3 primary care settings. Patient health status is examined using the Clinical COPD Questionnaire (CCQ). The parallel cohort design includes 3 levels of integration in IDM (groups 1, 2, 3) and randomization of 2 levels of personal assistance for patients (group A, high assistance, group B, low assistance). Interrupted time series (ITS) design was used to collect CCQ data at multiple time points before and after intervention, and multilevel linear regression modeling was used to analyze CCQ data. Of the 702 invited patients, 215 (30.6%) registered to a platform. Of these, 82 participated in group 1 (high integration IDM), 36 in group 1A (high assistance), and 46 in group 1B (low assistance); 96 participated in group 2 (medium integration IDM), 44 in group 2A (high assistance) and 52 in group 2B (low assistance); also, 37 participated in group 3 (no integration IDM). In the total group, no significant difference was found in change in CCQ trend (P=.334) before (-0.47% per month) and after the intervention (-0.084% per month). Also, no significant difference was found in CCQ changes before versus after the intervention between the groups with high versus low personal assistance. In all subgroups, there was no significant change in the CCQ trend before and after the intervention (group 1A, P=.237; 1B, P=.991; 2A, P=.120; 2B, P=.166; 3, P=.945). The e-Vita eHealth-supported COPD programs had no beneficial impact on the health status of COPD patients. Also, no differences were found between the patient groups receiving different levels of personal assistance. Netherlands Trial Registry NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6sbM5PayG). ©Esther PWA Talboom-Kamp, Noortje A Verdijk, Marise J Kasteleyn, Lara M Harmans, Irvin JSH Talboom, Ingrid Looijmans-van den Akker, Nan van Geloven, Mattijs E Numans, Niels H Chavannes. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 16.08.2017.

Focusing biodiversity research on the needs of decision makers

NASA Astrophysics Data System (ADS)

Smythe, Katie D.; Bernabo, J. Christopher; Carter, Thomas B.; Jutro, Peter R.

1996-11-01

The project on Biodiversity Uncertainties and Research Needs (BURN) ensures the advancement of usable knowledge on biodiversity by obtaining input from decision makers on their priority information needs about biodiversity and then using this input to engage leading scientists in designing policy-relevant research. Decision makers articulated concerns related to four issues: significance of biodiversity; status and trends of biodiversity; management for biodiversity; and the linkage of social, cultural, economic, legal, and biological objectives. Leading natural and social scientists then identified the research required to address the decision makers' needs and determined the probability of success. The diverse group of experts reached consensus on several fundamental issues, helping to clarify the role of biodiversity in land and resource management. The BURN participants identified several features that should be incorporated into policy-relevant research plans and management strategies for biodiversity. Research and assessment efforts should be: multidisciplinary and integrative, participatory with stakeholder involvement, hierarchical (multiple scales), and problem- and region-specific. The activities should be focused regionally within a global perspective. Meta-analysis of existing data is needed on all fronts to assess the state of the science. More specifically, the scientists recommended six priority research areas that should be pursued to address the information needs articulated by decision makers: (1) characterization of biodiversity, (2) environmental valuation, (3) management for sustainability—for humans and the environment (adaptive management), (4) information management strategies, (5) governance and stewardship issues, and (6) communication and outreach. Broad recommendations were developed for each research area to provide direction for research planning and resource management strategies. The results will directly benefit those groups that require biodiversity research to address their needs—whether to develop policy, manage natural resources, or make other decisions affecting biodiversity.

Forecasting of indirect consumables for a Job Shop

NASA Astrophysics Data System (ADS)

Shakeel, M.; Khan, S.; Khan, W. A.

2016-08-01

A job shop has an arrangement where similar machines (Direct consumables) are grouped together and use indirect consumables to produce a product. The indirect consumables include hack saw blades, emery paper, painting brush etc. The job shop is serving various orders at a particular time for the optimal operation of job shop. Forecasting is required to predict the demand of direct and indirect consumables in a job shop. Forecasting is also needed to manage lead time, optimize inventory cost and stock outs. The objective of this research is to obtain the forecast for indirect consumables. The paper shows how job shop can manage their indirect consumables more accurately by establishing a new technique of forecasting. This results in profitable use of job shop by multiple users.

Multicystic dedifferentiated retroperitoneal liposarcoma: tumour cyst fluid analysis and implications for management.

PubMed

Khoury, Mitri; Sim, Geok Choo; Harao, Michiko; Radvanyi, Laszlo; Amini, Behrang; Benjamin, Robert S; Pisters, Peter W T; Pollock, Raphael E; Tseng, William W

2015-07-08

Liposarcomas are soft tissue sarcomas of adipocyte origin. We describe a case of a dedifferentiated retroperitoneal liposarcoma with an unusual presentation on recurrence as a large, multicystic tumour. The patient was a 72-year-old woman who had undergone multiple treatments including two prior resections. For her most recent locoregional disease recurrence, the patient was offered surgical debulking for symptom palliation. At this operation, performed after two cycles of chemotherapy, the tumour cyst fluid was analysed and found to have a predominance of immune cells with no identifiable malignant cells. This case and the results of our tumour cyst fluid analysis raise several interesting considerations for the management of this unique situation in a rare disease. 2015 BMJ Publishing Group Ltd.

Using qualitative studies to improve the usability of an EMR.

PubMed

Rose, Alan F; Schnipper, Jeffrey L; Park, Elyse R; Poon, Eric G; Li, Qi; Middleton, Blackford

2005-02-01

The adoption of electronic medical records (EMRs) and user satisfaction are closely associated with the system's usability. To improve the usability of a results management module of a widely deployed web-based EMR, we conducted two qualitative studies that included multiple focus group and field study sessions. Qualitative research can help focus attention on user tasks and goals and identify patterns of care that can be visualized through task modeling exercises. Findings from both studies raised issues with the amount and organization of information in the display, interference with workflow patterns of primary care physicians, and the availability of visual cues and feedback. We used the findings of these studies to recommend design changes to the user interface of the results management module.

Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City.

PubMed

Albu, Jeanine; Sohler, Nancy; Matti-Orozco, Brenda; Sill, Jordan; Baxter, Daniel; Burke, Gary; Young, Edwin

2013-01-01

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community-clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre-post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.

Stories and metaphors in the sensemaking of multiple primary health care organizational identities

PubMed Central

2014-01-01

Background The Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms. Methods We conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis. Results The core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change. Conclusions In order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time. PMID:24588933

Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies.

PubMed

Miller, Jordan; MacDermid, Joy C; Richardson, Julie; Walton, David M; Gross, Anita

2017-01-01

Previous evidence suggests self-management programs for people with chronic pain improve knowledge and self-efficacy, but result in small to negligible changes in function. The purpose of this multiple case studies design was to describe the unique responses of six participants to a new self-management program aimed at improving function, to detail each component of the program, and to explore potential explanations for the varied trajectories of each of the participants. Six participants who had been experiencing chronic pain for at least 5 years were included. All participants were enrolled 6 weeks of ChrOnic pain self-ManageMent support with pain science EducatioN and exercise (COMMENCE). Participants completed an assessment at baseline, 7 weeks (1-week follow-up), and 18 weeks (12-week follow-up). Each participant had a unique initial presentation and goals. Assessments included: function as measured by the Short Musculoskeletal Function Assessment - Dysfunction Index, how much participants are bothered by functional difficulties, pain intensity, fatigue, pain interference, cognitive and psychological factors associated with pain and disability, pain neurophysiology, self-efficacy, satisfaction, and perceived change. The self-management program was 6-weeks in length, consisting of one individual visit and one group visit per week. The program incorporated three novel elements not commonly included in self-management programs: pain neurophysiology education, individualized exercises determined by the participants' goals, and additional cognitive behavioural approaches. Participants were all satisfied with self-management support received. Change in function was variable ranging from 59% improvement to 17% decline. Two potential explanations for variances in response, attendance and social context, are discussed. Several challenges were identified by participants as barriers to attendance. A primary care self-management intervention including pain education and individualized exercise has potential to improve function for some people with chronic pain, although strategies to improve adherence and reduce barriers to participation may be needed to optimize the impact.

Self-Management for People with Multiple Sclerosis

PubMed Central

Fraser, Robert; Ehde, Dawn; Amtmann, Dagmar; Johnson, Kurt L.; Johnson, Erica; Kraft, George H.

2013-01-01

People with multiple sclerosis (MS) must manage the day-to-day effects of the disease on their lives. Self-management interventions may be helpful in this challenge. An international, multidisciplinary consensus conference was held on November 15, 2010, by the University of Washington's Rehabilitation Research and Training Center for Multiple Sclerosis (MS RRTC), with funding from the Consortium of Multiple Sclerosis Centers (CMSC) and the National Institute on Disability and Rehabilitation Research (NIDRR), to discuss the concept of self-management for people with MS. The specific goals of the consensus conference were as follows: 1) review the current research on self-management and related issues in chronic disability and specifically in MS; 2) review optimal research methodologies, outcome measurement tools, program planning frameworks, and dissemination strategies for self-management research; and 3) establish recommendations on the next steps necessary to develop, adapt, and test self-management interventions for people with MS. The consensus conference and this document are the initial steps toward achieving the stated goals. Participants in the consensus conference concluded that it is necessary to: 1) define an empirically based conceptual model of self-management for people with MS; 2) establish reliable and valid self-management outcome measures; 3) use best practices to validate models of self-management interventions; and 4) plan dissemination and knowledge translation of interventions once their effectiveness is established. PMID:24453769

Defining ecological and economical hydropoweroperations: a framework for managing dam releasesto meet multiple conflicting objectives

USGS Publications Warehouse

Irwin, Elise R.

2014-01-01

Hydroelectric dams are a flexible source of power, provide flood control, and contribute to the economic growth of local communities through real-estate and recreation. Yet the impoundment of rivers can alter and fragment miles of critical riverine habitat needed for other competing needs such as downstream consumptive water use, fish and wildlife population viability, or other forms of recreation. Multiple conflicting interests can compromise progressive management especially with recognized uncertainties related to whether management actions will fulfill the objectives of policy makers, resource managers and/or facility owners. Decision analytic tools were used in a stakeholder-driven process to develop and implement a template for evaluation and prediction of the effects of water resource management of multiple-use systems under the context provided by R.L. Harris Dam on the Tallapoosa River, Alabama, USA. The approach provided a transparent and structured framework for decision-making and incorporated both existing and new data to meet multiple management objectives. Success of the template has been evaluated by the stakeholder governing body in an adaptive resource management framework since 2005 and is ongoing. Consequences of management of discharge at the dam were evaluated annually relative to stakeholder satisfaction to allow for adjustment of both management scenarios and objectives. This template can be applied to attempt to resolve conflict inherent in many dam-regulated systems where management decisions impact diverse values of stakeholders.

The role of Social Support in Multiple Morbidity: Self-Management among rural residents

PubMed Central

Bardach, Shoshana H.; Tarasenko, Yelena N.; Schoenberg, Nancy E.

2013-01-01

Social support generally is considered a valuable asset that may compensate for health service deficiencies among rural populations. Employing a mixed methods approach, we explored how vulnerable rural residents described social support in the context of self-management for multiple chronic conditions. Participants generally felt support was available, though emotional/informational support was perceived as less available than other types of support. Participants did not rely heavily on informal support to help them manage their multiple morbidities, preferring to call on their doctor and their own resources. We discuss implications of these findings for meeting this vulnerable population’s self-management needs. PMID:21841277

Labial adhesions and outcomes of office management.

PubMed

Granada, Catalina; Sokkary, Nancy; Sangi-Haghpeykar, Haleh; Dietrich, Jennifer E

2015-04-01

To evaluate clinical outcomes of labial adhesions (LA) and to examine the association between LA, lichen sclerosus (LS), eczema (ECZ), or asthma. Retrospective study. Single pediatric and adolescent gynecology clinic, Houston, Texas. 50 girls diagnosed with LA from 2006-2011. Resolution, recurrence, single vs multiple treatments, need for surgery, and conditions such as LS, ECZ, and asthma were reviewed. Mean age was 19.6 months (range 0-84 months), and 48% were Caucasian. Most patients were symptomatic (62%) and all 50 patients chose estrogen treatment. The majority (74%) required multiple treatments, as opposed to a single treatment (26%). Patients with multiple treatments were more likely to be severely agglutinated (P = .05) and to need manual separation after failed topical treatment (P = .08). The prevalence of asthma, LS, and ECZ was 9.8%, 7.8%, and 3.9% respectively. There was no association between LS, ECZ, or asthma, and number of treatments. Both asthma (N = 3; 8%), and LS (N = 2; 5%) were present among the severe agglutinated group; however, this difference was not statistically significant (P values .59 and .99). No association with ECZ was seen in either group. Severe agglutination tends to be associated with need of multiple treatments and manual separation. A concurrent diagnosis of LS, ECZ, or asthma was not associated with number of treatments but there appears to be a trend towards severity of LA in patients with asthma and LS. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Service delivery under translation: multi-stakeholder accountability in the non-profit community sector in New Zealand.

PubMed

Boon, Bronwyn; Greatbanks, Richard; Munro, Jenny; Gaffney, Michael

2017-03-01

This paper addresses the challenge reported in the research literature of providing adequate accounts of service quality and value to multiple stakeholders. Rather than starting with a particular accountability practice, we examine the accounts of complex service delivery and results from the perspective of five key stakeholder groups. The case study at the empirical centre of this research is a small New Zealand non-profit organisation that provides community-based wraparound casework to young people, and their families, with multiple and complex needs. This paper reports on data collected during 2009-2012 through interviews with five key stakeholders of this service: the young people, the caseworkers, the co-providers, the managers and the funders. Drawing on translation theory, the different points of reference and the consequential shifts in focus, content and meaning within the multiple stakeholder accounts are traced. The findings show that while each stakeholder group brings a unique point of reference to the service delivery, there are degrees of overlap in the focus and content of the accounts. This is particularly evident in the 'relationship' dimension. While overlaps may exist, points of invisibility are also revealed. Accountability tensions can be traced directly to these points of invisibility. As a result of this analysis, it is argued that more explicit attention to the impact of multiple stakeholders at the level of epistemology provides a mechanism for addressing some of the tensions routinely raised. © 2015 John Wiley & Sons Ltd.

International Myeloma Working Group recommendations for global myeloma care.

PubMed

Ludwig, H; Miguel, J S; Dimopoulos, M A; Palumbo, A; Garcia Sanz, R; Powles, R; Lentzsch, S; Ming Chen, W; Hou, J; Jurczyszyn, A; Romeril, K; Hajek, R; Terpos, E; Shimizu, K; Joshua, D; Hungria, V; Rodriguez Morales, A; Ben-Yehuda, D; Sondergeld, P; Zamagni, E; Durie, B

2014-05-01

Recent developments have led to remarkable improvements in the assessment and treatment of patients with multiple myeloma (MM). New technologies have become available to precisely evaluate the biology and extent of the disease, including information about cytogenetics and genetic abnormalities, extramedullary manifestations and minimal residual disease. New, more effective drugs have been introduced into clinical practice, which enable clinicians to significantly improve the outcome of patients but also pose new challenges for the prevention and management of their specific side effects. Given these various new options and challenges, it is important to identify the minimal requirements for diagnosis and treatment of patients, as access to the most sophisticated advances may vary depending on local circumstances. Here, we propose the minimal requirements and possible options for diagnosis, monitoring and treatment of patients with multiple myeloma.

Systematic Review of the Effect of Taping Techniques on Patellofemoral Pain Syndrome.

PubMed

Logan, Catherine A; Bhashyam, Abhiram R; Tisosky, Ashley J; Haber, Daniel B; Jorgensen, Anna; Roy, Adam; Provencher, Matthew T

Taping is commonly used in the management of several musculoskeletal conditions, including patellofemoral pain syndrome (PFPS). Specific guidelines for taping are unknown. To investigate the efficacy of knee taping in the management of PFPS. Our hypothesis was that tension taping and exercise would be superior to placebo taping and exercise as well as to exercise or taping alone. The PubMed/MEDLINE, Cochrane, Rehabilitation and Sports Medicine Source, and CINAHL databases were reviewed for English-language randomized controlled trials (RCTs) evaluating the efficacy of various taping techniques that were published between 1995 and April 2015. Keywords utilized included taping, McConnell, kinesio-taping, kinesiotaping, patellofemoral pain, and knee. Studies included consisted of RCTs (level 1 or 2) with participants of all ages who had anterior knee or patellofemoral pain symptoms and had received nonsurgical management using any taping technique. Systematic review. Level 2. A checklist method was used to determine selection, performance, detection, and attrition bias for each article. A quality of evidence grading was then referenced using the validated PEDro database for RCTs. Three difference comparison groups were compared: tension taping and exercise versus placebo taping and exercise (group 1), placebo taping and exercise versus exercise alone (group 2), and tension taping and exercise versus taping alone (group 3). Five RCTs with 235 total patients with multiple intervention arms were included. Taping strategies included McConnell and Kinesiotaping. Visual analog scale (VAS) scores indicated improvement in all 3 comparison groups (group 1: 91 patients, 39% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 66 [placebo taping + exercise]; group 2: 56 patients, 24% of total, mean VAS improvement 66 [placebo taping + exercise] vs 47.6 [exercise alone]; and group 3: 112 patients, 48% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 14.1 [taping alone]). This systematic review supports knee taping only as an adjunct to traditional exercise therapy for PFPS; however, it does not support taping in isolation.

43 CFR 3802.4-3 - Multiple-use conflicts.

Code of Federal Regulations, 2011 CFR

2011-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR MINERALS MANAGEMENT (3000) MINING CLAIMS UNDER THE GENERAL MINING LAWS Exploration and Mining, Wilderness Review Program § 3802.4-3 Multiple-use conflicts. In the event that uses...

Integrating management strategies for the mountain pine beetle with multiple-resource management of lodgepole pine forests

Treesearch

Mark D. McGregor; Dennis M. Cole

1985-01-01

Provides guidelines for integrating practices for managing mountain pine beetle populations with silvicultural practices for enhancing multiple resource values of lodgepole pine forests. Summarizes published and unpublished technical information and recent research on the ecology of pest and host and presents visual and classification criteria for recognizing...

Multiple use forest management in a catchment context

Treesearch

Wayne T. Swank

1998-01-01

Over the past several decades there has been an acceleration of needs, uses, and expectations of forest lands in many countries. Indeed, foresters in the United States are faced with exciting opportunities to provide answers on complex issues of planning, policy, and science related to multiple use management. Integrated catchment management provides a powerful...

Multiple-use management of upland hardwood forests

Treesearch

Frederick A. Dorrell

1971-01-01

In recent years the National Forests have experienced much controversy over multiple-use management Because of this, the Forest Service is examining ways to improve the multiple-use planning process. One of the new approaches involves a special plan for eight National Forests in the South and Central Appalachian Mountains, in which planning is done by interdisciplinary...

Sustainable Assessment for Large Science Classes: Non-Multiple Choice, Randomised Assignments through a Learning Management System

ERIC Educational Resources Information Center

Schultz, Madeleine

2011-01-01

This paper reports on the development of a tool that generates randomised, non-multiple choice assessment within the BlackBoard Learning Management System interface. An accepted weakness of multiple-choice assessment is that it cannot elicit learning outcomes from upper levels of Biggs' SOLO taxonomy. However, written assessment items require…

High Level of Integration in Integrated Disease Management Leads to Higher Usage in the e-Vita Study: Self-Management of Chronic Obstructive Pulmonary Disease With Web-Based Platforms in a Parallel Cohort Design

PubMed Central

Verdijk, Noortje A; Kasteleyn, Marise J; Harmans, Lara M; Talboom, Irvin JSH; Numans, Mattijs E; Chavannes, Niels H

2017-01-01

Background Worldwide, nearly 3 million people die of chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM in several settings, but it remains unknown which factors influence usage of eHealth and change in behavior of patients. Objective Our study, e-Vita COPD, compares different levels of integration of Web-based self-management platforms in IDM in three primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-management platform for COPD patients. Methods The e-Vita COPD study compares three different approaches to incorporating eHealth via Web-based self-management platforms into IDM of COPD using a parallel cohort design. Three groups integrated the platforms to different levels. In groups 1 (high integration) and 2 (medium integration), randomization was performed to two levels of personal assistance for patients (high and low assistance); in group 3 there was no integration into disease management (none integration). Every visit to the e-Vita and Zorgdraad COPD Web platforms was tracked objectively by collecting log data (sessions and services). At the first log-in, patients completed a baseline questionnaire. Baseline characteristics were automatically extracted from the log files including age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ), dyspnea scale (MRC), and quality of life questionnaire (EQ5D). To predict the use of the platforms, multiple linear regression analyses for the different independent variables were performed: integration in IDM (high, medium, none), personal assistance for the participants (high vs low), educational level, and self-efficacy level (General Self-Efficacy Scale [GSES]). All analyses were adjusted for age and gender. Results Of the 702 invited COPD patients, 215 (30.6%) registered to a platform. Of the 82 patients in group 1 (high integration IDM), 36 were in group 1A (personal assistance) and 46 in group 1B (low assistance). Of the 96 patients in group 2 (medium integration IDM), 44 were in group 2A (telephone assistance) and 52 in group 2B (low assistance). A total of 37 patients participated in group 3 (no integration IDM). In all, 107 users (49.8%) visited the platform at least once in the 15-month period. The mean number of sessions differed between the three groups (group 1: mean 10.5, SD 1.3; group 2: mean 8.8, SD 1.4; group 3: mean 3.7, SD 1.8; P=.01). The mean number of sessions differed between the high-assistance and low-assistance groups in groups 1 and 2 (high: mean 11.8, SD 1.3; low: mean 6.7, SD 1.4; F1,80=6.55, P=.01). High-assistance participants used more services (mean 45.4, SD 6.2) than low-assistance participants (mean 21.2, SD 6.8; F1,80=6.82, P=.01). No association was found between educational level and usage and between GSES and usage. Conclusions Use of a self-management platform is higher when participants receive adequate personal assistance about how to use the platform. Blended care, where digital health and usual care are integrated, will likely lead to increased use of the online program. Future research should provide additional insights into the preferences of different patient groups. Trial Registration Nederlands Trial Register NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6qO1hqiJ1) PMID:28566268

Impact of Pilates Exercise in Multiple Sclerosis

PubMed Central

Duff, Whitney R.D.; Andrushko, Justin W.; Renshaw, Doug W.; Chilibeck, Philip D.; Farthing, Jonathan P.; Danielson, Jana

2018-01-01

Abstract Background: Pilates is a series of exercises based on whole-body movement and may improve mobility in people with multiple sclerosis (MS). The purpose of this study was to determine the effect of Pilates on walking performance in people with MS. Methods: 30 individuals with MS who were not restricted to a wheelchair or scooter (Patient-Determined Disease Steps scale score <7) were randomized to receive Pilates (twice weekly) and massage therapy (once weekly) or once-weekly massage therapy only (control group). The Pilates was delivered in a group setting (five to ten participants per session). The primary outcome was change in walking performance (6-Minute Walk Test) after 12 weeks. Secondary outcomes included functional ability (Timed Up and Go test), balance (Fullerton Advanced Balance Scale), flexibility (sit and reach test), body composition (dual-energy X-ray absorptiometry), core endurance (plank-hold test), and muscle strength and voluntary activation (quadriceps). Intention-to-treat analysis was performed using a two-factor repeated-measures analysis of variance. Results: Walking distance increased by a mean (SD) of 52.4 (40.2) m in the Pilates group versus 15.0 (34.1) m in the control group (group × time, P = .01). Mean (SD) time to complete the Timed Up and Go test decreased by 1.5 (2.8) seconds in the Pilates group versus an increase of 0.3 (0.9) seconds in the control group (group × time, P = .03). There were no other significant differences between groups over time. Conclusions: Pilates improved walking performance and functional ability in persons with MS and is a viable exercise option to help manage the disease. PMID:29670495

Calf health from birth to weaning. III. housing and management of calf pneumonia

PubMed Central

2011-01-01

Calfhood diseases have a major impact on the economic viability of cattle operations. A three part review series has been developed focusing on calf health from birth to weaning. In this paper, the last of the three part series, we review disease prevention and management with particular reference to pneumonia, focusing primarily on the pre-weaned calf. Pneumonia in recently weaned suckler calves is also considered, where the key risk factors are related to the time of weaning. Weaning of the suckler calf is often combined with additional stressors including a change in nutrition, environmental change, transport and painful husbandry procedures (castration, dehorning). The reduction of the cumulative effects of these multiple stressors around the time of weaning together with vaccination programmes (preconditioning) can reduce subsequent morbidity and mortality in the feedlot. In most studies, calves housed individually and calves housed outdoors with shelter, are associated with decreased risk of disease. Even though it poses greater management challenges, successful group housing of calves is possible. Special emphasis should be given to equal age groups and to keeping groups stable once they are formed. The management of pneumonia in calves is reliant on a sound understanding of aetiology, relevant risk factors, and of effective approaches to diagnosis and treatment. Early signs of pneumonia include increased respiratory rate and fever, followed by depression. The single most important factor determining the success of therapy in calves with pneumonia is early onset of treatment, and subsequent adequate duration of treatment. The efficacy and economical viability of vaccination against respiratory disease in calves remains unclear. PMID:22018053

Exploration Systems Development (ESD) Approach to Enterprise Risk Management

NASA Technical Reports Server (NTRS)

Bauder, Stephen P.

2014-01-01

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

Using participatory action research in a community-based initiative addressing complex mental health needs.

PubMed

Knightbridge, Stephen M; King, Robert; Rolfe, Timothy J

2006-04-01

This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.

Does surgical stabilization improve outcomes in patients with isolated multiple distracted and painful non-flail rib fractures?

PubMed

Girsowicz, Elie; Falcoz, Pierre-Emmanuel; Santelmo, Nicola; Massard, Gilbert

2012-03-01

A best evidence topic was constructed according to a structured protocol. The question addressed was whether surgical stabilization is effective in improving the outcomes of patients with isolated multiple distracted and painful non-flail rib fractures. Of the 356 papers found using a report search, nine presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the nine retrieved studies clearly support the use of surgical stabilization in the management of isolated multiple non-flail and painful rib fractures for improving patient outcomes. The interest and benefit was shown not only in terms of pain (McGill pain questionnaire) and respiratory function (forced vital capacity, forced expiratory volume in 1 s and carbon monoxide diffusing capacity), but also in improved quality of life (RAND 36-Item Health Survey) and reduced socio-professional disability. Indeed, most of the authors justified surgical management based on the fact that the results of surgical stabilization showed improvement in short- and long-term patient outcomes, with fast reduction in pain and disability, as well as lower average wait before recommencing normal activities. Hence, the current evidence shows surgical stabilization to be safe and effective in alleviating post-operative pain and in improving patient recovery, thus enhancing the outcome after isolated multiple rib fractures. However, given the little published evidence, prospective trials are necessary to confirm these encouraging results.

Short-Term and Long-Term Effects of an Exercise-Based Patient Education Programme in People with Multiple Sclerosis: A Pilot Study

PubMed Central

Haas, Christian T.

2017-01-01

Background. Although people with Multiple Sclerosis (pwMS) benefit from physical exercise, they still show reduced physical activity and exercise behaviour. This study aimed to investigate short- and long-term effects of an exercise-based patient education programme (ePEP) that focuses on empowering pwMS to a sustainable and self-regulated exercise training management. Methods. Fourteen pwMS were randomly assigned to immediate experimental group (EG-I: n = 8) and waitlist-control group (EG-W: n = 6) and attended biweekly in a six-week ePEP. All participants were measured for walking ability, quality of life, fatigue, and self-efficacy towards physical exercise before and after the ePEP, after 12 weeks, and one year after baseline. Short-term effects were analysed in a randomised control trial and long-term effects of all ePEP participants (EG-I + EG-W = EG-all) in a quasi-experimental design. Results. Only functional gait significantly improved in EG-I compared to EG-W (p = 0.008, r = −0.67). Moderate to large effects were found in EG-all for walking ability. Not significant, however, relevant changes were detected for quality of life and fatigue. Self-efficacy showed no changes. Conclusion. The ePEP seems to be a feasible option to empower pwMS to a self-regulated and sustainable exercise training management shown in long-term walking improvements. PMID:28900546

Flexible Unicast-Based Group Communication for CoAP-Enabled Devices †

PubMed Central

Ishaq, Isam; Hoebeke, Jeroen; Van den Abeele, Floris; Rossey, Jen; Moerman, Ingrid; Demeester, Piet

2014-01-01

Smart embedded objects will become an important part of what is called the Internet of Things. Applications often require concurrent interactions with several of these objects and their resources. Existing solutions have several limitations in terms of reliability, flexibility and manageability of such groups of objects. To overcome these limitations we propose an intermediately level of intelligence to easily manipulate a group of resources across multiple smart objects, building upon the Constrained Application Protocol (CoAP). We describe the design of our solution to create and manipulate a group of CoAP resources using a single client request. Furthermore we introduce the concept of profiles for the created groups. The use of profiles allows the client to specify in more detail how the group should behave. We have implemented our solution and demonstrate that it covers the complete group life-cycle, i.e., creation, validation, flexible usage and deletion. Finally, we quantitatively analyze the performance of our solution and compare it against multicast-based CoAP group communication. The results show that our solution improves reliability and flexibility with a trade-off in increased communication overhead. PMID:24901978

Achieving Harmony among Different Social Identities within the Self-Concept: The Consequences of Internalising a Group-Based Philosophy of Life

PubMed Central

Turner-Zwinkels, Felicity M.; Postmes, Tom; van Zomeren, Martijn

2015-01-01

It can be hard for individuals to manage multiple group identities within their self-concept (e.g., being a Christian and a woman). We examine how the inter-identity fit between potentially conflicting identities can become more harmonious through a self-defining group philosophy for life. Specifically, we test the hypothesis that holistic group identities (based in group philosophies for life that prescribe the behavior of their members in any situation, such as religion) become more strongly related to other identities in the self-concept (e.g., gender) when they are strongly self-defining (i.e., devotedly applied to daily life). In three studies we investigated the inter-identity fit between individuals’ (highly holistic) religious identity and (less holistic) gender identity. Results provided converging support for our hypothesis across diverging methods (explicit questionnaires, more implicit associations, and a novel network analysis of group traits). We discuss the importance of understanding how some (i.e., holistic and self-defining) group identities may harmonize otherwise less harmonious group identities within one’s self-concept. PMID:26618917

Achieving Harmony among Different Social Identities within the Self-Concept: The Consequences of Internalising a Group-Based Philosophy of Life.

PubMed

Turner-Zwinkels, Felicity M; Postmes, Tom; van Zomeren, Martijn

2015-01-01

It can be hard for individuals to manage multiple group identities within their self-concept (e.g., being a Christian and a woman). We examine how the inter-identity fit between potentially conflicting identities can become more harmonious through a self-defining group philosophy for life. Specifically, we test the hypothesis that holistic group identities (based in group philosophies for life that prescribe the behavior of their members in any situation, such as religion) become more strongly related to other identities in the self-concept (e.g., gender) when they are strongly self-defining (i.e., devotedly applied to daily life). In three studies we investigated the inter-identity fit between individuals' (highly holistic) religious identity and (less holistic) gender identity. Results provided converging support for our hypothesis across diverging methods (explicit questionnaires, more implicit associations, and a novel network analysis of group traits). We discuss the importance of understanding how some (i.e., holistic and self-defining) group identities may harmonize otherwise less harmonious group identities within one's self-concept.

Development and feasibility of the Help to Overcome Problems Effectively (HOPE) self-management intervention for people living with multiple sclerosis.

PubMed

Anderson, Joanna K; Turner, Andy; Clyne, Wendy

2017-06-01

To describe the development and feasibility of a self-management intervention called the Help to Overcome Problems Effectively (HOPE: MS), aimed at improving the physical and psychological wellbeing of people living with Multiple Sclerosis (MS). HOPE: MS is an innovative, 6-week group-based, manualised self-management intervention combining positive psychology theory and practice, and cognitive behavioural therapy (CBT). Participants (N = 21) recruited via a local East Midlands branch of the MS Society attended one of three HOPE: MS interventions and completed self-reported outcome measures in week 1 and week 6. The following outcome measures were used: The Multiple Sclerosis Impact Scale; Multiple Sclerosis Fatigue Severity Scale; The Multiple Sclerosis Self-Efficacy Scale; The Adult State Hope Scale; The Hospital Anxiety and Depression Scale; The Positive and Negative Affect Scale. Post-intervention (6 weeks) mean scores decreased in the physical impact (baseline M = 65.6, SD = 17.4; 6 weeks M = 55.1, SD = 17.9, 95% CI [-4.39, -16.47] and the psychological impact of MS (baseline M = 24.0, SD = 7.3; 6 weeks M = 18.9; SD = 6.3, 95% CI [-2.54, -7.66]). There was also a decrease mean fatigue severity scores (baseline 49.4, SD = 13.3, 6 weeks M = 41.1, SD = 14.4, 95% CI [-2.65, -13.44]). There was a mean decrease in depression scores (baseline M = 6.9, SD = 3.5; 6 weeks M = 4.2, SD = 2.8, 95% CI [-1.43, -4.00]). There were smaller mean decreases in anxiety (baseline M = 7.6, SD = 3.4; 6 weeks M = 6.7 (4.0), 95% CI [0.69, -2.50]) and negative affect (baseline M = 22.9, SD = 6.8; 6 weeks M = 20.8 (8.1), 95% CI [0.69, -2.50]) refer Table 3 ). Mean MS self-efficacy scores (baseline 21.7, SD = 4.2; 6 weeks M = 24.1, SD = 4.7, 95% CI [0.23, 4.53]), mean total hope scores (baseline M = 23.3, SD = 10.7; 6 weeks M = 32.2 (10.6), 95% CI [4.91, 12.9]), hope agency scores (baseline M = 10.5, SD = 5.7; 6 weeks M = 15.7 (6.2), 95% CI [2.37, 8.01]), hope pathways (baseline M = 12.9, SD = 6.0; 6 weeks M = 16.6 (4.9), 95% CI [2.00, 5.43]) and positive affect scores increased (baseline M = 27.3, SD = 7.1; 6 months M = 32.2, SD = 8.4, 95% CI [0.42, 9.39]). Participants positively rated the intervention quality and delivery. This feasibility study showed that the HOPE: MS was acceptable and useful to people living with MS. Further robust evaluations using a randomised controlled trial design with longer follow ups are needed to confirm early promising results of the HOPE: MS. Implications for rehabilitation Living with MS requires constant adjustments to cope with unpredictable symptoms. Self-management interventions have the potential to help people living with MS to improve their quality of life. A feasibility study of the HOPE: MS self-management group-based intervention showed that it was acceptable and useful to people living with MS.

[Tele-medicine system for high-risk asthmatic patients].

PubMed

Kokubu, F; Suzuki, H; Sano, Y; Kihara, N; Adachi, M

1999-07-01

We have developed a tele-medicine system to monitor the airway status at home for patients with poorly controlled asthma, whereby a nurse provides instructions to individuals via the telephone to help them manage exacerbation under the supervision of their physicians. We examined the effectiveness of this system with a randomized control study. Patients with high hospitalization risk were enrolled in the study by screening patients for those with multiple previous emergency room visits and randomly assigned to either the tele-medicine or control group. After six months of participation in the program, the number of emergency room visits decreased significantly and the activities of daily living were improved in the tele-medicine group. Most of the patients in the tele-medicine group were able to continue measuring and transmitting peak expiratory flow (PEF) value successfully, and at six months had noticed an improvement in PEF. We therefore conclude that the system effectively contributes to the management of poorly controlled asthma. In addition, further consideration suggests that the reduction of emergency room visits may lead to reduction in hospitalization since we found a good correlation between number of emergency room visits and hospitalization from the studies published previously.

HABIT, a Randomized Feasibility Trial to Increase Hydroxyurea Adherence, Suggests Improved Health-Related Quality of Life in Youths with Sickle Cell Disease.

PubMed

Smaldone, Arlene; Findley, Sally; Manwani, Deepa; Jia, Haomiao; Green, Nancy S

2018-06-01

To examine the effect of a community health worker (CHW) intervention, augmented by tailored text messages, on adherence to hydroxyurea therapy in youths with sickle cell disease, as well as on generic and disease-specific health-related quality of life (HrQL) and youth-parent self-management responsibility concordance. We conducted a 2-site randomized controlled feasibility study (Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment [HABIT]) with 2:1 intervention allocation. Youths and parents participated as dyads. Intervention dyads received CHW visits and text message reminders. Data were analyzed using descriptive statistics, the Wilcoxon signed-rank test, and growth models adjusting for group assignment, time, and multiple comparisons. Changes in outcomes from 0 to 6 months were compared with their respective minimal clinically important differences. A total of 28 dyads (mean age of youths, 14.3 ± 2.6 years; 50% Hispanic) participated (18 in the intervention group, 10 in the control group), with 10.7% attrition. Accounting for group assignment, time, and multiple comparisons, at 6 months intervention youths reported improved generic HrQL total score (9.8 points; 95% CI, 0.4-19.2) and Emotions subscale score (15.0 points; 95% CI, 1.6-28.4); improved disease-specific subscale scores for Worry I (30.0 points; 95% CI, 8.5-51.5), Emotions (37.0 points, 95% CI, 9.4-64.5), and Communication I (17.8 points; 95% CI, 0.5-35.1); and 3-month dyad self-management responsibility concordance (3.5 points; 95% CI, -0.2 to 7.1). There were no differences in parent proxy-reported HrQL measures at 6 months. These findings add to research examining effects of behavioral interventions on HrQL outcomes in youths with sickle cell disease. ClinicalTrials.gov: NCT02029742. Copyright © 2018 Elsevier Inc. All rights reserved.

The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study.

PubMed

Valdivieso, Bernardo; García-Sempere, Anibal; Sanfélix-Gimeno, Gabriel; Faubel, Raquel; Librero, Julian; Soriano, Elisa; Peiró, Salvador

2018-04-25

To assess the effect of home based telehealth or structured telephone support interventions with respect to usual care on quality of life, mortality and healthcare utilization in elderly high-risk multiple chronic condition patients. 472 elderly high-risk patients with plurimorbidity in the region of Valencia (Spain) were recruited between June 2012 and May 2013, and followed for 12 months from recruitment. Patients were allocated to either: (a) a structured telephone intervention, a nurse-led case management program with telephone follow up every 15 days; (b) telehealth, which adds technology for remote self-management and the exchange of clinical data; or (c) usual care. Main outcome measures was quality of life measured by the EuroQol (EQ-5D) instrument, cognitive impairment, functional status, mortality and healthcare resource use. Inadequate randomization process led us to used propensity scores for adjusted analyses to control for imbalances between groups at baseline. EQ-5D score was significantly higher in the telehealth group compared to usual care (diff: 0.19, 0.08-0.30), but was not different to telephone support (diff: 0.04, -0.05 to 0.14). In adjusted analyses, inclusion in the telehealth group was associated with an additional 0.18 points in the EQ-5D score compared to usual care at 12 months (p<0.001), and with a gain of 0.13 points for the telephone support group (p<0.001). No differences in mortality or utilization were found, except for a borderline significant increase in General Practitioner visits. Telehealth was associated with better quality of life. Important limitations of the study and similarity of effects to telephone intervention call for careful endorsement of telemedicine. Clinicaltrials.gov (identifier: NCT02447562). Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan

PubMed Central

Wells, Timothy S.; Bhattarai, Gandhi R.; Hawkins, Kevin; Cheng, Yan; Ruiz, Joann; Barnowski, Cynthia A.; Spivack, Barney; Yeh, Charlotte S.

2016-01-01

Purpose of the Study: Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Primary Practice Setting: Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). Methodology and Sample: The three groups included the highest needs, highest costs (the “highest group”), the high needs, high costs (the “high group”), and the “all other group.” Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. Results: The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively. Implications for Case Management Practice: Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care. PMID:27301064

"It Might Actually Work This Time": Benefits and Barriers to Adapted 12-Step Facilitation Therapy and Mutual-Help Group Attendance From the Perspective of Dually Diagnosed Individuals.

PubMed

Hagler, Kylee J; Rice, Samara L; Muñoz, Rosa E; Salvador, Julie G; Forcehimes, Alyssa A; Bogenschutz, Michael P

2015-01-01

Most U.S. healthcare professionals encourage mutual-help group involvement as an adjunct to treatment or aftercare for individuals with substance use disorders, yet there are multiple challenges in engaging in these community groups. Dually diagnosed individuals (DDIs) may face additional challenges in affiliating with mutual-help groups. Twelve-step facilitation for DDIs (TSF-DD), a manualized treatment to facilitate mutual-help group involvement, was developed to help patients engage in Double Trouble in Recovery (DTR), a mutual-help group tailored to DDIs. Given the promising role that TSF-DD and DTR may have for increasing abstinence while managing psychiatric symptoms, the aim of the current study was to systematically examine reasons for TSF-DD and DTR attendance from the perspective of DDIs using focus group data. Participants were a subset (n = 15) of individuals diagnosed with an alcohol use disorder as well as a major depressive, bipolar, or psychotic disorder who participated in a parent study testing the efficacy of TSF-DD for increasing mutual-help group involvement and reducing alcohol use. Analyses of focus group data revealed that participants construed DTR and TSF-DD as helpful tools in the understanding and management of their disorders. Relative to other mutual-help groups in which participants reported feeling ostracized because of their dual diagnoses, participants reported that it was beneficial to learn about dual disorders in a safe and accepting environment. Participants also expressed aspects that they disliked. Results from this study yield helpful empirical recommendations to healthcare professionals seeking to increase DDIs' participation in DTR or other mutual-help groups.

An Integrated Coral Reef Ecosystem Model to Support Resource Management under a Changing Climate

PubMed Central

Weijerman, Mariska; Fulton, Elizabeth A.; Kaplan, Isaac C.; Gorton, Rebecca; Leemans, Rik; Mooij, Wolf M.; Brainard, Russell E.

2015-01-01

Millions of people rely on the ecosystem services provided by coral reefs, but sustaining these benefits requires an understanding of how reefs and their biotic communities are affected by local human-induced disturbances and global climate change. Ecosystem-based management that explicitly considers the indirect and cumulative effects of multiple disturbances has been recommended and adopted in policies in many places around the globe. Ecosystem models give insight into complex reef dynamics and their responses to multiple disturbances and are useful tools to support planning and implementation of ecosystem-based management. We adapted the Atlantis Ecosystem Model to incorporate key dynamics for a coral reef ecosystem around Guam in the tropical western Pacific. We used this model to quantify the effects of predicted climate and ocean changes and current levels of current land-based sources of pollution (LBSP) and fishing. We used the following six ecosystem metrics as indicators of ecosystem state, resilience and harvest potential: 1) ratio of calcifying to non-calcifying benthic groups, 2) trophic level of the community, 3) biomass of apex predators, 4) biomass of herbivorous fishes, 5) total biomass of living groups and 6) the end-to-start ratio of exploited fish groups. Simulation tests of the effects of each of the three drivers separately suggest that by mid-century climate change will have the largest overall effect on this suite of ecosystem metrics due to substantial negative effects on coral cover. The effects of fishing were also important, negatively influencing five out of the six metrics. Moreover, LBSP exacerbates this effect for all metrics but not quite as badly as would be expected under additive assumptions, although the magnitude of the effects of LBSP are sensitive to uncertainty associated with primary productivity. Over longer time spans (i.e., 65 year simulations), climate change impacts have a slight positive interaction with other drivers, generally meaning that declines in ecosystem metrics are not as steep as the sum of individual effects of the drivers. These analyses offer one way to quantify impacts and interactions of particular stressors in an ecosystem context and so provide guidance to managers. For example, the model showed that improving water quality, rather than prohibiting fishing, extended the timescales over which corals can maintain high abundance by at least 5–8 years. This result, in turn, provides more scope for corals to adapt or for resilient species to become established and for local and global management efforts to reduce or reverse stressors. PMID:26672983

An Integrated Coral Reef Ecosystem Model to Support Resource Management under a Changing Climate.

PubMed

Weijerman, Mariska; Fulton, Elizabeth A; Kaplan, Isaac C; Gorton, Rebecca; Leemans, Rik; Mooij, Wolf M; Brainard, Russell E

2015-01-01

Millions of people rely on the ecosystem services provided by coral reefs, but sustaining these benefits requires an understanding of how reefs and their biotic communities are affected by local human-induced disturbances and global climate change. Ecosystem-based management that explicitly considers the indirect and cumulative effects of multiple disturbances has been recommended and adopted in policies in many places around the globe. Ecosystem models give insight into complex reef dynamics and their responses to multiple disturbances and are useful tools to support planning and implementation of ecosystem-based management. We adapted the Atlantis Ecosystem Model to incorporate key dynamics for a coral reef ecosystem around Guam in the tropical western Pacific. We used this model to quantify the effects of predicted climate and ocean changes and current levels of current land-based sources of pollution (LBSP) and fishing. We used the following six ecosystem metrics as indicators of ecosystem state, resilience and harvest potential: 1) ratio of calcifying to non-calcifying benthic groups, 2) trophic level of the community, 3) biomass of apex predators, 4) biomass of herbivorous fishes, 5) total biomass of living groups and 6) the end-to-start ratio of exploited fish groups. Simulation tests of the effects of each of the three drivers separately suggest that by mid-century climate change will have the largest overall effect on this suite of ecosystem metrics due to substantial negative effects on coral cover. The effects of fishing were also important, negatively influencing five out of the six metrics. Moreover, LBSP exacerbates this effect for all metrics but not quite as badly as would be expected under additive assumptions, although the magnitude of the effects of LBSP are sensitive to uncertainty associated with primary productivity. Over longer time spans (i.e., 65 year simulations), climate change impacts have a slight positive interaction with other drivers, generally meaning that declines in ecosystem metrics are not as steep as the sum of individual effects of the drivers. These analyses offer one way to quantify impacts and interactions of particular stressors in an ecosystem context and so provide guidance to managers. For example, the model showed that improving water quality, rather than prohibiting fishing, extended the timescales over which corals can maintain high abundance by at least 5-8 years. This result, in turn, provides more scope for corals to adapt or for resilient species to become established and for local and global management efforts to reduce or reverse stressors.

Multi-resource and multi-scale approaches for meeting the challenge of managing multiple species

Treesearch

Frank R. Thompson; Deborah M. Finch; John R. Probst; Glen D. Gaines; David S. Dobkin

1999-01-01

The large number of Neotropical migratory bird (NTMB) species and their diverse habitat requirements create conflicts and difficulties for land managers and conservationists. We provide examples of assessments or conservation efforts that attempt to address the problem of managing for multiple NTMB species. We advocate approaches at a variety of spatial and geographic...

Using State-Wide Multiple Measures for School Leadership and Management: Costs Incurred vs. Benefits Gained

ERIC Educational Resources Information Center

Hentschke, Guilbert; Wohlstetter, Priscilla; Hirman, Jennifer; Zeehandelaar, Dara

2011-01-01

In this article, we examine the utility and value of multiple measures of school performance for school leaders and managers. The research was conducted within the context of the state of California through an investigation of how operators, managers and authorisers of autonomous "charter" (publicly financed but privately operated)…

The effectiveness of fluoroscopic cervical interlaminar epidural injections in managing chronic cervical disc herniation and radiculitis: preliminary results of a randomized, double-blind, controlled trial.

PubMed

Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Wargo, Bradley W; Malla, Yogesh

2010-01-01

Chronic neck pain is a common problem in the adult population with a typical 12-month prevalence of 30% to 50%. Cervical disc herniation and radiculitis is one of the common conditions described responsible for chronic neck and upper extremity pain. Cervical epidural injections for managing chronic neck pain with disc herniation are one of the commonly performed non-surgical interventions in the United States. However, the literature supporting cervical interlaminar epidural steroids in managing chronic neck pain is scant. A randomized, double-blind, controlled trial. A private interventional pain management practice and specialty referral center in the United States. To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in providing effective and long-lasting relief in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis, and to evaluate the differences between local anesthetic with or without steroids. Patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received cervical interlaminar epidural injections with 0.5% lidocaine, 4 mL, mixed with 1 mL of non-particulate betamethasone. Multiple outcome measures were utilized. They included the Numeric Rating Scale (NRS), the Neck Disability Index (NDI), employment status, and opioid intake. Assessments were done at baseline and 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50% or more; significant improvement in disability score was defined as a reduction of 50% or more. Significant pain relief (> or = 50%) was demonstrated in 77% of patients in both groups. Functional status improvement was demonstrated by a reduction (> or = 50%) in the NDI scores in 74% of Group I and 71% of Group II at 12 months. The overall average procedures per year were 3.7 +/- 1.1 in Group I and 4.0 +/- 0.91 in Group II; the average total relief per year was 39.45 +/- 11.59 weeks in Group I and 41.06 +/- 11.56 weeks in Group II over the 52 week study period in the patients defined as successful. The initial therapy was considered to be successful if a patient obtained consistent relief with 2 initial injections lasting at least 4 weeks. All others were considered failures. The study results are limited by the lack of a placebo group and a preliminary report of 70 patients, 35 in each group. Cervical interlaminar epidural injections with local anesthetic with or without steroids might be effective in 77% of patients with chronic function-limiting neck pain and upper extremity pain secondary to cervical disc herniation and radiculitis.

A telephone-delivered multiple health behaviour change intervention for colorectal cancer survivors: making the case for cost-effective healthcare.

PubMed

Gordon, L G; Patrao, T; Kularatna, S; Hawkes, A L

2015-11-01

In patients with colorectal cancer, a trial of a telephone-delivered multiple health behaviour change intervention, using acceptance commitment therapy strategies, found benefits for health and psychosocial outcomes including increased physical activity, improved dietary habits and lower body mass index. Our aim was to address the health economic outcomes by assessing the health system cost and health utility impacts of the intervention. A cost-consequences analysis was performed using data from a two-group randomised controlled intervention trial (n = 410). Outcomes included health-related quality of life (HRQoL), health utility and health system costs. At 12 months, clinically meaningful improvements were found for SF-6D over time but no significant differences were found between groups (P = 0.95). The cost of delivering the 6-month intervention was on average €280 per person and made up 21% of overall healthcare costs for participants during the intervention period. Excluding intervention costs, costs were similar for health professional visits and medications across groups. Despite significant positive intervention effects on health behaviours, health utility and HRQoL scores were similar across groups. On the basis that intervention costs were small and physical activity, diet and weight management improved, on balance the intervention is potentially a worthwhile investment in healthcare funds. ACTRN12608000399392. © 2015 John Wiley & Sons Ltd.

The return to work discussion: a qualitative study of the line manager conversation about return to work and the development of an educational programme.

PubMed

Cohen, Debbie; Allen, Joanna; Rhydderch, Melody; Aylward, Mansel

2012-07-01

To investigate the conversation between line manager and employee about return to work to inform the development of an online interactive educational programme for line managers to improve the effectiveness of their discussions. An inductive qualitative approach, using the principles of action research and motivational interviewing were adopted. The results informed the development of the educational programme for line managers. Middle grade line managers in a large public services employer in the UK. Four discussion groups were conducted over a period of 8 months. Line managers explored the challenges of the return to work interview, analysed their interactions with employees and constructed the content of an educational programme. Multiple methods were used to build engagement with participants, including video and role-play. Nine line managers were recruited across 3 business areas. Managers recognised that their conversations focused on the organisations' policies and procedures and the outcome, rather than the interaction. They recognised the strength of shifting style to shared decision-making and guidance rather than process and instruction. These communication strategies were depicted in the educational programme. The content and flow of the return to work discussion is of high importance and influences employee behaviour and return to work outcomes.

Development of a methodology for selecting criteria and indicators of sustainable forest management: a case study on participatory assessment.

PubMed

Mendoza, G A; Prabhu, R

2000-12-01

This paper describes an application of multiple criteria analysis (MCA) in assessing criteria and indicators adapted for a particular forest management unit. The methods include: ranking, rating, and pairwise comparisons. These methods were used in a participatory decision-making environment where a team representing various stakeholders and professionals used their expert opinions and judgements in assessing different criteria and indicators (C&I) on the one hand, and how suitable and applicable they are to a forest management unit on the other. A forest concession located in Kalimantan, Indonesia, was used as the site for the case study. Results from the study show that the multicriteria methods are effective tools that can be used as structured decision aids to evaluate, prioritize, and select sets of C&I for a particular forest management unit. Ranking and rating approaches can be used as a screening tool to develop an initial list of C&I. Pairwise comparison, on the other hand, can be used as a finer filter to further reduce the list. In addition to using these three MCA methods, the study also examines two commonly used group decision-making techniques, the Delphi method and the nominal group technique. Feedback received from the participants indicates that the methods are transparent, easy to implement, and provide a convenient environment for participatory decision-making.

Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

PubMed

Steinhaus, Michael E; Dare, David M; Gulotta, Lawrence V

2016-10-01

The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures. The purpose of this review is to highlight the strengths and weaknesses of the PROFHER trial and to assess the validity of its conclusion in the context of existing literature. The authors found no difference in the Oxford Shoulder Score (OSS) between the surgical and nonsurgical groups. Additionally, no difference was found between groups in any of the secondary outcomes, which included the Short-Form 12 (SF-12) health survey, surgical and fracture-related complications, additional surgery or therapy, inpatient medical complications, and mortality. They concluded that the recent increase in surgical management of proximal humerus fractures is perhaps unwarranted. While the randomization was successful and the pragmatic design may enable greater generalizability, this study possesses numerous flaws inherent in such an ambitious endeavor, including an inability to identify specific factors which explain the lack of superiority of surgical management. Despite its weaknesses, this study is a valuable datapoint which encourages surgeons to reexamine their surgical indications for this injury.

Feasibility of an International Multiple Sclerosis Rehabilitation Data Repository

PubMed Central

Bradford, Elissa Held; Baert, Ilse; Finlayson, Marcia; Feys, Peter

2018-01-01

Abstract Background: Multiple sclerosis (MS) rehabilitation evidence is limited due to methodological factors, which may be addressed by a data repository. We describe the perceived challenges of, motivators for, interest in participating in, and key features of an international MS rehabilitation data repository. Methods: A multimethod sequential investigation was performed with the results of two focus groups, using nominal group technique, and study aims informing the development of an online questionnaire. Percentage agreement and key quotations illustrated questionnaire findings. Subgroup comparisons were made between clinicians and researchers and between participants in North America and Europe. Results: Rehabilitation professionals from 25 countries participated (focus groups: n = 21; questionnaire: n = 166). The top ten challenges (C) and motivators (M) identified by the focus groups were database control/management (C); ethical/legal concerns (C); data quality (C); time, effort, and cost (C); best practice (M); uniformity (C); sustainability (C); deeper analysis (M); collaboration (M); and identifying research needs (M). Percentage agreement with questionnaire statements regarding challenges to, motivators for, interest in, and key features of a successful repository was at least 80%, 85%, 72%, and 83%, respectively, across each group of statements. Questionnaire subgroup analysis revealed a few differences (P < .05), including that clinicians more strongly identified with improving best practice as a motivator. Conclusions: Findings support clinician and researcher interest in and potential for success of an international MS rehabilitation data repository if prioritized challenges and motivators are addressed and key features are included. PMID:29507539

Feasibility of an International Multiple Sclerosis Rehabilitation Data Repository: Perceived Challenges and Motivators for Sharing Data.

PubMed

Bradford, Elissa Held; Baert, Ilse; Finlayson, Marcia; Feys, Peter; Wagner, Joanne

2018-01-01

Multiple sclerosis (MS) rehabilitation evidence is limited due to methodological factors, which may be addressed by a data repository. We describe the perceived challenges of, motivators for, interest in participating in, and key features of an international MS rehabilitation data repository. A multimethod sequential investigation was performed with the results of two focus groups, using nominal group technique, and study aims informing the development of an online questionnaire. Percentage agreement and key quotations illustrated questionnaire findings. Subgroup comparisons were made between clinicians and researchers and between participants in North America and Europe. Rehabilitation professionals from 25 countries participated (focus groups: n = 21; questionnaire: n = 166). The top ten challenges (C) and motivators (M) identified by the focus groups were database control/management (C); ethical/legal concerns (C); data quality (C); time, effort, and cost (C); best practice (M); uniformity (C); sustainability (C); deeper analysis (M); collaboration (M); and identifying research needs (M). Percentage agreement with questionnaire statements regarding challenges to, motivators for, interest in, and key features of a successful repository was at least 80%, 85%, 72%, and 83%, respectively, across each group of statements. Questionnaire subgroup analysis revealed a few differences (P < .05), including that clinicians more strongly identified with improving best practice as a motivator. Findings support clinician and researcher interest in and potential for success of an international MS rehabilitation data repository if prioritized challenges and motivators are addressed and key features are included.

Managing Disease Risks from Trade: Strategic Behavior with Many Choices and Price Effects.

PubMed

Chitchumnong, Piyayut; Horan, Richard D

2018-03-16

An individual's infectious disease risks, and hence the individual's incentives for risk mitigation, may be influenced by others' risk management choices. If so, then there will be strategic interactions among individuals, whereby each makes his or her own risk management decisions based, at least in part, on the expected decisions of others. Prior work has shown that multiple equilibria could arise in this setting, with one equilibrium being a coordination failure in which individuals make too few investments in protection. However, these results are largely based on simplified models involving a single management choice and fixed prices that may influence risk management incentives. Relaxing these assumptions, we find strategic interactions influence, and are influenced by, choices involving multiple management options and market price effects. In particular, we find these features can reduce or eliminate concerns about multiple equilibria and coordination failure. This has important policy implications relative to simpler models.

Managing endangered species within the use-preservation paradox: the Florida manatee (Trichechus manatus latirostris) as a tourism attraction.

PubMed

Sorice, Michael G; Shafer, C Scott; Ditton, Robert B

2006-01-01

A significant challenge to wildlife managers in tourism settings is to provide visitors with opportunities to observe rare and endangered wildlife while simultaneously protecting the target species from deleterious impacts. Nearly 100,000 people annually visit Crystal River, Florida, USA to observe and swim with the Florida manatee, an endangered species. This research aimed to investigate and describe human-manatee interactions in a tourism context, to understand the salient issues related to such interactions as identified by stakeholders, and to recommend a course of action to address multiple interests in the planning and management of human-manatee interactions. Five issues were identified by all stakeholder groups: water quality, harassment, density and crowding, education, and enforcement. Currently, the U.S. Fish and Wildlife Service, which is responsible for manatee management, does not have mechanisms in place to manage the tourism component of the manatee encounter. Although a regulatory approach can be taken, a better approach would be to create an organization of tour operators to establish "best practices" that reflect the goal of the managing agency to enhance manatee protection (and thus ensure their livelihood) and to enhance the visitor experience.

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

PubMed

Kahan, Deborah; Poremski, Daniel; Wise-Harris, Deborah; Pauly, Daniel; Leszcz, Molyn; Wasylenki, Donald; Stergiopoulos, Vicky

2016-01-01

This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers. Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

Managing Endangered Species Within the Use-Preservation Paradox: The Florida Manatee ( Trichechus manatus latirostris) as a Tourism Attraction

NASA Astrophysics Data System (ADS)

Sorice, Michael G.; Shafer, C. Scott; Ditton, Robert B.

2006-01-01

A significant challenge to wildlife managers in tourism settings is to provide visitors with opportunities to observe rare and endangered wildlife while simultaneously protecting the target species from deleterious impacts. Nearly 100,000 people annually visit Crystal River, Florida, USA to observe and swim with the Florida manatee, an endangered species. This research aimed to investigate and describe human-manatee interactions in a tourism context, to understand the salient issues related to such interactions as identified by stakeholders, and to recommend a course of action to address multiple interests in the planning and management of human-manatee interactions. Five issues were identified by all stakeholder groups: water quality, harassment, density and crowding, education, and enforcement. Currently, the U.S. Fish and Wildlife Service, which is responsible for manatee management, does not have mechanisms in place to manage the tourism component of the manatee encounter. Although a regulatory approach can be taken, a better approach would be to create an organization of tour operators to establish “best practices” that reflect the goal of the managing agency to enhance manatee protection (and thus ensure their livelihood) and to enhance the visitor experience.

Inadequate Triglyceride Management Worsens the Durability of Dipeptidyl Peptidase-4 Inhibitor in Subjects with Type 2 Diabetes Mellitus.

PubMed

Shimoda, Masashi; Miyoshi-Takai, Maiko; Irie, Shintaro; Tanabe, Akihito; Obata, Atsushi; Okauchi, Seizo; Hirukawa, Hidenori; Kimura, Tomohiko; Kohara, Kenji; Kamei, Shinji; Mune, Tomoatsu; Kaku, Kohei; Kaneto, Hideaki

2017-01-01

Dipeptidyl peptidase-4 (DPP-4) inhibitors are often used all over the world and exert various beneficial effects including glucose-lowering effect in many subjects with type 2 diabetes. It is poorly understood, however, which factors are closely related with the durability of glucose-lowering effect by DPP-4 inhibitor. In this study, we examined retrospectively which factors could mainly influence the durability of DPP-4 inhibitor. We enrolled 212 participants with type 2 diabetes to whom DPP-4 inhibitor was administered for over 1 year without an addition or increase of other hypoglycemic agents. Age and baseline HbA1c level were significantly higher in the effective group than those in the ineffective group. The effective group had a tendency of smaller amounts of weight change, average total cholesterol, and average triglyceride compared with the ineffective group. Multiple logistic regression analysis showed that average triglyceride and baseline HbA1c were independent predictors associated with the durability of DPP-4 inhibitor. Moreover, an average triglyceride level contributed to the durability of DPP-4 inhibitor in the obese group (BMI ≥ 25 kg/m 2 ) but not in the nonobese group (BMI < 25 kg/m 2 ). These results suggest the importance of strict triglyceride management to maintain the durability of glucose-lowering effect by DPP-4 inhibitor, especially in obese subjects with type 2 diabetes.

Evaluation of aromatherapy with essential oils of Rosa damascena for the management of premenstrual syndrome.

PubMed

Heydari, Naval; Abootalebi, Maliheh; Jamalimoghadam, Neda; Kasraeian, Maryam; Emamghoreishi, Masoumeh; Akbarzaded, Marzieh

2018-05-22

To investigate the efficacy of aromatherapy with essential oils of Rosa damascena for the management of premenstrual syndrome (PMS). The present triple-blind randomized clinical trial was conducted between March 5, 2016, and February 20, 2017, among female students attending Shiraz University of Medical Sciences, Shiraz, Iran, who experienced PMS, had a menstrual cycle of 24-35 days, were not using vitamin supplements or hormonal drugs, and did not have any underlying diseases. Block randomization was used to assign participants to an intervention group receiving aromatherapy with R. damascena at a 4% concentration or a control group who received aromatherapy with100% sweet almond oil. Aromatherapy was performed for 5 minutes, twice daily, for a total of 5 days during the luteal phase. The premenstrual symptoms screening tool questionnaire was completed at baseline and after 1 and 2 months of treatment. Per-protocol analyses were performed with patients and investigators masked to group assignments. There were 66 participants enrolled and 64 completed the study (33 in the intervention group and 31 in the control group). At 2 months, aromatherapy with R. damascena was associated with improved psychological (P<0.001), physical (P<0.001), social (P=0.002), and total (P<0.001) PMS symptoms compared with baseline. By contrast, no improvements were recorded in the control group. Aromatherapy with R. damascena improved multiple symptoms of PMS. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Report of the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology Colorectal Polyp Working Group: the development of a complex colorectal polyp minimum dataset.

PubMed

Chattree, A; Barbour, J A; Thomas-Gibson, S; Bhandari, P; Saunders, B P; Veitch, A M; Anderson, J; Rembacken, B J; Loughrey, M B; Pullan, R; Garrett, W V; Lewis, G; Dolwani, S; Rutter, M D

2017-01-01

The management of large non-pedunculated colorectal polyps (LNPCPs) is complex, with widespread variation in management and outcome, even amongst experienced clinicians. Variations in the assessment and decision-making processes are likely to be a major factor in this variability. The creation of a standardized minimum dataset to aid decision-making may therefore result in improved clinical management. An official working group of 13 multidisciplinary specialists was appointed by the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) to develop a minimum dataset on LNPCPs. The literature review used to structure the ACPGBI/BSG guidelines for the management of LNPCPs was used by a steering subcommittee to identify various parameters pertaining to the decision-making processes in the assessment and management of LNPCPs. A modified Delphi consensus process was then used for voting on proposed parameters over multiple voting rounds with at least 80% agreement defined as consensus. The minimum dataset was used in a pilot process to ensure rigidity and usability. A 23-parameter minimum dataset with parameters relating to patient and lesion factors, including six parameters relating to image retrieval, was formulated over four rounds of voting with two pilot processes to test rigidity and usability. This paper describes the development of the first reported evidence-based and expert consensus minimum dataset for the management of LNPCPs. It is anticipated that this dataset will allow comprehensive and standardized lesion assessment to improve decision-making in the assessment and management of LNPCPs. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

Are nurses prepared for retirement?

PubMed

Blakeley, Judith; Ribeiro, Violeta

2008-09-01

This study explored various factors and income sources that registered nurses believe are important in retirement planning. In many countries worldwide, many registered nurses are approaching retirement age. This raises concerns related to the level of preparedness of retiring nurses. A mail-out questionnaire was sent to 200 randomly selected nurses aged 45 and older. SPSS descriptors were used to outline the data. Multiple t-tests were conducted to test for significant differences between selected responses by staff nurses and a group of nurse managers, educators and researchers. Of 124 respondents, 71% planned to retire by age 60. Only 24% had done a large amount of planning. The top four planning strategies identified were related to keeping healthy and active, both physically and mentally; a major financial planning strategy ranked fifth. Work pensions, a government pension and a personal savings plan were ranked as the top three retirement income sources. No significant differences were found between the staff nurse and manager groups on any of the items. IMPLICATIONS FOR NURSING MANAGERS/CONCLUSIONS: The results of this study suggest that managers' preparation for retirement is no different from that of staff nurses. All nurses may need to focus more on financial preparation, and begin the process early in their careers if they are to have a comfortable and healthy retirement. Nurse managers are in a position to advocate with senior management for early and comprehensive pre-retirement education for all nurses and to promote educational sessions among their staff. Managers may find the content of this paper helpful as they work with nurses to help them better prepare for retirement. This exploratory study adds to the limited amount of research available on the topic.

Evaluation of Central North American prairie management based on species diversity, life form, and individual species metrics.

PubMed

Brudvig, Lars A; Mabry, Catherine M; Miller, James R; Walker, Tracy A

2007-06-01

Reintroduction of fire and grazing, alone or in combination, has increasingly been recognized as central to the restoration of North American mixed-grass and tallgrass prairies. Although ecological studies of these systems are abundant, they have generally been observational, or if experimental, have focused on plant species diversity. Species diversity measures alone are not sufficient to inform management, which often has goals associated with life-form groups and individual species. We examined the effects of prescribed fire, light cattle grazing, and a combination of fire and grazing on three vegetation components: species diversity, groups of species categorized by life-form, and individual species. We evaluated how successful these three treatments were in achieving specific management goals for prairies in the Iowa Loess Hills (U.S.A.). The grazing treatment promoted the greatest overall species richness, whereas grazing and burning and grazing treatments resulted in the lowest cover by woody species. Burning alone best achieved the management goals of increasing the cover and diversity of native species and reducing exotic forb and (predominantly exotic) cool-season grass cover. Species-specific responses to treatments appeared idiosyncratic (i.e., within each treatment there existed a set of species attaining their highest frequency) and nearly half of uncommon species were present in only one treatment. Because all management goals were not achieved by any one treatment, we conclude that management in this region may need refining. We suggest that a mosaic of burning and grazing (alone and in combination) may provide the greatest landscape-level species richness; however, this strategy would also likely promote the persistence of exotic species. Our results support the need to consider multiple measures, including species-specific responses, when planning and evaluating management.

Selection of multiple umbrella species for functional and taxonomic diversity to represent urban biodiversity.

PubMed

Sattler, T; Pezzatti, G B; Nobis, M P; Obrist, M K; Roth, T; Moretti, M

2014-04-01

Surrogates, such as umbrella species, are commonly used to reduce the complexity of quantifying biodiversity for conservation purposes. The presence of umbrella species is often indicative of high taxonomic diversity; however, functional diversity is now recognized as an important metric for biodiversity and thus should be considered when choosing umbrella species. We identified umbrella species associated with high taxonomic and functional biodiversity in urban areas in Switzerland. We analyzed 39,752 individuals of 574 animal species from 96 study plots and 1397 presences of 262 plant species from 58 plots. Thirty-one biodiversity measures of 7 taxonomic groups (plants, spiders, bees, ground beetles, lady bugs, weevils and birds) were included in within- and across-taxa analyses. Sixteen measures were taxonomical (species richness and species diversity), whereas 15 were functional (species traits including mobility, resource use, and reproduction). We used indicator value analysis to identify umbrella species associated with single or multiple biodiversity measures. Many umbrella species were indicators of high biodiversity within their own taxonomic group (from 33.3% in weevils to 93.8% in birds), to a lesser extent they were indicators across taxa. Principal component analysis revealed that umbrella species for multiple measures of biodiversity represented different aspects of biodiversity, especially with respect to measures of taxonomic and functional diversity. Thus, even umbrella species for multiple measures of biodiversity were complementary in the biodiversity aspects they represented. Thus, the choice of umbrella species based solely on taxonomic diversity is questionable and may not represent biodiversity comprehensively. Our results suggest that, depending on conservation priorities, managers should choose multiple and complementary umbrella species to assess the state of biodiversity. © 2013 Society for Conservation Biology.

Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group.

PubMed

Cavo, Michele; Terpos, Evangelos; Nanni, Cristina; Moreau, Philippe; Lentzsch, Suzanne; Zweegman, Sonja; Hillengass, Jens; Engelhardt, Monika; Usmani, Saad Z; Vesole, David H; San-Miguel, Jesus; Kumar, Shaji K; Richardson, Paul G; Mikhael, Joseph R; da Costa, Fernando Leal; Dimopoulos, Meletios-Athanassios; Zingaretti, Chiara; Abildgaard, Niels; Goldschmidt, Hartmut; Orlowski, Robert Z; Chng, Wee Joo; Einsele, Hermann; Lonial, Sagar; Barlogie, Bart; Anderson, Kenneth C; Rajkumar, S Vincent; Durie, Brian G M; Zamagni, Elena

2017-04-01

The International Myeloma Working Group consensus aimed to provide recommendations for the optimal use of 18 fluorodeoxyglucose ( 18 F-FDG) PET/CT in patients with multiple myeloma and other plasma cell disorders, including smouldering multiple myeloma and solitary plasmacytoma. 18 F-FDG PET/CT can be considered a valuable tool for the work-up of patients with both newly diagnosed and relapsed or refractory multiple myeloma because it assesses bone damage with relatively high sensitivity and specificity, and detects extramedullary sites of proliferating clonal plasma cells while providing important prognostic information. The use of 18 F-FDG PET/CT is mandatory to confirm a suspected diagnosis of solitary plasmacytoma, provided that whole-body MRI is unable to be performed, and to distinguish between smouldering and active multiple myeloma, if whole-body X-ray (WBXR) is negative and whole-body MRI is unavailable. Based on the ability of 18 F-FDG PET/CT to distinguish between metabolically active and inactive disease, this technique is now the preferred functional imaging modality to evaluate and to monitor the effect of therapy on myeloma-cell metabolism. Changes in FDG avidity can provide an earlier evaluation of response to therapy compared to MRI scans, and can predict outcomes, particularly for patients who are eligible to receive autologous stem-cell transplantation. 18 F-FDG PET/CT can be coupled with sensitive bone marrow-based techniques to detect minimal residual disease (MRD) inside and outside the bone marrow, helping to identify those patients who are defined as having imaging MRD negativity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Validation of a contemporary adherence measure for children with Type 1 diabetes: the Diabetes Management Questionnaire

PubMed Central

Mehta, S. N.; Nansel, T. R.; Volkening, L. K.; Butler, D. A.; Haynie, D. L.; Laffel, L. M. B.

2016-01-01

Aims To evaluate the psychometric properties of the Diabetes Management Questionnaire, a brief, self-report measure of adherence to contemporary diabetes management for young people with Type 1 diabetes and their caregivers. Methods A total of 273 parent-child dyads completed parallel versions of the Diabetes Management Questionnaire. Eligible children (aged 8–18 years) had Type 1 diabetes for ≥1 year. A multidisciplinary team designed the Diabetes Management Questionnaire as a brief, self-administered measure of adherence to Type 1 diabetes management over the preceding month; higher scores reflect greater adherence. Psychometrics were evaluated for the entire sample and according to age of the child. Results The children (49% female) had a mean ± SD (range) age 13.3 ± 2.9 (8–18) years and their mean ± SD HbA1c was 71 ± 15 mmol/mol (8.6 ± 1.4%). Internal consistency was good for parents (α = 0.83) and children (a = 0.79). Test-retest reliability was excellent for parents (intraclass correlation coefficient =0.83) and good for children (intraclass correlation coefficient = 0.65). Parent and child scores had moderate agreement (intraclass correlation coefficient = 0.54). Diabetes Management Questionnaire scores were inversely associated with HbA1c (parents: r = –0.41, P < 0.0001; children: r = –0.27, P < 0.0001). Psychometrics were stronger in the children aged ≥13 years compared with those aged < 13 years, but were acceptable in both age groups. Mean ± SD Diabetes Management Questionnaire scores were higher among children who were receiving insulin pump therapy (n = 181) than in children receiving multiple daily injections (n = 92) according to parent (75.9 ± 11.8 vs. 70.5 ± 15.5; P = 0.004) and child report (72.2 ± 12.1 vs. 67.6 ± 13.9; P = 0.006). Conclusions The Diabetes Management Questionnaire is a brief, valid self-report measure of adherence to contemporary diabetes self-management for people aged 8–18 years who are receiving either multiple daily injections or insulin pump therapy. PMID:26280463

Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.

PubMed

Liaw, Sok Ying; Wong, Lai Fun; Ang, Sophia Bee Leng; Ho, Jasmine Tze Yin; Siau, Chiang; Ang, Emily Neo Kim

2016-06-01

The timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses' knowledge and performances in recognising and responding to clinical deterioration. The interactive web-based programme addressed three areas: (1) early detection of changes in vital signs; (2) performance of nursing assessment and interventions using airway, breathing, circulation, disability and expose/examine and (3) reporting clinical deterioration using identity, situation, background, assessment and recommendation. Sixty-seven registered nurses participated in the randomised control study. The experimental group underwent a 3 h programme while the control group received no intervention. Pretests and post-tests, a mannequin-based assessment and a multiple-choice knowledge questionnaire were conducted. We evaluated the participants' performances in assessing, managing and reporting the deterioration of a patient using a validated performance tool. A significantly higher number of nurses from the experimental group than the control group monitored respiratory rates (48.2% vs 25%, p<0.05) and pulse rates (74.3% vs 37.5%, p<0.01) in the simulated environment, after the intervention. The post-test mean scores of the experimental group was significantly higher than the control group for knowledge (21.29 vs 18.28, p<0.001), performance in assessing and managing clinical deterioration (25.83 vs 19.50, p<0.001) and reporting clinical deterioration (12.83 vs 10.97, p<0.001). A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration. 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/

Volume serving and media management in a networked, distributed client/server environment

NASA Technical Reports Server (NTRS)

Herring, Ralph H.; Tefend, Linda L.

1993-01-01

The E-Systems Modular Automated Storage System (EMASS) is a family of hierarchical mass storage systems providing complete storage/'file space' management. The EMASS volume server provides the flexibility to work with different clients (file servers), different platforms, and different archives with a 'mix and match' capability. The EMASS design considers all file management programs as clients of the volume server system. System storage capacities are tailored to customer needs ranging from small data centers to large central libraries serving multiple users simultaneously. All EMASS hardware is commercial off the shelf (COTS), selected to provide the performance and reliability needed in current and future mass storage solutions. All interfaces use standard commercial protocols and networks suitable to service multiple hosts. EMASS is designed to efficiently store and retrieve in excess of 10,000 terabytes of data. Current clients include CRAY's YMP Model E based Data Migration Facility (DMF), IBM's RS/6000 based Unitree, and CONVEX based EMASS File Server software. The VolSer software provides the capability to accept client or graphical user interface (GUI) commands from the operator's console and translate them to the commands needed to control any configured archive. The VolSer system offers advanced features to enhance media handling and particularly media mounting such as: automated media migration, preferred media placement, drive load leveling, registered MediaClass groupings, and drive pooling.

Models for Forest Ecosystem Management: A European Perspective

PubMed Central

Pretzsch, H.; Grote, R.; Reineking, B.; Rötzer, Th.; Seifert, St.

2008-01-01

Background Forest management in Europe is committed to sustainability. In the face of climate change and accompanying risks, however, planning in order to achieve this aim becomes increasingly challenging, underlining the need for new and innovative methods. Models potentially integrate a wide range of system knowledge and present scenarios of variables important for any management decision. In the past, however, model development has mainly focused on specific purposes whereas today we are increasingly aware of the need for the whole range of information that can be provided by models. It is therefore assumed helpful to review the various approaches that are available for specific tasks and to discuss how they can be used for future management strategies. Scope Here we develop a concept for the role of models in forest ecosystem management based on historical analyses. Five paradigms of forest management are identified: (1) multiple uses, (2) dominant use, (3) environmentally sensitive multiple uses, (4) full ecosystem approach and (5) eco-regional perspective. An overview of model approaches is given that is dedicated to this purpose and to developments of different kinds of approaches. It is discussed how these models can contribute to goal setting, decision support and development of guidelines for forestry operations. Furthermore, it is shown how scenario analysis, including stand and landscape visualization, can be used to depict alternatives, make long-term consequences of different options transparent, and ease participation of different stakeholder groups and education. Conclusions In our opinion, the current challenge of forest ecosystem management in Europe is to integrate system knowledge from different temporal and spatial scales and from various disciplines. For this purpose, using a set of models with different focus that can be selected from a kind of toolbox according to particular needs is more promising than developing one overarching model, covering ecological, production and landscape issues equally well. PMID:17954471

Physical and mental health status of survivors of multiple cancer diagnoses: findings from the National Health Interview Survey.

PubMed

Andrykowski, Michael A

2012-07-15

Little research has identified the physical and mental health status of survivors of multiple primary cancer diagnoses. By using data from the population-based 2009 National Health Information Survey, 154 survivors of multiple primary cancer diagnoses, 1427 survivors of a single cancer diagnosis, and 25,004 individuals without a history of cancer diagnosis were identified. The multiple cancer group was compared with the single cancer and no cancer groups with regard to physical and mental health status using analysis of covariance and binary logistic regression. Relative to the no cancer group, the multiple cancer group reported significantly poorer mental health status, greater lifetime, recent, and current prevalence of a variety of medical conditions and comorbidities, and more health-related disability. Although observed group differences between the multiple cancer and single cancer groups were less pronounced than those between the multiple cancer and no cancer groups, a consistent pattern was also evident; the multiple cancer group reported significantly poorer status relative to the single cancer group across a range of mental and physical health and illness-related disability indices. Diagnosis of 2 or more primary cancers (excluding nonmelanoma skin cancers) is associated with increased risk for poorer physical and mental health status over and above that associated with diagnosis of a single primary cancer. Survivors of multiple and single primary cancer diagnoses should be considered as distinct subgroups, and increased attention should be devoted to the unique status and needs of survivors of multiple primary cancer diagnoses. Copyright © 2011 American Cancer Society.

EMBalance - validation of a decision support system in the early diagnostic evaluation and management plan formulation of balance disorders in primary care: study protocol of a feasibility randomised controlled trial.

PubMed

Rammazzo, Laura; Kikidis, Dimitris; Anwer, Amal; Macdonald, Nora; Kyrodimos, Efthymios; Maurer, Christoph; Wuyts, Floris; Luxon, Linda; Bibas, Athanasios; Bamiou, Doris-Eva

2016-09-05

Balance problems are caused by multiple factors and often lead to falls and related fractures, bringing large socio-economic costs. The complexity of balance control mechanisms, the lack of medical expertise, and the absence of specialised equipment contribute to the delayed or incorrect diagnosis and management ofthese patients. Advances in computer science have allowed the development of computer systems that support clinical diagnosis and treatment decisions based on individualised patient data. The aim of the EMBalance decision support system (DSS) is to support doctors facing this clinical challenge, to make a definitive diagnosis and implement an effective management plan. The EMBalance study will determine the accuracy of this supportive tool when used by non-specialist doctors. This study is funded by the European Union's Seventh Framework Programme. EMBalance is a proof-of-concept study designed as a non-commercial, international, multi-centre, single-blind, parallel-group randomised controlled trial to be carried out at four clinical sites in the United Kingdom, Germany, Greece and Belgium. The study is comprised of three stages: internal pilot, phase I (diagnosis) and stage II (management). For this purpose, 200 patients presenting with persistent dizziness (>3 months' duration) to primary care services will be randomised to either the intervention group (diagnostic assessment with the DSS) or a control group (diagnostic assessment without the DSS). Patients allocated to the intervention group will be assessed by a doctor with the support of the EMBalance DSS, while patients allocated to the control group will receive a visit as per standard practice. Ultimately, all patients' diagnoses and management plans will be certified by a consultant in neuro-otology. EMBalance is the first trial to test the accuracy of a DSS in both the diagnosis of and the management plan for vestibular disorders across the healthcare systems of four different countries. The EMBalance study is the result of a combined effort of engineers and physicians to develop an accurate tool to support non-specialist doctors, with no risk for the patient. This trial will provide reliable information about the benefits of implementing DSSs in primary care while supporting the feasibility of testing the EMBalance algorithms in further research. ClinicalTrials.gov NCT02704819 . Registered 29 February 2016.

Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial

PubMed Central

Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

2016-01-01

[Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists. PMID:27134355

Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

PubMed

Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

2016-03-01

[Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

Informed actions: where to cost effectively manage multiple threats to species to maximize return on investment.

PubMed

Auerbach, Nancy A; Tulloch, Ayesha I T; Possingham, Hugh P

Conservation practitioners, faced with managing multiple threats to biodiversity and limited funding, must prioritize investment in different management actions. From an economic perspective, it is routine practice to invest where the highest rate of return is expected. This return-on-investment (ROI) thinking can also benefit species conservation, and researchers are developing sophisticated approaches to support decision-making for cost-effective conservation. However, applied use of these approaches is limited. Managers may be wary of “black-box” algorithms or complex methods that are difficult to explain to funding agencies. As an alternative, we demonstrate the use of a basic ROI analysis for determining where to invest in cost-effective management to address threats to species. This method can be applied using basic geographic information system and spreadsheet calculations. We illustrate the approach in a management action prioritization for a biodiverse region of eastern Australia. We use ROI to prioritize management actions for two threats to a suite of threatened species: habitat degradation by cattle grazing, and predation by invasive red foxes (Vulpes vulpes). We show how decisions based on cost-effective threat management depend upon how expected benefits to species are defined and how benefits and costs co-vary. By considering a combination of species richness, restricted habitats, species vulnerability, and costs of management actions, small investments can result in greater expected benefit compared with management decisions that consider only species richness. Furthermore, a landscape management strategy that implements multiple actions is more efficient than managing only for one threat, or more traditional approaches that don't consider ROI. Our approach provides transparent and logical decision support for prioritizing different actions intended to abate threats associated with multiple species; it is of use when managers need a justifiable and repeatable approach to investment.

Li-ion battery thermal runaway suppression system using microchannel coolers and refrigerant injections

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

Bandhauer, Todd M.; Farmer, Joseph C.

A battery management system with thermally integrated fire suppression includes a multiplicity of individual battery cells in a housing; a multiplicity of cooling passages in the housing within or between the multiplicity of individual battery cells; a multiplicity of sensors operably connected to the individual battery cells, the sensors adapted to detect a thermal runaway event related to one or more of the multiplicity of individual battery cells; and a management system adapted to inject coolant into at least one of the multiplicity of cooling passages upon the detection of the thermal runaway event by the any one of themore » multiplicity of sensors, so that the thermal runaway event is rapidly quenched.« less

Patient participation in quality pain management during an acute care admission.

PubMed

McTier, Lauren J; Botti, Mari; Duke, Maxine

2014-04-01

The objective of the study was to explore patient participation in the context of pain management during a hospital admission for a cardiac surgical intervention of patients with cardiovascular disease. This is a single-institution study, with a case-study design. The unit of analysis was a cardiothoracic ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. Multiple methods of data collection were used including preadmission and predischarge patient interviews (n=98), naturalistic observations (n=48), and focus group interviews (n=2). Patients' preference for participation in pain management was not always commensurate with their involvement in pain management. Patients displayed a greater understanding of their role in pain management in terms of reporting pain and the use of multimodal analgesics after surgery. The majority of patients, however, did not understand the importance of reporting pain to avoid complications. Patients had limited opportunity to participate in their pain management. On occasions in which clinicians did involve patients, the involvement appeared to be focused on reporting pain rather than treatment of pain. Patient participation in pain management during hospitalization is not optimal. This has implications for the quality of pain management patients receive. Higher engagement of patients in their pain management during hospitalization is required to ensure comfort, reduce potential for complications, and adequately prepare the patients to manage their pain following discharge from hospital.

'Animateurs' and animation: what makes a good commissioning manager?

PubMed

Checkland, Kath; Snow, Stephanie; McDermott, Imelda; Harrison, Stephen; Coleman, Anna

2012-01-01

To examine the managerial behaviours adopted by commissioning managers in English primary care trusts (PCTs), and to explore the impact of these behaviours. Qualitative case studies were undertaken in four PCTs, focusing on staff engaged in the commissioning of hospital services. Both formal and informal observation were undertaken (150 hours), and 41 in-depth interviews conducted with managers and general practitioners (GPs). Managers adopted many managerial behaviours familiar from the literature, including sharing information, and networking inside and outside the organization. Multiple organizational layers and unclear decision-making processes hindered this activity. In addition, some managers with responsibility for facilitating practice-based commissioning (PbC) adopted a managerial mode that we have called being an 'animateur'. This approach involved the active management of disparate groups of people over whom the manager had no authority, and appeared to be a factor in determining success. It was facilitated by managerial autonomy and was more prevalent where managers were seen to have legitimacy. Some organizational practices appeared to inhibit its development. From 2012/13 it is planned that GPs will be taking more responsibility for commissioning in the English NHS. This research suggests that managers of the new commissioning organizations will require a deep and contextualized understanding of the NHS and that it is important that organizational processes do not inhibit managerial behaviour. Legitimacy may be an issue in contexts were managers are automatically transferred from their existing appointments.

Assessing risks to multiple resources affected by wildfire and forest management using an integrated probabilistic framework

Treesearch

Steven P. Norman; Danny C. Lee; Sandra Jacobson; Christine Damiani

2010-01-01

The tradeoffs that surround forest management are inherently complex, often involving multiple temporal and spatial scales. For example, conflicts may result when fuel treatments are designed to mediate long-term fuel hazards, but activities could impair sensitive aquatic habitat or degrade wildlife habitat in the short term. This complexity makes it hard for managers...

[First aid and management of multiple trauma: in-hospital trauma care].

PubMed

Boschin, Matthias; Vordemvenne, Thomas

2012-11-01

Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

Quality of life and patients' expectations in soft tissue sarcoma.

PubMed

Jones, Robin L; Cesne, Axel Le

2018-05-01

Assessment of health-related quality of life (HRQoL) is essential for holistic care. Greater efforts are required to incorporate HRQoL measures into clinical trials and daily practice. Considerable HRQoL data are available for localized soft tissue sarcomas (STS), particularly in the orthopedic setting. In future, HRQoL is expected to become increasingly important in the evaluation of palliative therapy in advanced STS. A patient-centric approach is advocated for STS management. Greater awareness of STS by nonspecialist clinicians, and timely referral to specialized sarcoma reference centers, is crucial for patient welfare. The patient is central to shared decision-making during consultations and during case review in tumor boards. The management approach to STS should be collaborative, involving a multidisciplinary team, multiple centers and patient advocacy groups.

Multiple forms of rhythmic movements in an adolescent boy with rhythmic movement disorder.

PubMed

Su, Changjun; Miao, Jianting; Liu, Yu; Liu, Rui; Lei, Gesheng; Zhang, Wei; Yang, Ting; Li, Zhuyi

2009-12-01

Rhythmic movement disorder (RMD) refers to a group of stereotyped, repetitive movements involving large muscles, usually occurring prior to the onset of sleep and persisting into sleep. RMD more commonly exhibits only one or two forms of rhythmic movements (RM) in most reported cases. However, multiple RM forms of RMD occurring in a patient in the same night have rarely been reported. In this report, we present the unique case of a 15-year-old boy with RMD affected by multiple forms of RM in the same night, including four known forms (i.e., body rocking, head banging, leg rolling, and rhythmic feet movements) and two new kinds of RM (bilateral rhythmic arm rocking and rhythmic hands movements). Two video-polysomnographic recordings were performed in this patient before starting pharmacologic treatment and after long-term oral clonazepam treatment (1.0mg nightly for 3 months). The characteristics of RMD with multiple RM forms and the effectiveness of clonazepam on the RM episodes and polysomnographic findings observed in our patient are discussed. This report raises the fact that a patient with RMD may present with multiple complex rhythmic movements disrupting sleep, which emphasizes that better understanding of the clinical features of complex rhythmic movements during sleep in primary care settings is essential for early clinical diagnosis and optimal management.

Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

PubMed

Ricci-Cabello, Ignacio; Olry de Labry-Lima, Antonio; Bolívar-Muñoz, Julia; Pastor-Moreno, Guadalupe; Bermudez-Tamayo, Clara; Ruiz-Pérez, Isabel; Quesada-Jiménez, Fermín; Moratalla-López, Enrique; Domínguez-Martín, Susana; de los Ríos-Álvarez, Ana M; Cruz-Vela, Pilar; Prados-Quel, Miguel A; López-De Hierro, José A

2013-10-23

In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. Clinical Trials U.S. National Institutes of Health, NCT01849731.

Assessing and Managing Multiple Risks in a Changing World – the Roskilde Recommendations

EPA Science Inventory

Roskilde University hosted a November 2015 workshop on “Environmental Risk – Assessing and Managing Multiple Risks in a Changing World”. Thirty attendees from 9 countries developed consensus recommendations regarding: implementation of a common currency (ecosyst...

Studies of transformational leadership in consumer service: market orientation behavior and alternative roles for the mediators and moderators of change commitment.

PubMed

Yang, Yi-Feng

2013-12-01

The present paper evaluates the relation between transformational leadership and market orientation along with the mediating and moderating effects of change commitment for employees in customer centers in Taiwan. 327 questionnaires were returned by personnel at several customer centers in four different insurance companies. Inter-rater agreement was acceptable based on the multiple raters (i.e., the consumer-related employees from the division groups) of one individual (i.e., a manager)--indicating the aggregated measures were acceptable. The multi-source sample comprised data taken from the four division centers: phone services, customer representatives, financial specialists, and front-line salespeople. The relations were assessed using a multiple mediation procedure incorporating bootstrap techniques and PRODCLIN2 with structural equation modeling analysis. The results reflect a mediating role for change commitment.

Cutaneous involvement in multiple myeloma (MM): A case series with clinicopathologic correlation.

PubMed

Malysz, Jozef; Talamo, Giampaolo; Zhu, Junjia; Clarke, Loren E; Bayerl, Michael G; Ali, Liaqat; Helm, Klaus F; Chung, Catherine G

2016-05-01

Disease-specific skin lesions are rare in patients with multiple myeloma (MM). We sought to further characterize the clinical and pathologic features of patients with cutaneous involvement with MM. We identified 13 patients with cutaneous lesions of MM. Cutaneous lesions consisted of pink, red, and violaceous papules, nodules, and/or plaques that varied in size. Histopathology revealed atypical plasma cells with occasional plasmablastic features. MM had aggressive biologic features and was at an advanced stage in the majority of patients. Despite aggressive management, including chemotherapy and stem-cell transplantation, most patients died of progressive disease within a few months after the development of cutaneous lesions. The study group was relatively small. Cutaneous involvement with MM is associated with aggressive biologic behavior and short survival. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Surgical Management of Gynecomastia: Subcutaneous Mastectomy and Liposuction.

PubMed

Kim, Dae Hwa; Byun, Il Hwan; Lee, Won Jai; Rah, Dong Kyun; Kim, Ji Ye; Lee, Dong Won

2016-12-01

The treatment of gynecomastia depends on multiple factors, and the best modality is controversial. In this study, we aimed to determine the best management approach by comparing outcomes of two groups of patients with gynecomastia who received subcutaneous mastectomy combined with liposuction and liposuction only. We conducted a retrospective analysis of 64 patients who underwent surgery for gynecomastia. We divided the patients into two groups: group A, patients who underwent liposuction only; and group B, patients who underwent liposuction and subcutaneous mastectomy. The serial photographs of all patients were clinically evaluated with respect to size, shape, scarring, and overall outcome by three plastic surgeons, and patient satisfaction was surveyed with regard to palpable lumps, size, shape, scarring, and overall outcome. Of the 64 subjects, 16 received liposuction only, and 48 received the combination procedure. A total of 125 breasts were involved. The doctors' scores for size and overall outcome were significantly better in the combination group, whereas scarring was better in the liposuction-only group. Similarly, patient satisfaction regarding size was significantly higher in the combination group, and satisfaction regarding scarring was significantly higher in the liposuction-only group. The scores for scarring in the combination treatment group were acceptable. Our study shows that combination treatment with liposuction and subcutaneous mastectomy results in satisfactory outcomes, including the extent of scarring. We conclude that this combination treatment should be recommended as the standard surgical treatment for gynecomastia and can provide excellent results in cases where glandular tissue needs to be removed. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Study on the social adaptation of Chinese children with down syndrome.

PubMed

Wang, Yan-Xia; Mao, Shan-Shan; Xie, Chun-Hong; Qin, Yu-Feng; Zhu, Zhi-Wei; Zhan, Jian-Ying; Shao, Jie; Li, Rong; Zhao, Zheng-Yan

2007-06-30

To evaluate social adjustment and related factors among Chinese children with Down syndrome (DS). A structured interview and Peabody Picture Vocabulary Test (PPVT) were conducted with a group of 36 DS children with a mean age of 106.28 months, a group of 30 normally-developing children matched for mental age (MA) and a group of 40 normally-developing children matched for chronological age (CA). Mean scores of social adjustment were compared between the three groups, and partial correlations and stepwise multiple regression models were used to further explore related factors. There was no difference between the DS group and the MA group in terms of communication skills. However, the DS group scored much better than the MA group in self-dependence, locomotion, work skills, socialization and self-management. Children in the CA group achieved significantly higher scores in all aspects of social adjustment than the DS children. Partial correlations indicate a relationship between social adjustment and the PPVT raw score and also between social adjustment and age (significant r ranging between 0.24 and 0.92). A stepwise linear regression analysis showed that family structure was the main predictor of social adjustment. Newborn history was also a predictor of work skills, communication, socialization and self-management. Parental education was found to account for 8% of self-dependence. Maternal education explained 6% of the variation in locomotion. Although limited by the small sample size, these results indicate that Chinese DS children have better social adjustment skills when compared to their mental-age-matched normally-developing peers, but that the Chinese DS children showed aspects of adaptive development that differed from Western DS children. Analyses of factors related to social adjustment suggest that effective early intervention may improve social adaptability.

The telesupervised adaptive ocean sensor fleet

NASA Astrophysics Data System (ADS)

Elfes, Alberto; Podnar, Gregg W.; Dolan, John M.; Stancliff, Stephen; Lin, Ellie; Hosler, Jeffrey C.; Ames, Troy J.; Moisan, John; Moisan, Tiffany A.; Higinbotham, John; Kulczycki, Eric A.

2007-09-01

We are developing a multi-robot science exploration architecture and system called the Telesupervised Adaptive Ocean Sensor Fleet (TAOSF). TAOSF uses a group of robotic boats (the OASIS platforms) to enable in-situ study of ocean surface and sub-surface phenomena. The OASIS boats are extended-deployment autonomous ocean surface vehicles, whose development is funded separately by the National Oceanic and Atmospheric Administration (NOAA). The TAOSF architecture provides an integrated approach to multi-vehicle coordination and sliding human-vehicle autonomy. It allows multiple mobile sensing assets to function in a cooperative fashion, and the operating mode of the vessels to range from autonomous control to teleoperated control. In this manner, TAOSF increases data-gathering effectiveness and science return while reducing demands on scientists for tasking, control, and monitoring. It combines and extends prior related work done by the authors and their institutions. The TAOSF architecture is applicable to other areas where multiple sensing assets are needed, including ecological forecasting, water management, carbon management, disaster management, coastal management, homeland security, and planetary exploration. The first field application chosen for TAOSF is the characterization of Harmful Algal Blooms (HABs). Several components of the TAOSF system have been tested, including the OASIS boats, the communications and control interfaces between the various hardware and software subsystems, and an airborne sensor validation system. Field tests in support of future HAB characterization were performed under controlled conditions, using rhodamine dye as a HAB simulant that was dispersed in a pond. In this paper, we describe the overall TAOSF architecture and its components, discuss the initial tests conducted and outline the next steps.

Safety leadership: application in construction site.

PubMed

Cooper, Dominic

2010-01-01

The extant safety literature suggests that managerial Safety Leadership is vital to the success and maintenance of a behavioral safety process. The current paper explores the role of Managerial Safety Leadership behaviors in the success of a behavioral safety intervention in the Middle-East with 47,000 workers from multiple nationalities employed by fourteen sub-contractors and one main contractor. A quasi-experimental repeating ABABAB, within groups design was used. Measurement focused on managerial Safety Leadership and employee safety behaviors as well as Corrective Actions. Data was collected over 104 weeks. During this time, results show safety behavior improved by 30 percentage points from an average of 65% during baseline to an average of 95%. The site achieved 121 million man-hours free of lost-time injuries on the longest run. Stepwise multiple regression analyses indicated 86% of the variation in employee safety behavior was associated with senior, middle and front-line manager's Safety Leadership behaviors and the Corrective Action Rate. Approximately 38% of the variation in the Total Recordable Incident Rate (TRIR) was associated with the Observation rate, Corrective Action Rate and Observers Records of managerial safety leaders (Visible Ongoing Support). The results strongly suggest manager's Safety Leadership influences the success of Behavioral Safety processes.

Allergen source materials: state-of-the-art.

PubMed

Esch, Robert E

2009-01-01

A variety of positive outcomes can be realized from validation and risk management activities (see Table 4). They are dependent on the participation of multiple functional groups including the quality unit, regulatory and legal affairs, engineering and production operations, research and development, and sales and marketing. Quality risk management is receiving increased attention in the area of public health, pharmacovigilance, and pharmaceutical manufacturing. Recent examples of its regulatory use in our industry include the assessment of the potential risks of transmissible spongiform encephalopathies (TSE) agents through contaminated products], the risks of precipitates in allergenic extracts, and the revision of the potency limits for standardized dust mite and grass allergen vaccines. Its application to allergen source material process validation activities allowed for a practical strategy, especially in a complex manufacturing environment involving hundreds of products with multiple intended uses. In addition, the use of tools such as FMEA was useful in evaluating proposed changes made to manufacturing procedures and product specifications, new regulatory actions, and customer feedback or complaints. The success of such a quality assurance programs will ultimately be reflected in the elimination or reduction of product failures, improvement in the detection and prediction of potential product failures, and increased confidence in product quality.

Designing a new cropping system for high productivity and sustainable water usage under climate change

NASA Astrophysics Data System (ADS)

Meng, Qingfeng; Wang, Hongfei; Yan, Peng; Pan, Junxiao; Lu, Dianjun; Cui, Zhenling; Zhang, Fusuo; Chen, Xinping

2017-02-01

The food supply is being increasingly challenged by climate change and water scarcity. However, incremental changes in traditional cropping systems have achieved only limited success in meeting these multiple challenges. In this study, we applied a systematic approach, using model simulation and data from two groups of field studies conducted in the North China Plain, to develop a new cropping system that improves yield and uses water in a sustainable manner. Due to significant warming, we identified a double-maize (M-M; Zea mays L.) cropping system that replaced the traditional winter wheat (Triticum aestivum L.) -summer maize system. The M-M system improved yield by 14-31% compared with the conventionally managed wheat-maize system, and achieved similar yield compared with the incrementally adapted wheat-maize system with the optimized cultivars, planting dates, planting density and water management. More importantly, water usage was lower in the M-M system than in the wheat-maize system, and the rate of water usage was sustainable (net groundwater usage was ≤150 mm yr-1). Our study indicated that systematic assessment of adaptation and cropping system scale have great potential to address the multiple food supply challenges under changing climatic conditions.

The Diagnostic and Prognostic Role of microRNA in Colorectal Cancer - a Comprehensive review.

PubMed

Mazeh, Haggi; Mizrahi, Ido; Ilyayev, Nadia; Halle, David; Brücher, Bjoern; Bilchik, Anton; Protic, Mladjan; Daumer, Martin; Stojadinovic, Alexander; Itzhak, Avital; Nissan, Aviram

2013-01-01

The discovery of microRNA, a group of regulatory short RNA fragments, has added a new dimension to the diagnosis and management of neoplastic diseases. Differential expression of microRNA in a unique pattern in a wide range of tumor types enables researches to develop a microRNA-based assay for source identification of metastatic disease of unknown origin. This is just one example of many microRNA-based cancer diagnostic and prognostic assays in various phases of clinical research.Since colorectal cancer (CRC) is a phenotypic expression of multiple molecular pathways including chromosomal instability (CIN), micro-satellite instability (MIS) and CpG islands promoter hypermethylation (CIMP), there is no one-unique pattern of microRNA expression expected in this disease and indeed, there are multiple reports published, describing different patterns of microRNA expression in CRC.The scope of this manuscript is to provide a comprehensive review of the scientific literature describing the dysregulation of and the potential role for microRNA in the management of CRC. A Pubmed search was conducted using the following MeSH terms, "microRNA" and "colorectal cancer". Of the 493 publications screened, there were 57 papers describing dysregulation of microRNA in CRC.

Correlation between safety climate and contractor safety assessment programs in construction

PubMed Central

Sparer, EH1; Murphy, LA; Taylor, KM; Dennerlein, Jt

2015-01-01

Background Contractor safety assessment programs (CSAPs) measure safety performance by integrating multiple data sources together; however, the relationship between these measures of safety performance and safety climate within the construction industry is unknown. Methods 401 construction workers employed by 68 companies on 26 sites and 11 safety managers employed by 11 companies completed brief surveys containing a nine-item safety climate scale developed for the construction industry. CSAP scores from ConstructSecure, Inc., an online CSAP database, classified these 68 companies as high or low scorers, with the median score of the sample population as the threshold. Spearman rank correlations evaluated the association between the CSAP score and the safety climate score at the individual level, as well as with various grouping methodologies. In addition, Spearman correlations evaluated the comparison between manager-assessed safety climate and worker-assessed safety climate. Results There were no statistically significant differences between safety climate scores reported by workers in the high and low CSAP groups. There were, at best, weak correlations between workers’ safety climate scores and the company CSAP scores, with marginal statistical significance with two groupings of the data. There were also no significant differences between the manager-assessed safety climate and the worker-assessed safety climate scores. Conclusions A CSAP safety performance score does not appear to capture safety climate, as measured in this study. The nature of safety climate in construction is complex, which may be reflective of the challenges in measuring safety climate within this industry. PMID:24038403

A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

PubMed

Abidi, Samina

2017-10-26

Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

Configuration of multiple human stressors and their impacts on fish assemblages in Alpine river basins of Austria.

PubMed

Schinegger, Rafaela; Pucher, Matthias; Aschauer, Christiane; Schmutz, Stefan

2018-03-01

This work addresses multiple human stressors and their impacts on fish assemblages of the Drava and Mura rivers in southern Austria. The impacts of single and multiple human stressors on riverine fish assemblages in these basins were disentangled, based on an extensive dataset. Stressor configuration, i.e. various metrics of multiple stressors belonging to stressor groups hydrology, morphology, connectivity and water quality were investigated for the first time at river basin scale in Austria. As biological response variables, the Fish Index Austria (FIA) and its related single as well as the WFD biological- and total state were investigated. Stressor-response analysis shows divergent results, but a general trend of decreasing ecological integrity with increasing number of stressors and maximum stressor is observed. Fish metrics based on age structure, fish region index and biological status responded best to single stressors and/or their combinations. The knowledge gained in this work provides a basis for advanced investigations in Alpine river basins and beyond, supports WFD implementation and helps prioritizing further actions towards multi-stressor restoration- and management. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

AgMIP Training in Multiple Crop Models and Tools

NASA Technical Reports Server (NTRS)

Boote, Kenneth J.; Porter, Cheryl H.; Hargreaves, John; Hoogenboom, Gerrit; Thornburn, Peter; Mutter, Carolyn

2015-01-01

The Agricultural Model Intercomparison and Improvement Project (AgMIP) has the goal of using multiple crop models to evaluate climate impacts on agricultural production and food security in developed and developing countries. There are several major limitations that must be overcome to achieve this goal, including the need to train AgMIP regional research team (RRT) crop modelers to use models other than the ones they are currently familiar with, plus the need to harmonize and interconvert the disparate input file formats used for the various models. Two activities were followed to address these shortcomings among AgMIP RRTs to enable them to use multiple models to evaluate climate impacts on crop production and food security. We designed and conducted courses in which participants trained on two different sets of crop models, with emphasis on the model of least experience. In a second activity, the AgMIP IT group created templates for inputting data on soils, management, weather, and crops into AgMIP harmonized databases, and developed translation tools for converting the harmonized data into files that are ready for multiple crop model simulations. The strategies for creating and conducting the multi-model course and developing entry and translation tools are reviewed in this chapter.

Factors Contributing to the Self-Reported Prevalence of Multiple Chemical Sensitivity in Public Facility Workers and the General Population of Korea.

PubMed

Heo, Yong; Kim, Sang-Hoon; Lee, Seok-Ki; Kim, Hyoung-Ah

Multiple chemical sensitivity (MCS), an acquired disorder with multiple recurrent symptoms, has been studied for its association with diverse environmental factors. The present study investigated the factors associated with the self-reported prevalence of MCS in public facility workers and the general population in Korea. The Quick Environmental Exposure Sensitivity Inventory (QEESI) questionnaire was obtained from public facility workers (N=530) and the general population (N=500) to determine the prevalence of MCS and the degree of its risk. Information about demographic characteristics, subjective perceptions of sick building syndrome or sick house syndrome or allergy (SBS/SHS/Allergy), and certain home- or workplace-related events were also obtained. There was not a statistical difference between the public facility workers and the general population in the QEESI scores. The overall prevalence of MCS was 14.4% and there was no statistical difference between the two groups. Regarding the overall degree of risk of MCS, 21.8% of the study subjects were categorized as "very suggestive", and there was no significant difference between the two groups. Gender and the subjective perception of SBS/SHS/Allergy significantly affected the prevalence of MCS and the MCS risk criteria. Considering the absence of diagnostic criteria and/or treatment methods for MCS in Korea, these results can be utilized in establishing future strategies to manage MCS.

Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

PubMed Central

Sánchez-Carrillo, C I

1989-01-01

Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries, psychological trauma, and survival. PMID:2508177

Post-traumatic stress disorder.

PubMed

Bisson, Jonathan I

2007-08-01

Post-traumatic stress disorder (PTSD) may affect 10% of women and 5% of men at some stage, and symptoms may persist for several years. Risk factors include major trauma, lack of social support, peritraumatic dissociation, and psychiatric or personality factors. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent; and to treat PTSD? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 36 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: affect management, antiepileptic drugs, antihypertensive drugs, benzodiazepines, brofaromine, carbamazepine, CBT, drama therapy, eye movement desensitisation and reprocessing, fluoxetine, group therapy, hydrocortisone, hypnotherapy, inpatient treatment programmes, internet-based psychotherapy, mirtazepine, multiple-session CBT, multiple-session collaborative trauma support, multiple-session education, nefazodone, olanzapine, paroxetine, phenelzine, propranolol, psychodynamic psychotherapy, risperidone, SSRIss, sertraline, single-session group debriefing, single-session individual debriefing, supportive psychotherapy, supportive counselling, temazepam, tricyclic antidepressants, venlafaxine.

An Analysis of Student Affairs Professionals' Management of Role Conflict and Multiple Roles in Relation to Work/Life Balance

ERIC Educational Resources Information Center

Mayo, Nicole Lepone

2013-01-01

The purpose of this inquiry is to study how student affairs professionals manage role conflict in relation to work/life balance based on the challenging culture of the field. The underlying goals are to identify the barriers or challenges of managing multiple roles as a student affairs administrator and identify strategies to assist employees in…

Assessing and managing multiple risks in a changing world – the Roskilde recommendations.

EPA Science Inventory

Roskilde University (Denmark) hosted a November 2015 workshop, Environmental Risk—Assessing and Managing Multiple Risks in a Changing World. This Focus article presents the consensus recommendations of 30 attendees from 9 countries regarding implementation of a common curre...

Guidelines for supportive care in multiple myeloma 2011.

PubMed

Snowden, John A; Ahmedzai, Sam H; Ashcroft, John; D'Sa, Shirley; Littlewood, Timothy; Low, Eric; Lucraft, Helen; Maclean, Rhona; Feyler, Sylvia; Pratt, Guy; Bird, Jennifer M

2011-07-01

Supportive care plays an increasingly important role in the modern management of multiple myeloma. While modern treatments have significantly prolonged overall and progression free survival through improved disease control, the vast majority of patients remain incurable, and live with the burden of the disease itself and the cumulative side effects of treatments. Maintenance of quality of life presents challenges at all stages of the disease from diagnosis through the multiple phases of active treatment to the end of life. Written on behalf of the British Committee for Standards in Haematology (BCSH) and the UK Myeloma Forum (UKMF), these evidence based guidelines summarize the current national consensus for supportive and symptomatic care in multiple myeloma in the following areas; pain management, peripheral neuropathy, skeletal complications, infection, anaemia, haemostasis and thrombosis, sedation, fatigue, nausea, vomiting, anorexia, constipation, diarrhoea, mucositis, bisphosphonate-induced osteonecrosis of the jaw, complementary therapies, holistic needs assessment and end of life care. Although most aspects of supportive care can be supervised by haematology teams primarily responsible for patients with multiple myeloma, multidisciplinary collaboration involving specialists in palliative medicine, pain management, radiotherapy and surgical specialities is essential, and guidance is provided for appropriate interdisciplinary referral. These guidelines should be read in conjunction with the BCSH/UKMF Guidelines for the Diagnosis and Management of Multiple Myeloma 2011. © 2011 Blackwell Publishing Ltd.

Information basis for developing comprehensive waste management system-US-Japan joint nuclear energy action plan waste management working group phase I report.

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

Nutt, M.; Nuclear Engineering Division

2010-05-25

The activity of Phase I of the Waste Management Working Group under the United States - Japan Joint Nuclear Energy Action Plan started in 2007. The US-Japan JNEAP is a bilateral collaborative framework to support the global implementation of safe, secure, and sustainable, nuclear fuel cycles (referred to in this document as fuel cycles). The Waste Management Working Group was established by strong interest of both parties, which arise from the recognition that development and optimization of waste management and disposal system(s) are central issues of the present and future nuclear fuel cycles. This report summarizes the activity of themore » Waste Management Working Group that focused on consolidation of the existing technical basis between the U.S. and Japan and the joint development of a plan for future collaborative activities. Firstly, the political/regulatory frameworks related to nuclear fuel cycles in both countries were reviewed. The various advanced fuel cycle scenarios that have been considered in both countries were then surveyed and summarized. The working group established the working reference scenario for the future cooperative activity that corresponds to a fuel cycle scenario being considered both in Japan and the U.S. This working scenario involves transitioning from a once-through fuel cycle utilizing light water reactors to a one-pass uranium-plutonium fuel recycle in light water reactors to a combination of light water reactors and fast reactors with plutonium, uranium, and minor actinide recycle, ultimately concluding with multiple recycle passes primarily using fast reactors. Considering the scenario, current and future expected waste streams, treatment and inventory were discussed, and the relevant information was summarized. Second, the waste management/disposal system optimization was discussed. Repository system concepts were reviewed, repository design concepts for the various classifications of nuclear waste were summarized, and the factors to consider in repository design and optimization were then discussed. Japan is considering various alternatives and options for the geologic disposal facility and the framework for future analysis of repository concepts was discussed. Regarding the advanced waste and storage form development, waste form technologies developed in both countries were surveyed and compared. Potential collaboration areas and activities were next identified. Disposal system optimization processes and techniques were reviewed, and factors to consider in future repository design optimization activities were also discussed. Then the potential collaboration areas and activities related to the optimization problem were extracted.« less

Changing climate and the value of the tea landscape in Assam

NASA Astrophysics Data System (ADS)

Biggs, E. M.; Gupta, N.; Duncan, J.; Saikia, S. D.

2015-12-01

Tea production has a measurable impact upon millions of people's livelihoods in northeast India. The region is experiencing changes in climate characteristics which are placing added pressure on the tea industry for sustaining livelihoods. To increase understanding of the role of tea within the Assam landscape, this research has engaged with multiple local tea-producing stakeholders. Approximately 65% of Assam's tea is produced in large plantations, with the remaining 35% produced in smallholdings. Questionnaires were used to obtain information on land management practices operationalised by plantation managers and smallholders. Focus group sessions using the Delphi technique were conducted with tea workers (labourers for the plantations) to ascertain the level of importance of the tea sector to sustaining their livelihoods. Questionnaires and focus group surveys also attempted to establish stakeholder understanding of climate change. Data were analysed using spatial statistics to investigate intra- and inter-region variation in responses. Focus group responses were categorised to determine the livelihood asset base available to tea workers within plantations, with patterns of (dis)similarity observed spatially. Results indicate that land management practices (e.g. fertiliser and pesticide application), tea processing methods (e.g. onsite factory and energy generation), and social provisions for tea workers (e.g. sanitation and education facilities) varied greatly across the main tea growing regions of Assam. Tea workers listed numerous environmental and social factors as important for sustaining livelihoods, with the top ranked factors similar across some plantations (e.g. drinking water availability and access). Plantation managers are highly concerned with how climate conditions are affecting tea production, and although workers were aware of climate change issues in some plantations, socioeconomic conditions seemed of more pressing concern to their livelihoods.

Fluoroscopic Caudal Epidural Injections in Managing Post Lumbar Surgery Syndrome: Two-Year Results of a Randomized, Double-Blind, Active-Control Trial

PubMed Central

Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A.; Pampati, Vidyasagar; Datta, Sukdeb

2012-01-01

Study Design: A randomized, active control, double-blind trial. Objective: To evaluate the effectiveness of fluoroscopically directed caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to post lumbar surgery syndrome. Summary of Background Data: There is a paucity of evidence concerning caudal epidural injections for managing chronic persistent low back pain with or without lower extremity pain caused by post lumbar surgery syndrome. Methods: This active control randomized study included 140 patients with 70 patients in each group. Group I received 0.5% lidocaine, 10 mL; Group II received 9 mL of 0.5% lidocaine mixed with 1 mL of 6 mg of nonparticulate betamethasone. The multiple outcome measures included the numeric rating scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as at least 50% improvement in pain and Oswestry Disability Index scores. Patients with a positive response to the first 2 procedures with at least 3 weeks of relief were considered to be successful. All others were considered as failures. Results: Overall in Group I, 53% and 47% of the patients and in Group II, 59% and 58% of the patients, showed significant improvement with reduction in pain scores and disability index at 12 months and 24 months. In contrast, in the successful groups, significant pain relief and improvement in function were observed in 70% and 62% of Group I at one and 2 years; in 75% and 69% of Group II at one and 2 years. The results in the successful group showed that at the end of the first year patients experienced approximately 38 weeks of relief and at the end of 2 years Group I had 62 weeks and Group II had 68 weeks of relief. Overall total relief for 2 years was 48 weeks in Group I and 54 weeks in Group II. The average procedures in the successful groups were at 4 in one year and 6 at the end of 2 years. Conclusion: Caudal epidural injections of local anesthetic with or without steroid might be effective in patients with chronic persistent low back and/or lower extremity pain in patients with post lumbar surgery syndrome. PMID:23028241

Percolation galaxy groups and clusters in the sdss redshift survey: identification, catalogs, and the multiplicity function

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

Berlind, Andreas A.; Frieman, Joshua A.; Weinberg, David H.

2006-01-01

We identify galaxy groups and clusters in volume-limited samples of the SDSS redshift survey, using a redshift-space friends-of-friends algorithm. We optimize the friends-of-friends linking lengths to recover galaxy systems that occupy the same dark matter halos, using a set of mock catalogs created by populating halos of N-body simulations with galaxies. Extensive tests with these mock catalogs show that no combination of perpendicular and line-of-sight linking lengths is able to yield groups and clusters that simultaneously recover the true halo multiplicity function, projected size distribution, and velocity dispersion. We adopt a linking length combination that yields, for galaxy groups withmore » ten or more members: a group multiplicity function that is unbiased with respect to the true halo multiplicity function; an unbiased median relation between the multiplicities of groups and their associated halos; a spurious group fraction of less than {approx}1%; a halo completeness of more than {approx}97%; the correct projected size distribution as a function of multiplicity; and a velocity dispersion distribution that is {approx}20% too low at all multiplicities. These results hold over a range of mock catalogs that use different input recipes of populating halos with galaxies. We apply our group-finding algorithm to the SDSS data and obtain three group and cluster catalogs for three volume-limited samples that cover 3495.1 square degrees on the sky. We correct for incompleteness caused by fiber collisions and survey edges, and obtain measurements of the group multiplicity function, with errors calculated from realistic mock catalogs. These multiplicity function measurements provide a key constraint on the relation between galaxy populations and dark matter halos.« less

Polarity management: the key challenge for integrated health systems.

PubMed

Burns, L R

1999-01-01

Integrated health systems are confronted with numerous dilemmas that must be managed. Many of these dilemmas are an inherent part of the system's structure, given that multiple competing hospitals, medical groups, and (sometimes) health plans are often under one organizational roof. This article presents an analysis of these dilemmas--referred to in the management literature as polarities--as they are found in six integrated health systems in Illinois. The nine polarities that must be managed include (1) hospital systems that want to be organizations of physicians; (2) system expansion by growing the physician component; (3) system centralization and physician decentralization; (4) centripetal and centrifugal forces involving physicians; (5) system objectives and physician interests; (6) system centralization and hospital decentralization; (7) primary care physicians and specialists; (8) physician autonomy via collectivization; and (9) vertical and virtual integration. The article identifies some of the solutions to the polarities that have been enacted by systems. In general, executives and physicians in integrated health systems must attend to the processes of integration as much as or more than the structures of integration.

Semantic Data Integration and Knowledge Management to Represent Biological Network Associations.

PubMed

Losko, Sascha; Heumann, Klaus

2017-01-01

The vast quantities of information generated by academic and industrial research groups are reflected in a rapidly growing body of scientific literature and exponentially expanding resources of formalized data, including experimental data, originating from a multitude of "-omics" platforms, phenotype information, and clinical data. For bioinformatics, the challenge remains to structure this information so that scientists can identify relevant information, to integrate this information as specific "knowledge bases," and to formalize this knowledge across multiple scientific domains to facilitate hypothesis generation and validation. Here we report on progress made in building a generic knowledge management environment capable of representing and mining both explicit and implicit knowledge and, thus, generating new knowledge. Risk management in drug discovery and clinical research is used as a typical example to illustrate this approach. In this chapter we introduce techniques and concepts (such as ontologies, semantic objects, typed relationships, contexts, graphs, and information layers) that are used to represent complex biomedical networks. The BioXM™ Knowledge Management Environment is used as an example to demonstrate how a domain such as oncology is represented and how this representation is utilized for research.

MyDiabetesMyWay: An Evolving National Data Driven Diabetes Self-Management Platform.

PubMed

Wake, Deborah J; He, Jinzhang; Czesak, Anna Maria; Mughal, Fezan; Cunningham, Scott G

2016-09-01

MyDiabetesMyWay (MDMW) is an award-wining national electronic personal health record and self-management platform for diabetes patients in Scotland. This platform links multiple national institutional and patient-recorded data sources to provide a unique resource for patient care and self-management. This review considers the current evidence for online interventions in diabetes and discusses these in the context of current and ongoing developments for MDMW. Evaluation of MDMW through patient reported outcomes demonstrates a positive impact on self-management. User feedback has highlighted barriers to uptake and has guided platform evolution from an education resource website to an electronic personal health record now encompassing remote monitoring, communication tools and personalized education links. Challenges in delivering digital interventions for long-term conditions include integration of data between institutional and personal recorded sources to perform big data analytics and facilitating technology use in those with disabilities, low digital literacy, low socioeconomic status and in minority groups. The potential for technology supported health improvement is great, but awareness and adoption by health workers and patients remains a significant barrier. © 2016 Diabetes Technology Society.