Organizational strategy and diversity management: diversity-sensitive orientation as a moderating influence.

PubMed

Dansky, Kathryn H; Weech-Maldonado, Robert; De Souza, Gita; Dreachslin, Janice L

2003-01-01

Empirical studies on diversity suggest that health care organizations have been slow to embrace diversity management. We propose that sensitivity to diversity, at the corporate level, moderates strategic decision making, which influences human resource management practices such as diversity initiatives. This study of 203 hospitals explored the relationships among organizational strategy, organizational sensitivity to diversity, and diversity management practices.

Research of information classification and strategy intelligence extract algorithm based on military strategy hall

NASA Astrophysics Data System (ADS)

Chen, Lei; Li, Dehua; Yang, Jie

2007-12-01

Constructing virtual international strategy environment needs many kinds of information, such as economy, politic, military, diploma, culture, science, etc. So it is very important to build an information auto-extract, classification, recombination and analysis management system with high efficiency as the foundation and component of military strategy hall. This paper firstly use improved Boost algorithm to classify obtained initial information, then use a strategy intelligence extract algorithm to extract strategy intelligence from initial information to help strategist to analysis information.

The Prevention of Childhood Sexual Abuse

ERIC Educational Resources Information Center

Finkelhor, David

2009-01-01

David Finkelhor examines initiatives to prevent child sexual abuse, which have focused on two primary strategies--offender management and school-based educational programs. Recent major offender management initiatives have included registering sex offenders, notifying communities about their presence, conducting background employment checks,…

Addressing strategy execution challenges to lead sustainable change.

PubMed

Shirey, Maria R

2011-01-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses strategy execution challenges that must be addressed to lead sustainable change.

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study.

PubMed

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2007-11-16

As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives.

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

PubMed Central

Bruni, Rebecca A; Laupacis, Andreas; Levinson, Wendy; Martin, Douglas K

2007-01-01

Background As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. Methods This study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. Results The Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy. Conclusion We described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives. PMID:18021393

Perceptions Regarding Selected Educational Strategies Used by Extension Educators

ERIC Educational Resources Information Center

Kwaw-Mensah, David; Martin, Robert A.

2013-01-01

Purpose: The purpose of this study was to identify the perceptions that extension educators in the North Central region of the United States hold regarding selected educational strategies pertaining to livestock waste management education. Livestock waste management education has been recognized as one of extension's major initiatives in the…

National Readmission Patterns of Isolated Splenic Injuries Based on Initial Management Strategy.

PubMed

Rosenberg, Graeme M; Knowlton, Lisa; Rajasingh, Charlotte; Weng, Yingjie; Maggio, Paul M; Spain, David A; Staudenmayer, Kristan L

2017-12-01

Options for managing splenic injuries have evolved with a focus on nonoperative management. Long-term outcomes, such as readmissions and delayed splenectomy rate, are not well understood. To describe the natural history of isolated splenic injuries in the United States and determine whether patterns of readmission were influenced by management strategy. The Healthcare Cost and Utilization Project's Nationwide Readmission Database is an all-payer, all-ages, longitudinal administrative database that provides data on more than 35 million weighted US discharges yearly. The database was used to identify patients with isolated splenic injuries and the procedures that they received. Adult patients with isolated splenic injuries admitted from January 1 through June 30, 2013, and from January 1 through June 30, 2014, were included. Those who died during the index hospitalization or who had an additional nonsplenic injury with an Abbreviated Injury Score of 2 or greater were excluded. Univariate and mixed-effects logistic regression analysis controlling for center effect were used. Weighted numbers are reported. Initial management strategy at the time of index hospitalization, including nonprocedural management, angioembolization, and splenectomy. All-cause 6-month readmission rate. Secondary outcome was delayed splenectomy rate. A weighted sample of 3792 patients (2146 men [56.6%] and 1646 women [43.4%]; mean [SE] age, 48.5 [0.7] years) with 5155 admission events was included. During the index hospitalization, 825 (21.8%) underwent splenectomy, 293 (7.7%) underwent angioembolization, and 2673 (70.5%) had no procedure. The overall readmission rate was 21.1% (799 patients). Readmission rates did not differ based on initial management strategy (195 patients undergoing splenectomy [23.6%], 70 undergoing angioembolism [23.9%], and 534 undergoing no procedure [20%]; P = .33). Splenectomy was performed in 36 of 799 readmitted patients (4.5%) who did not have a splenectomy at their index hospitalization, leading to an overall delayed splenectomy rate of 1.2% (36 of 2967 patients). In mixed-effects logistic regression analysis controlling for patient, injury, clinical, and hospital characteristics, the choice of splenectomy (odds ratio, 0.93; 95% CI, 0.66-1.31) vs angioembolization (odds ratio, 1.19; 95% CI, 0.72-1.97) as initial management strategy was not associated with readmission. This national evaluation of the natural history of isolated splenic injuries from index admission through 6 months found that approximately 1 in 5 patients are readmitted within 6 months of discharge after an isolated splenic injury. However, the chance of readmission for splenectomy after initial nonoperative management was 1.2%. This finding suggests that the current management strategies used for isolated splenic injuries in the United States are well matched to patient need.

Targeted intervention strategies to optimise diversion of BMW in the Dublin, Ireland region

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

Purcell, M., E-mail: mary.purcell@cit.ie; Centre for Water Resources Research, School of Architecture, Landscape and Civil Engineering, University College Dublin, Newstead, Belfield, Dublin 4; Magette, W.L.

Highlights: > Previous research indicates that targeted strategies designed for specific areas should lead to improved diversion. > Survey responses and GIS model predictions from previous research were the basis for goal setting. > Then logic modelling and behavioural research were employed to develop site-specific management intervention strategies. > Waste management initiatives can be tailored to specific needs of areas rather than one size fits all means currently used. - Abstract: Urgent transformation is required in Ireland to divert biodegradable municipal waste (BMW) from landfill and prevent increases in overall waste generation. When BMW is optimally managed, it becomes amore » resource with value instead of an unwanted by-product requiring disposal. An analysis of survey responses from commercial and residential sectors for the Dublin region in previous research by the authors proved that attitudes towards and behaviour regarding municipal solid waste is spatially variable. This finding indicates that targeted intervention strategies designed for specific geographic areas should lead to improved diversion rates of BMW from landfill, a requirement of the Landfill Directive 1999/31/EC. In the research described in this paper, survey responses and GIS model predictions from previous research were the basis for goal setting, after which logic modelling and behavioural research were employed to develop site-specific waste management intervention strategies. The main strategies devised include (a) roll out of the Brown Bin (Organics) Collection and Community Workshops in Dun Laoghaire Rathdown, (b) initiation of a Community Composting Project in Dublin City (c) implementation of a Waste Promotion and Motivation Scheme in South Dublin (d) development and distribution of a Waste Booklet to promote waste reduction activities in Fingal (e) region wide distribution of a Waste Booklet to the commercial sector and (f) Greening Irish Pubs Initiative. Each of these strategies was devised after interviews with both the residential and commercial sectors to help make optimal waste management the norm for both sectors. Strategy (b), (e) and (f) are detailed in this paper. By integrating a human element into accepted waste management approaches, these strategies will make optimal waste behaviour easier to achieve. Ultimately this will help divert waste from landfill and improve waste management practice as a whole for the region. This method of devising targeted intervention strategies can be adapted for many other regions.« less

Improving the Standards-Based Management-Recognition initiative to provide high-quality, equitable maternal health services in Malawi: an implementation research protocol.

PubMed

Mumtaz, Zubia; Salway, Sarah; Nyagero, Josephat; Osur, Joachim; Chirwa, Ellen; Kachale, Fannie; Saunders, Duncan

2016-01-01

The Government of Malawi is seeking evidence to improve implementation of its flagship quality of care improvement initiative-the Standards Based Management-Recognition for Reproductive Health (SBM-R(RH)). This implementation study will assess the quality of maternal healthcare in facilities where the SBM-R(RH) initiative has been employed, identify factors that support or undermine effectiveness of the initiative and develop strategies to further enhance its operation. Data will be collected in 4 interlinked modules using quantitative and qualitative research methods. Module 1 will develop the programme theory underlying the SBM-R(RH) initiative, using document review and in-depth interviews with policymakers and programme managers. Module 2 will quantitatively assess the quality and equity of maternal healthcare provided in facilities where the SBM-R(RH) initiative has been implemented, using the Malawi Integrated Performance Standards for Reproductive Health. Module 3 will conduct an organisational ethnography to explore the structures and processes through which SBM-R(RH) is currently operationalised. Barriers and facilitators will be identified. Module 4 will involve coordinated co-production of knowledge by researchers, policymakers and the public, to identify and test strategies to improve implementation of the initiative. The research outcomes will provide empirical evidence of strategies that will enhance the facilitators and address the barriers to effective implementation of the initiative. It will also contribute to the theoretical advances in the emerging science of implementation research.

Applying Project Management Strategies in a Large Curriculum Conversion Project in Higher Education

ERIC Educational Resources Information Center

Gardner, Joel; Bennett, Patrick A.; Hyatt, Niccole; Stoker, Kevin

2017-01-01

Higher education is undergoing great changes that require universities to adapt quickly, and making these changes can be difficult. One discipline that can aid in executing change is project management, which has developed a set of clear processes and strategies for completing initiatives quickly and effectively. Several authors have identified…

Should Quality School Education Be a Kaizen (Improvement) or an Innovation?

ERIC Educational Resources Information Center

Sun-Keung Pang, Nicholas

1998-01-01

Reviews Hong Kong's School Management Initiative implementation strategies (rational-empirical, power-coercive, and normative-reeducative), compares them with New South Wales, Australia's strategies, and suggests an appropriate strategy for future reforms. In Australia, changes were radical and thorough (using power-coercive strategies), whereas…

Green supply chain management strategy selection using analytic network process: case study at PT XYZ

NASA Astrophysics Data System (ADS)

Adelina, W.; Kusumastuti, R. D.

2017-01-01

This study is about business strategy selection for green supply chain management (GSCM) for PT XYZ by using Analytic Network Process (ANP). GSCM is initiated as a response to reduce environmental impacts from industrial activities. The purposes of this study are identifying criteria and sub criteria in selecting GSCM Strategy, and analysing a suitable GSCM strategy for PT XYZ. This study proposes ANP network with 6 criteria and 29 sub criteria, which are obtained from the literature and experts’ judgements. One of the six criteria contains GSCM strategy options, namely risk-based strategy, efficiency-based strategy, innovation-based strategy, and closed loop strategy. ANP solves complex GSCM strategy-selection by using a more structured process and considering green perspectives from experts. The result indicates that innovation-based strategy is the most suitable green supply chain management strategy for PT XYZ.

Influence of temperature on spring flight initiation for southwestern ponderosa pine bark beetles (Coleoptera: Curculionidae, Scolytinae)

Treesearch

M. L. Gaylord; K. K. Williams; R. W. Hofstetter; J. D. McMillin; T. E. Degomez; M. R. Wagner

2008-01-01

Determination of temperature requirements for many economically important insects is a cornerstone of pest management. For bark beetles (Coleoptera: Curculionidae, Scolytinae), this information can facilitate timing of management strategies. Our goals were to determine temperature predictors for flight initiation of three species of Ips bark beetles...

Technology Transfer and Innovation Initiatives in Strategic Management: Generating an Alternative Perspective

ERIC Educational Resources Information Center

Major, E.

2003-01-01

This paper taps the strategic management discipline to inform our understanding of technology transfer and innovation (TTI) initiatives. With special focus on the UK Foresight programme it considers the impacts that the resource-based and core competence approaches to strategy can have on understanding the nature and effectiveness of TTI…

Achieving excellence in the management of accounts receivable.

PubMed

Ladewig, T L; Hecht, B A

1993-09-01

Recent changes in healthcare reimbursement rules and practices have made the task of accounts receivable management a particularly demanding one for most financial managers. One multihospital system, after pursuing numerous strategies to reduce its accounts receivable with only marginal levels of success, launched a systemwide initiative to share both the positive and the negative accounts receivable management experiences of each department at each hospital in the system with all patient accounting staff. The objective of the initiative was to use the lessons learned from those experiences to attain excellence in accounts receivable management throughout the system. The ultimate success of the initiative is detailed in the following article.

Sustained transfer of knowledge to practice in long-term care: facilitators and barriers of a mental health learning initiative.

PubMed

Stolee, Paul; McAiney, Carrie A; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

2009-01-01

This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management support, particularly designation of time for PRP activities, development of PRP teams, and supportive learning strategies were significant factors affecting sustained knowledge transfer. Continuing education that is provided and evaluated on an ongoing basis, secures management commitment, is integrated within a broader system strategy, and provides on-the-job support has the greatest potential to affect care.

To Spray or Not to Spray: A Decision Analysis of Coffee Berry Borer in Hawaii

PubMed Central

2017-01-01

Integrated pest management strategies were adopted to combat the coffee berry borer (CBB) after its arrival in Hawaii in 2010. A decision tree framework is used to model the CBB integrated pest management recommendations, for potential use by growers and to assist in developing and evaluating management strategies and policies. The model focuses on pesticide spraying (spray/no spray) as the most significant pest management decision within each period over the entire crop season. The main result from the analysis suggests the most important parameter to maximize net benefit is to ensure a low initial infestation level. A second result looks at the impact of a subsidy for the cost of pesticides and shows a typical farmer receives a positive net benefit of $947.17. Sensitivity analysis of parameters checks the robustness of the model and further confirms the importance of a low initial infestation level vis-a-vis any level of subsidy. The use of a decision tree is shown to be an effective method for understanding integrated pest management strategies and solutions. PMID:29065464

Funding big research with small money.

PubMed

Hickey, Joanne V; Koithan, Mary; Unruh, Lynn; Lundmark, Vicki

2014-06-01

This department highlights change management strategies that maybe successful in strategically planning and executing organizational change initiatives.With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools,and resources that mobilize and sustain organizational change initiatives.In this article, the guest authors introduce crowd sourcing asa strategy for funding big research with small money.

Acute upper gastrointestinal bleeding (UGIB) - initial evaluation and management.

PubMed

Khamaysi, Iyad; Gralnek, Ian M

2013-10-01

Acute upper gastrointestinal bleeding (UGIB) is the most common reason that the 'on-call' gastroenterologist is consulted. Despite the diagnostic and therapeutic capabilities of upper endoscopy, there is still significant associated morbidity and mortality in patients experiencing acute UGIB, thus this is a true GI emergency. Acute UGIB is divided into non-variceal and variceal causes. The most common type of acute UGIB is 'non-variceal' and includes diagnoses such as peptic ulcer (gastric and duodenal), gastroduodenal erosions, Mallory-Weiss tears, erosive oesophagitis, arterio-venous malformations, Dieulafoy's lesion, and upper GI tract tumours and malignancies. This article focuses exclusively on initial management strategies for acute upper GI bleeding. We discuss up to date and evidence-based strategies for patient risk stratification, initial patient management prior to endoscopy, potential causes of UGIB, role of proton pump inhibitors, prokinetic agents, prophylactic antibiotics, vasoactive pharmacotherapies, and timing of endoscopy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Development of practice and consensus-based strategies including a treat-to-target approach for the management of moderate and severe juvenile dermatomyositis in Germany and Austria.

PubMed

Hinze, Claas H; Oommen, Prasad T; Dressler, Frank; Urban, Andreas; Weller-Heinemann, Frank; Speth, Fabian; Lainka, Elke; Brunner, Jürgen; Fesq, Heike; Foell, Dirk; Müller-Felber, Wolfgang; Neudorf, Ulrich; Rietschel, Christoph; Schwarz, Tobias; Schara, Ulrike; Haas, Johannes-Peter

2018-06-25

Juvenile dermatomyositis (JDM) is the most common inflammatory myopathy in childhood and a major cause of morbidity among children with pediatric rheumatic diseases. The management of JDM is very heterogeneous. The JDM working group of the Society for Pediatric Rheumatology (GKJR) aims to define consensus- and practice-based strategies in order to harmonize diagnosis, treatment and monitoring of JDM. The JDM working group was established in 2015 consisting of 23 pediatric rheumatologists, pediatric neurologists and dermatologists with expertise in the management of JDM. Current practice patterns of management in JDM had previously been identified via an online survey among pediatric rheumatologists and neurologists. Using a consensus process consisting of online surveys and a face-to-face consensus conference statements were defined regarding the diagnosis, treatment and monitoring of JDM. During the conference consensus was achieved via nominal group technique. Voting took place using an electronic audience response system, and at least 80% consensus was required for individual statements. Overall 10 individual statements were developed, finally reaching a consensus of 92 to 100% regarding (1) establishing a diagnosis, (2) case definitions for the application of the strategies (moderate and severe JDM), (3) initial diagnostic testing, (4) monitoring and documentation, (5) treatment targets within the context of a treat-to-target strategy, (6) supportive therapies, (7) explicit definition of a treat-to-target strategy, (8) various glucocorticoid regimens, including intermittent intravenous methylprednisolone pulse and high-dose oral glucocorticoid therapies with tapering, (9) initial glucocorticoid-sparing therapy and (10) management of refractory disease. Using a consensus process among JDM experts, statements regarding the management of JDM were defined. These statements and the strategies aid in the management of patients with moderate and severe JDM.

Sex Role and Topic Management Strategies in Interpersonal Communication.

ERIC Educational Resources Information Center

Schneider, Michael J.; Bradac, James J.

Thirty male and twenty female students were used to investigate the strategies of topic management. In pairs, they were told that the male (or female) would like to become friends with the female (or male), and were assigned a dialogue which created a positive or a negative context. Then the subject assigned as the initiator was given one of three…

Lessons from the business sector for successful knowledge management in health care: a systematic review.

PubMed

Kothari, Anita; Hovanec, Nina; Hastie, Robyn; Sibbald, Shannon

2011-07-25

The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. 83 articles were reviewed and data were extracted to: (1) uncover reasons for initiating knowledge management strategies, (2) identify potential knowledge management strategies/solutions, and (3) describe facilitators and barriers to knowledge management. KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate) knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build.

Lessons from the business sector for successful knowledge management in health care: A systematic review

PubMed Central

2011-01-01

Background The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. Methods We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. Results 83 articles were reviewed and data were extracted to: (1) uncover reasons for initiating knowledge management strategies, (2) identify potential knowledge management strategies/solutions, and (3) describe facilitators and barriers to knowledge management. Conclusions KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate) knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build. PMID:21787403

The Pain Associates' International Network Initiative: a novel practical approach to the challenge of chronic pain management in Europe.

PubMed

Morlion, Bart; Walch, Heribert; Yihune, Gabriel; Vielvoye-Kerkmeer, Ans; de Jong, Zuzana; Castro-Lopes, José; Stanton-Hicks, Michael

2008-01-01

Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up-to-date training in pain management.

Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis.

PubMed

Konijeti, Gauree G; Sauk, Jenny; Shrime, Mark G; Gupta, Meera; Ananthakrishnan, Ashwin N

2014-06-01

Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to analyze the cost effectiveness of competing strategies for recurrent CDI. We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence. We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year. At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin. Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates <14.9%. Fidaxomicin required a cost <$1359 to meet our cost-effectiveness threshold. In clinical settings where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral vancomycin. In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI.

77 FR 65364 - Mid-Atlantic Fishery Management Council (MAFMC); Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... Economic Impact, Governance and Regulatory Process goals, objectives and strategies initially drafted on... and threats on science and data and ecosystem based fishery management. No formal actions will be...

"Endovascular embolic hemispherectomy": a strategy for the initial management of catastrophic holohemispheric epilepsy in the neonate.

PubMed

Oluigbo, Chima; Pearl, Monica S; Tsuchida, Tammy N; Chang, Taeun; Ho, Cheng-Ying; Gaillard, William D

2017-03-01

Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate. We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere. Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age. The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.

Electronic freight management (EFM) standards strategy

DOT National Transportation Integrated Search

2006-04-01

The EFM initiative is a U.S. Department of Transportation (DOT)-sponsored research effort aimed at improving the operating efficiency, safety, and security of freight movement. The initiative involves conducting a deployment test using Web services t...

Management strategies to effect change in intensive care units: lessons from the world of business. Part I. Targeting quality improvement initiatives.

PubMed

Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

2014-02-01

The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives. These tools are relevant to health care today as focus is placed on limiting low-value care and measuring, reporting, and improving quality. In the ICU, the complexity of illness and the need to standardize processes make these tools even more appealing. Herein, we highlight four techniques to help prioritize initiatives. First, the "80/20 rule" mandates focus on the few (20%) interventions likely to drive the majority (80%) of improvement. Second, benchmarking--a process of comparison with peer units or institutions--is essential to identifying areas of strength and weakness. Third, root cause analyses, in which structured retrospective reviews of negative events are performed, can be used to identify and fix systems errors. Finally, failure mode and effects analysis--a process aimed at prospectively identifying potential sources of error--allows for systems fixes to be instituted in advance to prevent negative outcomes. These techniques originated in fields other than health care, yet adoption has and can help ICU managers prioritize issues for quality improvement.

Reinventing Information Services.

ERIC Educational Resources Information Center

Farkas-Conn, Irene; And Others

1996-01-01

This special section includes seven articles that discuss reinventing information services. Highlights include linking information services to business strategies; meeting client initiatives; information services at the Ottawa laboratory of Bell-Northern Research (BNR); product service strategies; information management and transition economies;…

Urethritis in men: benefits, risks, and costs of alternative strategies of management.

PubMed

Braun, P; Sherman, H; Komaroff, A L

1982-01-01

Four alternative strategies for the management of men with acute urethritis were analyzed: treating patients with tetracycline, with or without a urethral culture, without basing the initial treatment decision on the results of a gram-stained smear; treating patients with penicillin, without basing initial treatment on the results of a gram-stained smear; basing initial treatment with tetracycline or penicillin on the results of a gram-stained smear; and basing treatment on the results of both a gram-stained smear and a culture. The tetracycline strategy resulted in fewer days of morbidity, a lower probability of premature death, lower dollar costs, and a much lower rate of uncured nongonococcal urethritis, but in slightly higher rates of uncured gonorrhea and syphilis than more traditional strategies. Use of culture with the tetracycline strategy (1A) permitted tracing of gonorrhea contacts, achieved the same low morbidity, and added little cost. The conclusions were true regardless of the probability of gonorrhea and for reasonable estimates of probable compliance with oral medication regimens. Test-of-cure cultures for patients who were asymptomatic after treatment for gonorrhea required the expenditure of from $4,900 to $109,800 for each case of asymptomatic persistent gonorrhea discovered and cured, depending on the strategy used.

An initial evaluation of potential options for managing riparian reserves of the Aquatic Conservation Strategy of the Northwest Forest Plan

Treesearch

Gordon H. Reeves; Brian R. Pickard; K. Norman Johnson

2016-01-01

The Aquatic Conservation Strategy (ACS) of the Northwest Forest Plan guides management of riparian and aquatic ecosystems on federal lands in western Oregon, western Washington, and northern California. We applied new scientific findings and tools to evaluate two potential options, A and B, for refining interim riparian reserves to meet ACS goals and likely challenges...

Evolution in Clinical Knowledge Management Strategy at Intermountain Healthcare

PubMed Central

Hulse, Nathan C.; Galland, Joel; Borsato, Emerson P.

2012-01-01

In this manuscript, we present an overview of the clinical knowledge management strategy at Intermountain Healthcare in support of our electronic medical record systems. Intermountain first initiated efforts in developing a centralized enterprise knowledge repository in 2001. Applications developed, areas of emphasis served, and key areas of focus are presented. We also detail historical and current areas of emphasis, in response to business needs. PMID:23304309

Conservation strategies – where we were and where we’re going

Treesearch

Tom Tuchman

2017-01-01

Twenty years ago the Redwood region was dominated by the so called “timber wars”. On public lands the Northwest Forest Plan forced a new ecosystem management approach. On private lands, the Headwaters Forest initiative and Redwood Summer events were forcing state and federal regulators and landowners to rethink forest management strategies on private lands. The...

Effectiveness of a confinement strategy in reducing pack stock impacts at campsites in the Selway-Bitterroot Wilderness, Idaho

Treesearch

David R. Spildie; David N. Cole; Sarah C. Walker

2000-01-01

In 1993, a management program was initiated in the Seven Lakes Basin in the Selway-Bitterroot Wilderness to bring high levels of campsite impact into compliance with management standards. The core of the strategy involved confining use, particularly by stock groups, and restoring certain campsites and portions of campsites. In just five years, campsite impacts were...

Cost-effectiveness of Competing Strategies for Management of Recurrent Clostridium difficile Infection: A Decision Analysis

PubMed Central

Konijeti, Gauree G.; Sauk, Jenny; Shrime, Mark G.; Gupta, Meera; Ananthakrishnan, Ashwin N.

2014-01-01

Background. Clostridium difficile infection (CDI) is an important cause of morbidity and healthcare costs, and is characterized by high rates of disease recurrence. The cost-effectiveness of newer treatments for recurrent CDI has not been examined, yet would be important to inform clinical practice. The aim of this study was to analyze the cost effectiveness of competing strategies for recurrent CDI. Methods. We constructed a decision-analytic model comparing 4 treatment strategies for first-line treatment of recurrent CDI in a population with a median age of 65 years: metronidazole, vancomycin, fidaxomicin, and fecal microbiota transplant (FMT). We modeled up to 2 additional recurrences following the initial recurrence. We assumed FMT delivery via colonoscopy as our base case, but conducted sensitivity analyses based on different modes of delivery. Willingness-to-pay threshold was set at $50 000 per quality-adjusted life-year. Results. At our base case estimates, initial treatment of recurrent CDI using FMT colonoscopy was the most cost-effective strategy, with an incremental cost-effectiveness ratio of $17 016 relative to oral vancomycin. Fidaxomicin and metronidazole were both dominated by FMT colonoscopy. On sensitivity analysis, FMT colonoscopy remained the most cost-effective strategy at cure rates >88.4% and CDI recurrence rates <14.9%. Fidaxomicin required a cost <$1359 to meet our cost-effectiveness threshold. In clinical settings where FMT is not available or applicable, the preferred strategy appears to be initial treatment with oral vancomycin. Conclusions. In this decision analysis examining treatment strategies for recurrent CDI, we demonstrate that FMT colonoscopy is the most cost-effective initial strategy for management of recurrent CDI. PMID:24692533

Dissociated neural processing for decisions in managers and non-managers.

PubMed

Caspers, Svenja; Heim, Stefan; Lucas, Marc G; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

2012-01-01

Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing.

Dissociated Neural Processing for Decisions in Managers and Non-Managers

PubMed Central

Caspers, Svenja; Heim, Stefan; Lucas, Marc G.; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

2012-01-01

Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing. PMID:22927984

Instituting organizational learning for quality improvement through strategic planning nominal group processes.

PubMed

White, D B

2000-01-01

Healthcare managers are faced with unprecedented challenges as characterized by managed care constraints, downsizing, increased client needs, and a society demanding more responsive services. Managers must initiate change for quality, efficiency, and survival. This article provides information and strategies for (a) assessing the change readiness of an organization, (b) conducting an organizational diagnosis, (c) instituting a team culture, (d) developing a change strategy, (e) integrating the strategy with a quality improvement process, and (f) identifying the leadership skills to implement organization renewal. Nominal group processes, namely, SWOT and the Search Conference, are described, and case examples are provided. The implementation strategies have been used successfully in a variety of milieus; practical advice for success is described in detail.

Stakeholder analysis and mapping as targeted communication strategy.

PubMed

Shirey, Maria R

2012-09-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author highlights the importance of stakeholder theory and discusses how to apply the theory to conduct a stakeholder analysis. This article also provides an explanation of how to use related stakeholder mapping techniques with targeted communication strategies.

The Development of a Strategic Prioritisation Method for Green Supply Chain Initiatives.

PubMed

Masoumik, S Maryam; Abdul-Rashid, Salwa Hanim; Olugu, Ezutah Udoncy

2015-01-01

To maintain a competitive position, companies are increasingly required to integrate their proactive environmental strategies into their business strategies. The shift from reactive and compliance-based to proactive and strategic environmental management has driven companies to consider the strategic factors while identifying the areas in which they should focus their green initiatives. In previous studies little attention was given to providing the managers with a basis from which they could strategically prioritise these green initiatives across their companies' supply chains. Considering this lacuna in the literature, we present a decision-making method for prioritising green supply chain initiatives aligned with the preferred green strategies alternatives for the manufacturing companies. To develop this method, the study considered a position between determinism and the voluntarism orientation of environmental management involving both external pressures and internal competitive drivers and key resources as decision factors. This decision-making method was developed using the analytic network process (ANP) technique. The elements of the decision model were derived from the literature. The causal relationships among the multiple decision variables were validated based on the results of structural equation modelling (SEM) using a dataset collected from a survey of the ISO 14001-certified manufacturers in Malaysia. A portion of the relative weights required for computation in ANP was also calculated using the SEM results. A case study is presented to demonstrate the applicability of the method.

The Development of a Strategic Prioritisation Method for Green Supply Chain Initiatives

PubMed Central

Masoumik, S. Maryam; Abdul-Rashid, Salwa Hanim; Olugu, Ezutah Udoncy

2015-01-01

To maintain a competitive position, companies are increasingly required to integrate their proactive environmental strategies into their business strategies. The shift from reactive and compliance-based to proactive and strategic environmental management has driven companies to consider the strategic factors while identifying the areas in which they should focus their green initiatives. In previous studies little attention was given to providing the managers with a basis from which they could strategically prioritise these green initiatives across their companies’ supply chains. Considering this lacuna in the literature, we present a decision-making method for prioritising green supply chain initiatives aligned with the preferred green strategies alternatives for the manufacturing companies. To develop this method, the study considered a position between determinism and the voluntarism orientation of environmental management involving both external pressures and internal competitive drivers and key resources as decision factors. This decision-making method was developed using the analytic network process (ANP) technique. The elements of the decision model were derived from the literature. The causal relationships among the multiple decision variables were validated based on the results of structural equation modelling (SEM) using a dataset collected from a survey of the ISO 14001-certified manufacturers in Malaysia. A portion of the relative weights required for computation in ANP was also calculated using the SEM results. A case study is presented to demonstrate the applicability of the method. PMID:26618353

Managing Change in Small Primary Schools.

ERIC Educational Resources Information Center

Wilson, Valerie; McPake, Joanna

1998-01-01

This report summarizes a two-phase research project on the strategies used by headteachers in small Scottish primary schools to manage mandated educational changes. The research focused on four initiatives of the past decade: 5-14 Curriculum Guidelines, School Development Planning, Staff Development and Appraisal, and Devolved School Management.…

Prediction errors in wildland fire situation analyses.

Treesearch

Geoffrey H. Donovan; Peter Noordijk

2005-01-01

Wildfires consume budgets and put the heat on fire managers to justify and control suppression costs. To determine the appropriate suppression strategy, land managers must conduct a wildland fire situation analysis (WFSA) when:A wildland fire is expected to or does escape initial attack,A wildland fire managed for resource benefits...

WITHDRAWN: Initial management strategies for dyspepsia.

PubMed

Delaney, Brendan; Ford, Alex C; Forman, David; Moayyedi, Paul; Qume, Michelle

2009-10-07

This review considers management strategies (combinations of initial investigation and empirical treatments) for dyspeptic patients. Dyspepsia was defined to include both epigastric pain and heartburn. To determine the effectiveness, acceptability, and cost effectiveness of the following initial management strategies for patients presenting with dyspepsia (a) Initial pharmacological therapy (including endoscopy for treatment failures). (b) Early endoscopy. (c) Testing for Helicobacter pylori (H. pylori )and endoscope only those positive. (d) H. pylori eradication therapy with or without prior testing. Trials were located through electronic searches and extensive contact with trialists. All randomised controlled trials of dyspeptic patients presenting in primary care. Data were collected on dyspeptic symptoms, quality of life and use of resources. An individual patient data meta-analysis of health economic data was conducted Twenty-five papers reporting 27 comparisons were found. Trials comparing proton pump inhibitors (PPI) with antacids (three trials) and histamine H2-receptor antagonists (H2RAs) (three trials), early endoscopy with initial acid suppression (five trials), H. pylori test and endoscope versus usual management (three trials), H. pylori test and treat versus endoscopy (six trials), and test and treat versus acid suppression alone in H. pylori positive patients (four trials), were pooled. PPIs were significantly more effective than both H2RAs and antacids. Relative risks (RR) and 95% confidence intervals (CI) were; for PPI compared with antacid 0.72 (95% CI 0.64 to 0.80), PPI compared with H2RA 0.63 (95% CI 0.47 to 0.85). Results for other drug comparisons were either absent or inconclusive. Initial endoscopy was associated with a small reduction in the risk of recurrent dyspeptic symptoms compared with H. pylori test and treat (OR 0.75, 95% CI 0.58 to 0.96), but was not cost effective (mean additional cost of endoscopy US$401 (95% CI $328 to 474). Test and treat may be more effective than acid suppression alone (RR 0.59 95% CI 0.42 to 0.83). Proton pump inhibitor drugs (PPIs) are effective in the treatment of dyspepsia in these trials which may not adequately exclude patients with gastro-oesophageal reflux disease (GORD). The relative efficacy of histamine H2-receptor antagonists (H2RAs) and PPIs is uncertain. Early investigation by endoscopy or H. pylori testing may benefit some patients with dyspepsia but is not cost effective as part of an overall management strategy.

Ethical Challenges in Evaluation with Communities: A Manager's Perspective.

ERIC Educational Resources Information Center

Nee, David; Mojica, Maria I.

1999-01-01

Senior staff members at a family foundation share their perspectives, as managers and practitioners, on the ethical challenges and opportunities facing professionals engaged in the evaluation of comprehensive, community-based initiatives and other nontraditional program strategies. (Author/SLD)

Canada-wide standards and innovative transboundary air quality initiatives.

PubMed

Barton, Jane

2008-01-01

Canada's approach to air quality management is one that has brought with it opportunities for the development of unique approaches to risk management. Even with Canada's relatively low levels of pollution, science has demonstrated clearly that air quality and ecosystem improvements are worthwhile. To achieve change and address air quality in Canada, Canadian governments work together since, under the constitution, they share responsibility for the environment. At the same time, because air pollution knows no boundaries, working with the governments of other nations is essential to get results. International cooperation at all levels provides opportunities with potential for real change. Cooperation within transboundary airsheds is proving a fruitful source of innovative opportunities to reduce cross-border barriers to air quality improvements. In relation to the NERAM Colloquium objective to establish principles for air quality management based on the identification of international best practice in air quality policy development and implementation, Canada has developed, both at home and with the United States, interesting air management strategies and initiatives from which certain lessons may be taken that could be useful in other countries with similar situations. In particular, the Canada-wide strategies for smog and acid rain were developed by Canadian governments, strategies that improve and protect air quality at home, while Canada-U.S. transboundary airshed projects provide examples of international initiatives to improve air quality.

Concurrent Validity of the Classroom Strategies Scale for Elementary School--Observer Form

ERIC Educational Resources Information Center

Reddy, Linda A.; Fabiano, Gregory A.; Dudek, Christopher M.

2013-01-01

The present study is an initial investigation of the concurrent validity of a new assessment, the Classroom Strategies Scale (CSS version 2.0) for Elementary School--Observer Form. The CSS assesses teachers' use of instructional and behavioral management strategies. In the present study, the CSS is compared to the Classroom Assessment Scoring…

Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

PubMed

McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

2017-01-01

To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy Publications, Inc.

A framework for engaging stakeholders on the management of alien species.

PubMed

Novoa, Ana; Shackleton, Ross; Canavan, Susan; Cybèle, Cathleen; Davies, Sarah J; Dehnen-Schmutz, Katharina; Fried, Jana; Gaertner, Mirijam; Geerts, Sjirk; Griffiths, Charles L; Kaplan, Haylee; Kumschick, Sabrina; Le Maitre, David C; Measey, G John; Nunes, Ana L; Richardson, David M; Robinson, Tamara B; Touza, Julia; Wilson, John R U

2018-01-01

Alien species can have major ecological and socioeconomic impacts in their novel ranges and so effective management actions are needed. However, management can be contentious and create conflicts, especially when stakeholders who benefit from alien species are different from those who incur costs. Such conflicts of interests mean that management strategies can often not be implemented. There is, therefore, increasing interest in engaging stakeholders affected by alien species or by their management. Through a facilitated workshop and consultation process including academics and managers working on a variety of organisms and in different areas (urban and rural) and ecosystems (terrestrial and aquatic), we developed a framework for engaging stakeholders in the management of alien species. The proposed framework for stakeholder engagement consists of 12 steps: (1) identify stakeholders; (2) select key stakeholders for engagement; (3) explore key stakeholders' perceptions and develop initial aims for management; (4) engage key stakeholders in the development of a draft management strategy; (5) re-explore key stakeholders' perceptions and revise the aims of the strategy; (6) co-design general aims, management objectives and time frames with key stakeholders; (7) co-design a management strategy; (8) facilitate stakeholders' ownership of the strategy and adapt as required; and (9) implement the strategy and monitor management actions to evaluate the need for additional or future actions. In case additional management is needed after these actions take place, some extra steps should be taken: (10) identify any new stakeholders, benefits, and costs; (11) monitor engagement; and (12) revise management strategy. Overall, we believe that our framework provides an effective approach to minimize the impact of conflicts created by alien species management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical Effectiveness Research in Managed-care Systems: Lessons from the Pediatric Asthma Care PORT

PubMed Central

Finkelstein, Jonathan A; Lozano, Paula; Streiff, Kachen A; Arduino, Kelly E; Sisk, Cynthia A; Wagner, Edward H; Weiss, Kevin B; Inui, Thomas S

2002-01-01

Objective To highlight the unique challenges of evaluative research on practice behavior change in the “real world” settings of contemporary managed-care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team). Study Setting The Pediatric Asthma Care PORT is a five-year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed-care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a “Planned Asthma Care Intervention” incorporating joint “asthma check-ups” by nurse-physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway. Data Collection Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and “lessons” that might be useful to investigators planning interventional research in similar care-delivery settings. Conclusions Randomized trials in “real world” settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed-care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a “usual care” arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition-related quality improvement initiatives, procedures for avoiding respondent burden in health plan enrollees, and anticipation and minimization of risks from experimental arm contamination and major organizational change. With attention to these delivery system issues, as well as the usual design features of randomized trials, we believe managed-care organizations can serve as important laboratories to test care improvement strategies. PMID:12132605

Integrated corridor management : phase I, concept development and foundational research. Task 3.4, identify integrated corridor management institutional strategies and administration

DOT National Transportation Integrated Search

2006-04-12

Task 3 involves overall foundational research to further the understanding of various aspects of Integrated Corridor Management (ICM) and to identify integration issues needed to evaluate the feasibility of the ICM initiative. The focus of Task 3.4 a...

Student Learning Strategy and Soft-skill in Clothing Business Management

NASA Astrophysics Data System (ADS)

Ampera, D.

2018-02-01

Clothing Business Management course is a subject delivering knowledge and skills about how to manage clothing business. This course requires students’ ethics, leadership, commitment, toughness, honesty, and the ability to take initiative, argue logically, and work together. However, students are not fully efficient in managing a business during practical task. The purpose of the study is to investigate: (1) the differences of students’ learning achievement between those receiving gradual and conventional learning strategy, (2)the effect of interactions between learning strategy and soft skills toward students learning achievement, (3) the differences of learning achievement of high soft skills students who receive gradual and conventional learning strategy, (4) the differences of learning achievement of low soft skills students who receive gradual and conventional learning strategy. The 2x2 treatment-by-level experimental study was carried out in Dressmaking Study Program. The result proved significantly that, overall, differences of students learning achievement exist, except of low soft skills students.

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.

Treatment strategy for a multidrug-resistant Klebsiella UTI.

PubMed

Fleming, Erin; Heil, Emily L; Hynicka, Lauren M

2014-01-01

To describe the management strategy for a multidrug-resistant (MDR) Klebsiella urinary tract infection (UTI). A 69-year-old Caucasian woman with a past medical history of recurrent UTIs and a right-lung transplant presented with fever to 101.4°F, chills, malaise, and cloudy, foul-smelling urine for approximately 1 week. She was found to have a MDR Klebsiella UTI that was sensitive to tigecycline and cefepime. To further evaluate the degree of resistance Etest minimum inhibitory concentrations were requested for cefepime, amikacin, meropenem, and ertapenem. The patient received a 14-day course of amikacin, which resulted in resolution of her symptoms. One month later, the patient's UTI symptoms returned. The urine culture again grew MDR Klebsiella, sensitive only to tigecycline. Fosfomycin was initiated and resulted in limited resolution of her symptoms. Colistin was started, however, therapy was discontinued on day 5 secondary to the development of acute kidney injury. Despite the short course of therapy, the patient's symptoms resolved. The case presented lends itself well to numerous discussion items that are important to consider when determining optimal treatment for MDR Gram-negative bacilli (GNBs). Susceptibility testing is an important tool for optimizing antibiotic therapy, however, automated systems may overestimate the susceptibility profile for a MDR GNB. Treatment strategies evaluated to treat MDR GNB, include combination therapy with a carbepenem and synergy using polymyxin. We have described the management strategy for a MDR Klebsiella UTI, the consequences of the initial management strategy, and potential strategies to manage these types of infections in future patients.

Manager’s Guide to Technology Transition in an Evolutionary Acquisition Environment

DTIC Science & Technology

2005-06-01

program managers, product managers, staffs, and organizations that manage the development , procurement, production, and fielding of systems...rapidly advancing technologies. Technology transitions can occur during the development of systems, or even after a system has been in the field ...Documentation Evolutionary acquisition is an acquisition strategy that defines, develops , produces or acquires, and fields an initial hardware or software

Adapting natural resource management to climate change: The South Central Oregon and Northern Rockies Adaptation Partnerships

NASA Astrophysics Data System (ADS)

Halofsky, J.; Peterson, D. L.

2015-12-01

Concrete ways to adapt to climate change are needed to help natural resource managers take the first steps to incorporate climate change into management and take advantage of opportunities to balance the negative effects of climate change. We recently initiated two science-management climate change adaptation partnerships, one with three national forests and one national park in south central Oregon, and the other with 16 national forests, three national parks and other stakeholders in the northern Rockies region. Goals of both partnerships were to: (1) synthesize published information and data to assess the exposure, sensitivity, and adaptive capacity of key resource areas, including water use, infrastructure, fisheries, and vegetation and disturbance; (2) develop science-based adaptation strategies and tactics that will help to mitigate the negative effects of climate change and assist the transition of biological systems and management to a warmer climate; (3) ensure adaptation strategies and tactics are incorporated into relevant planning documents; and (4) foster an enduring partnership to facilitate ongoing dialogue and activities related to climate change in the partnerships regions. After an initial vulnerability assessment by agency and university scientists and local resource specialists, adaptation strategies and tactics were developed in a series of scientist-manager workshops. The final vulnerability assessments and adaptation actions are incorporated in technical reports. The partnerships produced concrete adaptation options for national forest and other natural resource managers and illustrated the utility of place-based vulnerability assessments and scientist-manager workshops in adapting to climate change.

Post-game analysis: An initial experiment for heuristic-based resource management in concurrent systems

NASA Technical Reports Server (NTRS)

Yan, Jerry C.

1987-01-01

In concurrent systems, a major responsibility of the resource management system is to decide how the application program is to be mapped onto the multi-processor. Instead of using abstract program and machine models, a generate-and-test framework known as 'post-game analysis' that is based on data gathered during program execution is proposed. Each iteration consists of (1) (a simulation of) an execution of the program; (2) analysis of the data gathered; and (3) the proposal of a new mapping that would have a smaller execution time. These heuristics are applied to predict execution time changes in response to small perturbations applied to the current mapping. An initial experiment was carried out using simple strategies on 'pipeline-like' applications. The results obtained from four simple strategies demonstrated that for this kind of application, even simple strategies can produce acceptable speed-up with a small number of iterations.

Adaptive Management and the Value of Information: Learning Via Intervention in Epidemiology

PubMed Central

Shea, Katriona; Tildesley, Michael J.; Runge, Michael C.; Fonnesbeck, Christopher J.; Ferrari, Matthew J.

2014-01-01

Optimal intervention for disease outbreaks is often impeded by severe scientific uncertainty. Adaptive management (AM), long-used in natural resource management, is a structured decision-making approach to solving dynamic problems that accounts for the value of resolving uncertainty via real-time evaluation of alternative models. We propose an AM approach to design and evaluate intervention strategies in epidemiology, using real-time surveillance to resolve model uncertainty as management proceeds, with foot-and-mouth disease (FMD) culling and measles vaccination as case studies. We use simulations of alternative intervention strategies under competing models to quantify the effect of model uncertainty on decision making, in terms of the value of information, and quantify the benefit of adaptive versus static intervention strategies. Culling decisions during the 2001 UK FMD outbreak were contentious due to uncertainty about the spatial scale of transmission. The expected benefit of resolving this uncertainty prior to a new outbreak on a UK-like landscape would be £45–£60 million relative to the strategy that minimizes livestock losses averaged over alternate transmission models. AM during the outbreak would be expected to recover up to £20.1 million of this expected benefit. AM would also recommend a more conservative initial approach (culling of infected premises and dangerous contact farms) than would a fixed strategy (which would additionally require culling of contiguous premises). For optimal targeting of measles vaccination, based on an outbreak in Malawi in 2010, AM allows better distribution of resources across the affected region; its utility depends on uncertainty about both the at-risk population and logistical capacity. When daily vaccination rates are highly constrained, the optimal initial strategy is to conduct a small, quick campaign; a reduction in expected burden of approximately 10,000 cases could result if campaign targets can be updated on the basis of the true susceptible population. Formal incorporation of a policy to update future management actions in response to information gained in the course of an outbreak can change the optimal initial response and result in significant cost savings. AM provides a framework for using multiple models to facilitate public-health decision making and an objective basis for updating management actions in response to improved scientific understanding. PMID:25333371

Adaptive management and the value of information: learning via intervention in epidemiology

USGS Publications Warehouse

Shea, Katriona; Tildesley, Michael J.; Runge, Michael C.; Fonnesbeck, Christopher J.; Ferrari, Matthew J.

2014-01-01

Optimal intervention for disease outbreaks is often impeded by severe scientific uncertainty. Adaptive management (AM), long-used in natural resource management, is a structured decision-making approach to solving dynamic problems that accounts for the value of resolving uncertainty via real-time evaluation of alternative models. We propose an AM approach to design and evaluate intervention strategies in epidemiology, using real-time surveillance to resolve model uncertainty as management proceeds, with foot-and-mouth disease (FMD) culling and measles vaccination as case studies. We use simulations of alternative intervention strategies under competing models to quantify the effect of model uncertainty on decision making, in terms of the value of information, and quantify the benefit of adaptive versus static intervention strategies. Culling decisions during the 2001 UK FMD outbreak were contentious due to uncertainty about the spatial scale of transmission. The expected benefit of resolving this uncertainty prior to a new outbreak on a UK-like landscape would be £45–£60 million relative to the strategy that minimizes livestock losses averaged over alternate transmission models. AM during the outbreak would be expected to recover up to £20.1 million of this expected benefit. AM would also recommend a more conservative initial approach (culling of infected premises and dangerous contact farms) than would a fixed strategy (which would additionally require culling of contiguous premises). For optimal targeting of measles vaccination, based on an outbreak in Malawi in 2010, AM allows better distribution of resources across the affected region; its utility depends on uncertainty about both the at-risk population and logistical capacity. When daily vaccination rates are highly constrained, the optimal initial strategy is to conduct a small, quick campaign; a reduction in expected burden of approximately 10,000 cases could result if campaign targets can be updated on the basis of the true susceptible population. Formal incorporation of a policy to update future management actions in response to information gained in the course of an outbreak can change the optimal initial response and result in significant cost savings. AM provides a framework for using multiple models to facilitate public-health decision making and an objective basis for updating management actions in response to improved scientific understanding.

Conservative management of vestibular schwannoma: Predictors of growth and hearing.

PubMed

Jethanamest, Daniel; Rivera, Andrew M; Ji, Hongzhao; Chokkalingam, Venkatakarthikeyan; Telischi, Fred F; Angeli, Simon I

2015-09-01

To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss. Retrospective review. A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed. A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03-8.50; P = 0.04) for tumor growth. Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Predictive validity of the classroom strategies scale-observer form on statewide testing scores: an initial investigation.

PubMed

Reddy, Linda A; Fabiano, Gregory A; Dudek, Christopher M; Hsu, Louis

2013-12-01

The present study examined the validity of a teacher observation measure, the Classroom Strategies Scale--Observer Form (CSS), as a predictor of student performance on statewide tests of mathematics and English language arts. The CSS is a teacher practice observational measure that assesses evidence-based instructional and behavioral management practices in elementary school. A series of two-level hierarchical generalized linear models were fitted to data of a sample of 662 third- through fifth-grade students to assess whether CSS Part 2 Instructional Strategy and Behavioral Management Strategy scale discrepancy scores (i.e., ∑ |recommended frequency--frequency ratings|) predicted statewide mathematics and English language arts proficiency scores when percentage of minority students in schools was controlled. Results indicated that the Instructional Strategy scale discrepancy scores significantly predicted mathematics and English language arts proficiency scores: Relatively larger discrepancies on observer ratings of what teachers did versus what should have been done were associated with lower proficiency scores. Results offer initial evidence of the predictive validity of the CSS Part 2 Instructional Strategy discrepancy scores on student academic outcomes. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Middle manager involvement in strategy development in not-for profit organizations: the director of nursing perspective--how organizational structure impacts on the role.

PubMed

Carney, M

2004-01-01

An attempt was made to link organizational structure and strategic management and, in the process, to identify how organizational structure impacts on the strategic management role of Directors of Nursing working in acute care hospitals in the Republic of Ireland. Directors of Nursing are recognized as holding a pivotal role in health care delivery. The need for their involvement in strategic management is acknowledged, yet it is not clear if this role is influenced by organizational structure. It is recognized that strategic involvement increases the likelihood that middle managers' initiatives will be in line with top management's concept of corporate strategy. The principal thesis is that organizational members will exercise a higher level of strategic consensus if they have been initially involved in the development of strategy. The study was undertaken in not-for-profit health service organizations, through a series of 25 semi-structured interviews with Directors of Nursing. The review of the literature was undertaken simultaneously with grounded theory analysis of the interviews. This research suggests that structure does impact on the role, conferring both positive benefits and negative consequences. Structure is identified in this study, in terms of organizational hierarchy, and the locus of control pertaining in each organization. Two predominating structure models are discussed and analysed.

Applied Mycology Can Contribute to Sustainable Rural Livelihoods: Building upon China's Matsutake Management Initiatives.

PubMed

Brown, Madeline; McLellan, Timothy; Li, Huili; Karunarathna, Samantha C

2018-02-01

Matsutake mushrooms are an important part of rural livelihoods and forest ecosystems across large parts of China, as well as elsewhere in East Asia, Northern Europe and North America. Mushroom harvesters have developed sophisticated understandings of matsutake ecology and production, and are applying this knowledge in various innovative management strategies. At the same time, Chinese government agencies and scientists are promoting matsutake-based livelihoods to support development and conservation goals. We collaborated with matsutake harvesters in one Yunnan community to carry out a systematic experiment on a popular shiro-level management technique: covering matsutake shiros with either plastic or leaf litter. Our experimental results suggest that although leaf litter coverings are superior to plastic coverings, shiros that are left uncovered may produce the highest yields. Complementing our experimental work is a multi-sited household survey of existing matsutake management practices across Yunnan, which shows that a high proportion of harvesters are already engaged in a broad range of potentially beneficial management strategies. Though both findings highlight limitations of previous initiatives led by government and research actors in China, this existing body of work is an important foundation and opportunity for developing applied mycology in the region. In and beyond China, working with communities to develop site-specific management strategies through rigorous and participatory scientific inquiry can provide salient benefits for both scientists and resource users.

Applied Mycology Can Contribute to Sustainable Rural Livelihoods: Building upon China's Matsutake Management Initiatives

NASA Astrophysics Data System (ADS)

Brown, Madeline; McLellan, Timothy; Li, Huili; Karunarathna, Samantha C.

2018-02-01

Matsutake mushrooms are an important part of rural livelihoods and forest ecosystems across large parts of China, as well as elsewhere in East Asia, Northern Europe and North America. Mushroom harvesters have developed sophisticated understandings of matsutake ecology and production, and are applying this knowledge in various innovative management strategies. At the same time, Chinese government agencies and scientists are promoting matsutake-based livelihoods to support development and conservation goals. We collaborated with matsutake harvesters in one Yunnan community to carry out a systematic experiment on a popular shiro-level management technique: covering matsutake shiros with either plastic or leaf litter. Our experimental results suggest that although leaf litter coverings are superior to plastic coverings, shiros that are left uncovered may produce the highest yields. Complementing our experimental work is a multi-sited household survey of existing matsutake management practices across Yunnan, which shows that a high proportion of harvesters are already engaged in a broad range of potentially beneficial management strategies. Though both findings highlight limitations of previous initiatives led by government and research actors in China, this existing body of work is an important foundation and opportunity for developing applied mycology in the region. In and beyond China, working with communities to develop site-specific management strategies through rigorous and participatory scientific inquiry can provide salient benefits for both scientists and resource users.

A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

PubMed

Barkun, Alan N; Crott, Ralph; Fallone, Carlo A; Kennedy, Wendy A; Lachaine, Jean; Levinton, Carey; Armstrong, David; Chiba, Naoki; Thomson, Alan; Veldhuyzen van Zanten, Sander; Sinclair, Paul; Escobedo, Sergio; Chakraborty, Bijan; Smyth, Sandra; White, Robert; Kalra, Helen; Nevin, Krista

2010-08-01

The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial. To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting. The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, qualityadjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined. Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most costeffective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values. Although no strategy was the indisputable cost effective option, CanDys omeprazole may be the strategy of choiceover a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.

Consistent indicators and methods and a scalable sample design to meet assessment, inventory, and monitoring information needs across scales

USDA-ARS?s Scientific Manuscript database

Within the Bureau of Land Management (BLM), as in many land management agencies throughout the world, much effort is invested in monitoring and assessment for specific management needs. The BLM Assessment, Inventory, and Monitoring (AIM) Strategy was initiated, in part, to evaluate and make recommen...

Effectiveness of Systems Engineering (SE) Tailored for the Science & Technology (S&T) Environment: Improvement of USAF Airdrop Accuracy

DTIC Science & Technology

2011-10-27

public release; distribution is unlimited  Dr. Keith Bowman, AFRL, Precision Airdrop ( PAD ) Program Manager  Ms. Carol Ventresca, SynGenics Corporation...Presentation Outline  Entrance Criteria for PAD  Integrated Product Team (IPT)  S&T SE Process Steps  Initial Project S&T Development Strategy...Entrance Criteria for PAD  Integrated Product Team (IPT)  S&T SE Process Steps  Initial Project S&T Development Strategy  User Understanding of

INITIATE: An Intelligent Adaptive Alert Environment.

PubMed

Jafarpour, Borna; Abidi, Samina Raza; Ahmad, Ahmad Marwan; Abidi, Syed Sibte Raza

2015-01-01

Exposure to a large volume of alerts generated by medical Alert Generating Systems (AGS) such as drug-drug interaction softwares or clinical decision support systems over-whelms users and causes alert fatigue in them. Some of alert fatigue effects are ignoring crucial alerts and longer response times. A common approach to avoid alert fatigue is to devise mechanisms in AGS to stop them from generating alerts that are deemed irrelevant. In this paper, we present a novel framework called INITIATE: an INtellIgent adapTIve AlerT Environment to avoid alert fatigue by managing alerts generated by one or more AGS. We have identified and categories the lifecycle of different alerts and have developed alert management logic as per the alerts' lifecycle. Our framework incorporates an ontology that represents the alert management strategy and an alert management engine that executes this strategy. Our alert management framework offers the following features: (1) Adaptability based on users' feedback; (2) Personalization and aggregation of messages; and (3) Connection to Electronic Medical Records by implementing a HL7 Clinical Document Architecture parser.

Polish country study to address climate change: Strategies of the GHG`s emission reduction and adaptation of the Polish economy to the changed climate. Final report

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

NONE

1996-01-01

The Polish Country Study Project was initiated in 1992 as a result of the US Country Study Initiative whose objective was to grant the countries -- signatories of the United Nations` Framework Convention on Climate Change -- assistance that will allow them to fulfill their obligations in terms of greenhouse gases (GHG`s) inventory, preparation of strategies for the reduction of their emission, and adapting their economies to the changed climatic conditions. In February 1993, in reply to the offer from the United States Government, the Polish Government expressed interest in participation in this program. The Study proposal, prepared by themore » Ministry of Environmental Protection, Natural Resources and Forestry was presented to the US partner. The program proposal assumed implementation of sixteen elements of the study, encompassing elaboration of scenarios for the strategy of mission reduction in energy sector, industry, municipal management, road transport, forestry, and agriculture, as well as adaptations to be introduced in agriculture, forestry, water management, and coastal management. The entire concept was incorporated in macroeconomic strategy scenarios. A complementary element was the elaboration of a proposal for economic and legal instruments to implement the proposed strategies. An additional element was proposed, namely the preparation of a scenario of adapting the society to the expected climate changes.« less

Lymphoedema management: an international intersect between developed and developing countries. Similarities, differences and challenges.

PubMed

Stout, Nicole L; Brantus, Pierre; Moffatt, Christine

2012-01-01

Lymphoedema is a chronic swelling condition that contributes to disability, dysfunction and lost quality of life. Significant disparities exist worldwide regarding the availability of resources necessary to identify, treat and manage lymphoedema. This disparity transcends socio-economic status and is a common problem in both developed and developing countries. The overall impact of lymphoedema as a public health problem, however, is underestimated, principally due to the lack of epidemiologic data. These problems pose barriers to optimal identification and management of this disabling, lifelong condition. In 1997, the World Health Organization (50.29) resolved that lymphatic filariasis should be eliminated as a public health problem. A component of this strategy focuses on disability management for those suffering from lymphatic filariasis-related morbidity. This initiative has enhanced lymphoedema awareness in developing countries. However, significant deficits persist in health care providers' knowledge, educational initiatives and basic disease identification and treatment. In developed countries, lymphoedema continues to be an underrecognised condition and assumed to be only cancer-related. Health care resources allocated to treat and manage the disease are insufficient for basic and ongoing care, resulting in disease progression and disability. The International Lymphoedema Framework project, established in 2002, seeks to establish a consensus for best practices in the management of lymphoedema worldwide to reduce this disability burden. A basic global construct for lymphoedema management is needed to decrease morbidity and promote optimal disease management across all cultural and socio-economic boundaries. Many countries are unaware of the importance of lymphoedema management and have not defined a national strategy with respect to this problem. The objective of this article is to define similarities and differences in strategies for lymphoedema management between developed and developing countries and advocate for a cohesive and concerted approach to disease management.

Hexavalent Chromium Minimization Strategy

DTIC Science & Technology

2011-05-01

Logistics 4 Initiative - DoD Hexavalent Chromium Minimization Non- Chrome Primer IIEXAVAJ ENT CHRO:M I~UMI CHROMIUM (VII Oil CrfVli.J CANCEfl HAnRD CD...Management Office of the Secretary of Defense Hexavalent Chromium Minimization Strategy Report Documentation Page Form ApprovedOMB No. 0704-0188...00-2011 4. TITLE AND SUBTITLE Hexavalent Chromium Minimization Strategy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

Managing the Transformation: A Change Management Strategy for U.S. Marine Corps Expeditionary Energy Initiatives

DTIC Science & Technology

2017-12-01

themes into the change management narrative in preparation for the synthesis of all the information . C. SYNTHESIS With the narratives from both the...positive results. Relying on managers to synthesize and act on a large volume of information unnecessarily exposes the organization to risk, including...challenges and threats. 3. Information Flow and Intra-Organizational Relationships The management of information in the Marine Corps, specifically how it is

Adapting Natural Resource Management to Climate Change: The Blue Mountains and Northern Rockies Adaptation Partnerships

NASA Astrophysics Data System (ADS)

Halofsky, J.; Peterson, D. L.

2014-12-01

Concrete ways to adapt to climate change are needed to help natural resource managers take the first steps to incorporate climate change into management and take advantage of opportunities to balance the negative effects of climate change. We recently initiated two science-management climate change adaptation partnerships, one with three national forests and other key stakeholders in the Blue Mountains region of northeastern Oregon, and the other with 16 national forests, three national parks and other stakeholders in the northern Rockies region. Goals of both partnerships were to: (1) synthesize published information and data to assess the exposure, sensitivity, and adaptive capacity of key resource areas, including water use, infrastructure, fisheries, and vegetation and disturbance; (2) develop science-based adaptation strategies and tactics that will help to mitigate the negative effects of climate change and assist the transition of biological systems and management to a warmer climate; (3) ensure adaptation strategies and tactics are incorporated into relevant planning documents; and (4) foster an enduring partnership to facilitate ongoing dialogue and activities related to climate change in the partnerships regions. After an initial vulnerability assessment by agency and university scientists and local resource specialists, adaptation strategies and tactics were developed in a series of scientist-manager workshops. The final vulnerability assessments and adaptation actions are incorporated in technical reports. The partnerships produced concrete adaptation options for national forest and other natural resource managers and illustrated the utility of place-based vulnerability assessments and scientist-manager workshops in adapting to climate change.

Cockroach Clean-Up Tour . Urban Pest Management. Teaching Environmental Living Skills to Elementary Students.

ERIC Educational Resources Information Center

Cowles, Kathleen Letcher

Integrated Pest Management (IPM), a decision-making approach to pest control, is designed to help individuals decide if pest suppression treatments are necessary, when they should be initiated, where they should be applied, and what strategy/mix of tatics to use. IPM combines a variety of approaches with which to manage pests, including human…

Work Values, Cognitive Strategies, and Applicant Reactions in a Structured Pre-Employment Interview for Ethical Integrity.

ERIC Educational Resources Information Center

Pawlowski, Donna R.; Hollwitz, John

2000-01-01

Notes that companies emphasize ethical behavior, and schools and professional groups devote many resources to applied ethics training. Describes initial construct validation of a structured ethical integrity pre-employment interview. Reviews evidence relating to cognitive and impression management strategies used when college students encounter an…

Enterprise Education: The Frustration of a Pure Contest

ERIC Educational Resources Information Center

Jones, Colin

2007-01-01

Purpose: This paper seeks to discuss the development of a strategy game for enterprise education. It is argued that requiring students to initially struggle with the game's rules and strategies results in a worthwhile test of their persistence and ability to manage ambiguity. Further, that in the absence of uncertainty, students will not benefit…

High- Versus Low-Gradient Severe Aortic Stenosis: Demographics, Clinical Outcomes, and Effects of the Initial Aortic Valve Replacement Strategy on Long-Term Prognosis.

PubMed

Taniguchi, Tomohiko; Morimoto, Takeshi; Shiomi, Hiroki; Ando, Kenji; Kanamori, Norio; Murata, Koichiro; Kitai, Takeshi; Kawase, Yuichi; Izumi, Chisato; Miyake, Makoto; Mitsuoka, Hirokazu; Kato, Masashi; Hirano, Yutaka; Matsuda, Shintaro; Inada, Tsukasa; Nagao, Kazuya; Murakami, Tomoyuki; Takeuchi, Yasuyo; Yamane, Keiichiro; Toyofuku, Mamoru; Ishii, Mitsuru; Minamino-Muta, Eri; Kato, Takao; Inoko, Moriaki; Ikeda, Tomoyuki; Komasa, Akihiro; Ishii, Katsuhisa; Hotta, Kozo; Higashitani, Nobuya; Kato, Yoshihiro; Inuzuka, Yasutaka; Maeda, Chiyo; Jinnai, Toshikazu; Morikami, Yuko; Saito, Naritatsu; Minatoya, Kenji; Kimura, Takeshi

2017-05-01

There is considerable debate on the management of patients with low-gradient severe aortic stenosis (LG-AS), defined as aortic valve area <1 cm 2 with peak aortic jet velocity ≤4.0 m/s, and mean aortic pressure gradient ≤40 mm Hg. In the CURRENT AS registry (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis), there were 2097 patients (initial aortic valve replacement [AVR] strategy: n=977, and conservative strategy: n=1120) with high-gradient severe aortic stenosis (HG-AS) and 1712 patients (initial AVR strategy: n=219, and conservative strategy: n=1493) with LG-AS. AVR was more frequently performed in HG-AS patients than in LG-AS patients (60% versus 28%) during the entire follow-up. In the comparison between the initial AVR and conservative groups, the propensity score-matched cohorts were developed in both HG-AS (n=887 for each group) and LG-AS (n=218 for each group) strata. The initial AVR strategy when compared with the conservative strategy was associated with markedly lower risk for a composite of aortic valve-related death or heart failure hospitalization in both HG-AS and LG-AS strata (hazard ratio, 0.30; 95% confidence interval, 0.25-0.37; P <0.001 and hazard ratio, 0.46; 95% confidence interval, 0.32-0.67; P <0.001, respectively). Among 1358 patients with LG-AS with preserved left ventricular ejection fraction, the initial AVR strategy was associated with a better outcome than the conservative strategy (adjusted hazard ratio, 0.37; 95% confidence interval, 0.23-0.59; P <0.001). The initial AVR strategy was associated with better outcomes than the conservative strategy in both HG-AS and LG-AS patients, although AVR was less frequently performed in LG-AS patients than in HG-AS patients. The favorable effect of initial AVR strategy was also seen in patients with LG-AS with preserved left ventricular ejection fraction. URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000012140. © 2017 American Heart Association, Inc.

Emphysematous pyelonephritis with calculus: Management strategies.

PubMed

Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

2007-07-01

Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures.

Implementation strategies influence the structure, process and outcome of quality systems: an empirical study of hospital departments in Sweden.

PubMed

Kunkel, S; Rosenqvist, U; Westerling, R

2009-02-01

To analyse whether the organisation of quality systems (structure, process, and outcome) is related to how these systems were implemented (implementation prerequisites, cooperation between managers and staff, and source of initiative). A questionnaire was developed, piloted and distributed to 600 hospital departments. Questions were included to reflect implementation prerequisites (adequate resources, competence, problem-solving capacity and high expectations), cooperative implementation, source of initiative (manager, staff and purchaser), structure (resources and administration), process (culture and cooperation) and outcome (goal evaluation and competence development). The adjusted response rate was 75%. Construct validity and reliability was assessed by confirmatory factor analysis, and Cronbach alpha scores were calculated. The relationships among the variables were analysed with structural equation modelling with LISREL. Implementation prerequisites were highly related to structure (0.51) and process (0.33). Cooperative implementation was associated with process (0.26) and outcome (0.34). High manager initiative was related to structure (0.19) and process (0.17). The numbers in parentheses can be interpreted as correlations. Construct validity was good, and reliability was excellent for all factors (Cronbach alpha>0.78). The model was a good representation of reality (model fit p value = 0.082). The implementation of organisationally demanding quality systems may require managers to direct and lead the process while assuring that their staff get opportunities to contribute to the planning and designing of the new system. This would correspond to a cooperative implementation strategy rather than to top-down or bottom-up strategies. The results of this study could be used to adjust implementation processes.

Integrating LMSs in the Educational Process: Greek Teachers' Initial Perceptions about LAMS

ERIC Educational Resources Information Center

Papadakis, Spyros; Dovros, Nikos; Paschalis, Giorgos; Rossiou, Eleni

2012-01-01

E-learning with the use of Learning Management Systems, has been increasingly adopted in Primary, Secondary and Higher Education with the expectation to increase students' motivation and infuse activity-centred learning strategies with various educational benefits. This study has investigated the initial perceptions of Greek teachers about the…

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Implementing practice management strategies to improve patient care: the EPIC project.

PubMed

Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

2012-01-01

Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

Change in MSW characteristics under recent management strategies in Taiwan.

PubMed

Chang, Yu-Min; Liu, Chien-Chung; Hung, Chao-Yang; Hu, Allen; Chen, Shiao-Shing

2008-12-01

Reduction and recycling initiatives such as producer responsibility and pay-as-you-throw are being implemented in Taiwan. This paper presents a study assessing the impact of recently implemented municipal solid waste (MSW) reduction and recycling management strategies on the characteristics of waste feedstock for incineration in Taiwan. Through the periodic sampling of two typical MSW incineration plants, proximate and ultimate analyses were conducted according to standard methods to explore the influence of MSW reduction and recycling management strategies on incineration feed waste characteristics. It was observed that the annual amount of MSW generated in 2005 decreased by about 10% compared to 2003 and that the characteristics of MSW have changed significantly due to recent management strategies. The heating value of the MSW generated in Taiwan increased yearly by about 5% after program implementation. A comparison of the monthly variations in chemical concentrations indicated that the chlorine content in MSW has changed. This change results from usage reduction of PVC plastic due to the recycling fund management (RFM) program, and the food waste as well as salt content reduction due to the total recycling for kitchen garbage program. This achievement will improve the reduction of dioxin emissions from MSW incineration. In summary, management strategies must be conducted in tandem with the global trend to achieve a zero-waste-discharge country. When implementing these strategies and planning for future MSW management systems, it is important to consider the changes that may occur in the composition and characteristics of MSW over time.

Managing implementation: roles of line managers, senior managers, and human resource professionals in an occupational health intervention.

PubMed

Hasson, Henna; Villaume, Karin; von Thiele Schwarz, Ulrica; Palm, Kristina

2014-01-01

To contrast line managers', senior managers', and (human resource) HR professionals' descriptions of their roles, tasks, and possibilities to perform them during the implementation of an occupational health intervention. Interviews with line managers (n = 13), senior managers (n = 7), and HR professionals (n = 9) 6 months after initiation of an occupational health intervention at nine organizations. The groups' roles were described coherently, except for the HR professionals. These roles were seldom performed in practice, and two main reasons appeared: use of individuals' engagement rather than an implementation strategy, and lack of integration of the intervention with other stakeholders and organizational processes. Evaluation of stakeholders' perceptions of each other's and their own roles is important, especially concerning HR professionals. Clear role descriptions and implementation strategies, and aligning an intervention to organizational processes, are crucial for efficient intervention management.

An empirical machine learning method for predicting potential fire control locations for pre-fire planning and operational fire management

Treesearch

Christopher D. O' Connor; David E. Calkin; Matthew P. Thompson

2017-01-01

During active fire incidents, decisions regarding where and how to safely and effectively deploy resources to meet management objectives are often made under rapidly evolving conditions, with limited time to assess management strategies or for development of backup plans if initial efforts prove unsuccessful. Under all but the most extreme fire weather conditions,...

The Case of the Wild House Mouse. Urban Pest Management. Teaching Environmental Living Skills to Elementary Students.

ERIC Educational Resources Information Center

Cowles, Kathleen Letcher

Integrated Pest Management (IPM), a decision-making approach to pest control, is designed to help individuals decide if pest suppression treatments are necessary, when they should be initiated, where they should be applied, and what strategy and mix of tactics to use. IPM combines a variety of approaches with which to manage pests. These include…

Innovative Approaches for Urban Watershed Wet-Weather Flow Management and Control: State of Technology Review Report

EPA Science Inventory

This report documents initial efforts to identify innovative strategies for managing the effects of wet-weather flow in an urban setting. It served as a communication tool and a starting point for discussion with experts. As such, the document is a compilation of literature rev...

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

PubMed Central

Kaminski, Thomas W.; Hertel, Jay; Amendola, Ned; Docherty, Carrie L.; Dolan, Michael G.; Hopkins, J. Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

Objective: To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Background: Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. Recommendations: The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available. PMID:23855363

National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes.

PubMed

Kaminski, Thomas W; Hertel, Jay; Amendola, Ned; Docherty, Carrie L; Dolan, Michael G; Hopkins, J Ty; Nussbaum, Eric; Poppy, Wendy; Richie, Doug

2013-01-01

To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.

Evaluating Niger's experience in strengthening supervision, improving availability of child survival drugs through cost recovery, and initiating training for Integrated Management of Childhood Illness (IMCI)

PubMed Central

Tawfik, Youssef M; Legros, Stephane; Geslin, Colette

2001-01-01

Background WHO and UNICEF have recently developed the "Integrated Management of Childhood Illness" (IMCI) as an efficient strategy to assist developing countries reduce childhood mortality. Early experience with IMCI implementation suggests that clinical training is essential but not sufficient for the success of the strategy. Attention needs to be given to strengthening health systems, such as supervision and drug supply. Results This paper presents results of evaluating an innovative approach for implementing IMCI in Niger. It starts with strengthening district level supervision and improving the availability of child survival drugs through cost recovery well before the beginning of IMCI clinical training. The evaluation documented the effectiveness of the initial IMCI clinical training and referral. Conclusions Strengthening supervision and assuring the availability of essential drugs need to precede the initiation of IMCI Clinical training. Longer term follow up is necessary to confirm the impact of the approach on IMCI preparation and implementation. PMID:11504567

A cost-effectiveness analysis of conservative versus surgical management for the initial treatment of stress urinary incontinence.

PubMed

Richardson, Monica L; Sokol, Eric R

2014-11-01

We sought to determine whether conservative or surgical therapy is more cost effective for the initial treatment of stress urinary incontinence (SUI). We created a decision tree model to compare costs and cost effectiveness of 3 strategies for the initial treatment of SUI: (1) continence pessary, (2) pelvic floor muscle therapy (PFMT), and (3) midurethral sling (MUS). We identified probabilities of SUI after 12 months of use of a pessary, PFMT, or MUS using published data. Parameter estimates included Health Utility Indices of no incontinence (.93) and persistent incontinence (0.7) after treatment. Morbidities associated with MUS included mesh erosion, retention, de novo urge incontinence, and recurrent SUI. Cost data were derived from Medicare in 2012 US dollars. One- and 2-way sensitivity analysis was used to examine the effect of varying rates of pursuing surgery if conservative management failed and rates of SUI cure with pessaries and PFMT. The primary outcome was an incremental cost-effectiveness ratio threshold <$50,000. Compared to PFMT, initial treatment of SUI with MUS was the more cost-effective strategy with an incremental cost-effectiveness ratio of $32,132/quality-adjusted life year. Initial treatment with PFMT was also acceptable as long as subjective cure was >35%. In 3-way sensitivity analysis, subjective cure would need to be >40.5% for PFMT and 43.5% for a continence pessary for the MUS scenario to not be the preferred strategy. At 1 year, MUS is more cost effective than a continence pessary or PFMT for the initial treatment for SUI. Copyright © 2014. Published by Elsevier Inc.

Moving Forward: Evaluating a Curriculum for Managing Responsive Behaviors in a Geriatric Psychiatry Inpatient Population

ERIC Educational Resources Information Center

Speziale, Jennifer; Black, Ed; Coatsworth-Puspoky, Robin; Ross, Tom; O'Regan, Tony

2009-01-01

Purpose: The Gentle Persuasive Approaches (GPA) curriculum was developed as an adjunct to other educational initiatives that were part of Ontario, Canada's Alzheimer Strategy. GPA emphasizes that an individual's unique personal history has a direct application to the interpretation of and response to their behavior. It incorporates strategies into…

Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project.

PubMed

Turkelson, Carman; Aebersold, Michelle; Redman, Richard; Tschannen, Dana

Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.

Hydrological information system based on on-line monitoring--from strategy to implementation in the Brantas River Basin, East Java, Indonesia.

PubMed

Marini, G W; Wellguni, H

2003-01-01

The worsening environmental situation of the Brantas River, East Java, is addressed by a comprehensive basin management strategy which relies on accurate water quantity and quality data retrieved from a newly installed online monitoring network. Integrated into a Hydrological Information System, the continuously measured indicative parameters allow early warning, control and polluter identification. Additionally, long-term analyses have been initiated for improving modelling applications like flood forecasting, water resource management and pollutant propagation. Preliminary results illustrate the efficiency of the installed system.

White-collar productivity and quality issues; Proceedings of the Symposium on Productivity and Quality: Strategies for Improving Operations in Government and Industry, Washington, DC, September 25, 26, 1984

NASA Technical Reports Server (NTRS)

Gerard, M. (Editor); Edwards, P. W. (Editor)

1985-01-01

Techniques for improving the productivity of white-collar workers while maintaining high product quality are examined in reviews and reports. The emphasis is on the application of strategies developed in the private sector to government-agency and aerospace-industry operations. Topics discussed include international competition, organizational attitudes and orientation, management practices, education and training, renewing large organizations, encouraging innovation, national initiatives, employee involvement, management involvement, and applications of new technology.

How I treat and manage strokes in sickle cell disease

PubMed Central

Kassim, Adetola A.; Galadanci, Najibah A.; Pruthi, Sumit

2015-01-01

Neurologic complications are a major cause of morbidity and mortality in sickle cell disease (SCD). In children with sickle cell anemia, routine use of transcranial Doppler screening, coupled with regular blood transfusion therapy, has decreased the prevalence of overt stroke from ∼11% to 1%. Limited evidence is available to guide acute and chronic management of individuals with SCD and strokes. Current management strategies are based primarily on single arm clinical trials and observational studies, coupled with principles of neurology and hematology. Initial management of a focal neurologic deficit includes evaluation by a multidisciplinary team (a hematologist, neurologist, neuroradiologist, and transfusion medicine specialist); prompt neuro-imaging and an initial blood transfusion (simple followed immediately by an exchange transfusion or only exchange transfusion) is recommended if the hemoglobin is >4 gm/dL and <10 gm/dL. Standard therapy for secondary prevention of strokes and silent cerebral infarcts includes regular blood transfusion therapy and in selected cases, hematopoietic stem cell transplantation. A critical component of the medical care following an infarct is cognitive and physical rehabilitation. We will discuss our strategy of acute and long-term management of strokes in SCD. PMID:25824688

A Brownfields strategy for the Toronto Port Area

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

Ibbotson, B.G.; Benson, B.A.

The Port Area of Toronto consists of several hundred acres, much of it created by filling near-shore sections of the Inner Harbour. The quality of the fill materials and the industrial activities that have taken place in the Port Area have resulted in soil and/or ground water quality conditions at many locations that do not meet current regulatory criteria and guidelines. As the administrator of properties representing more than 400 acres in the Port Area, the City of Toronto Economic Development Corporation (TEDCO) has a leadership role in the redevelopment of the Port Area. To date, a few TEDCO sitesmore » have always been restored and redeveloped on an individual basis, with little attention paid to ground water issues. To move forward on other redevelopment initiatives and to attract capital, it is necessary to increase the certainty with respect to regulatory requirements, the distribution of liabilities, and those parts of decision-making processes that consider soil and ground water issues. To address these needs, TEDCO has designed an overall soil and ground water management strategy that can be applied to its properties in the Port Area. The resulting strategy consists of four interrelated parts: an area-wide initiative to monitor ground water characteristics and assess ecological conditions; a collection of three protocols for managing individual sites; an information management system; and direction on the administration of the strategy. Together, the four parts provide a comprehensive and pragmatic approach to managing soil and ground water on TEDCO properties. The use of a multi-party agreement to formalize the strategy and specify roles and responsibilities of TEDCO, the municipality, and the Ontario Ministry of Environment and Energy is recommended.« less

Management Strategies for Hydrocephalus in Alobar Holoprosencephaly: A Case Report and Discussion.

PubMed

Sarica, Can; Yucetas, Cem; Ozen, Ali; Ucler, Necati; Konca, Capan; Akar, Selahattin

2018-06-14

Holoprosencephaly is a rare congenital malformation resulting from an impaired midline division of the prosencephalon into distinct cerebral hemispheres. Hydrocephalus is a frequent problem among the few survivors with alobar holoprosencephaly (aHPE), its most severe form. The literature about neurosurgical management of hydrocephalus in this condition is limited and dispersed, and there are still some points that need to be resolved. We report the case of a newborn with aHPE, hydrocephalus, and central diabetes insipidus. We delineate the complexity of the management of these patients and emphasize the benefits of using an initial programmable shunt valve. Further discussion about management strategies includes reviewing previous reports and the benefits of shunting for hypothalamic osmoreceptor function. © 2018 S. Karger AG, Basel.

The status of the art of human malignant glioma management: the promising role of targeting tumor-initiating cells.

PubMed

Florio, Tullio; Barbieri, Federica

2012-10-01

Glioblastoma is the most prevalent and malignant form of brain cancer, but the current available multimodality treatments yield poor survival improvement. Thus, innovative therapeutic strategies represent the challenging topic for glioblastoma management. Multidisciplinary advances, supporting current standard of care therapies and investigational trials that reveal potential drug targets for glioblastoma are reviewed. A radical change in glioblastoma therapeutic approaches could arise from the identification of cancer stem cells, putative tumor-initiating cells involved in tumor initiation, progression and resistance, as innovative drug target. Still controversial identification of markers and molecular regulators in glioma tumor-initiating cells and novel approaches targeting these cells are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

The office of strategy management.

PubMed

Kaplan, Robert S; Norton, David P

2005-10-01

There is a disconnect in most companies between strategy formulation and strategy execution. On average, 95% of a company's employees are unaware of, or do not understand, its strategy. If employees are unaware of the strategy, they surely cannot help the organization implement it effectively. It doesn't have to be like this. For the past 15 years, the authors have studied companies that achieved performance breakthroughs by adopting the Balanced Scorecard and its associated tools to help them better communicate strategy to their employees and to guide and monitor the execution of that strategy. Some companies, of course, have achieved better, longer-lasting improvements than others. The organizations that have managed to sustain their strategic focus have typically established a new corporate-level unit to oversee all activities related to strategy: an office of strategy management (OS M). The OSM, in effect, acts as the CEO's chief of staff. It coordinates an array of tasks: communicating corporate strategy; ensuring that enterprise-level plans are translated into the plans of the various units and departments; executing strategic initiatives to deliver on the grand design; aligning employees' plans for competency development with strategic objectives; and testing and adapting the strategy to stay abreast of the competition. The OSM does not do all the work, but it facilitates the processes so that strategy is executed in an integrated fashion across the enterprise. Although the companies that Kaplan and Norton studied use the Balanced Scorecard as the framework for their strategy management systems, the authors say the lessons of the OSM are applicable even to companies that do not use it.

Engineering youth service system infrastructure: Hawaii's continued efforts at large-scale implementation through knowledge management strategies.

PubMed

Nakamura, Brad J; Mueller, Charles W; Higa-McMillan, Charmaine; Okamura, Kelsie H; Chang, Jaime P; Slavin, Lesley; Shimabukuro, Scott

2014-01-01

Hawaii's Child and Adolescent Mental Health Division provides a unique illustration of a youth public mental health system with a long and successful history of large-scale quality improvement initiatives. Many advances are linked to flexibly organizing and applying knowledge gained from the scientific literature and move beyond installing a limited number of brand-named treatment approaches that might be directly relevant only to a small handful of system youth. This article takes a knowledge-to-action perspective and outlines five knowledge management strategies currently under way in Hawaii. Each strategy represents one component of a larger coordinated effort at engineering a service system focused on delivering both brand-named treatment approaches and complimentary strategies informed by the evidence base. The five knowledge management examples are (a) a set of modular-based professional training activities for currently practicing therapists, (b) an outreach initiative for supporting youth evidence-based practices training at Hawaii's mental health-related professional programs, (c) an effort to increase consumer knowledge of and demand for youth evidence-based practices, (d) a practice and progress agency performance feedback system, and (e) a sampling of system-level research studies focused on understanding treatment as usual. We end by outlining a small set of lessons learned and a longer term vision for embedding these efforts into the system's infrastructure.

How Bell Labs creates star performers.

PubMed

Kelley, R; Caplan, J

1993-01-01

How can managers increase the productivity of professionals when most of their work goes on inside their heads? Robert Kelley and Janet Caplan believe that defining the difference between star performers and average workers is the answer. Many managers assume that top performers are just smarter. But the authors' research at the Bell Laboratories Switching Systems Business Unit (SSBU) has revealed that the real difference between stars and average workers is not IQ but the ways top performers do their jobs. Their study has led to a training program based on the strategies of star performers. The SSBU training program, known as the Productivity Enhancement Group (PEG), uses an expert model to demystify productivity. The star engineers selected to develop the expert model identified and ranked nine work strategies, such as taking initiative, networking, and self-management. Middle performers were also asked what makes for top-quality work, but their definitions and ranking of the strategies differed significantly from those of the top performers. Taking initiative, for example, meant something very different to an average worker than it did to a star. And for the middle performers, the ability to give good presentations was a core strategy, while it was peripheral for the top engineers. Once PEG got underway, respected engineers ran the training sessions, which included case studies, work-related exercises, and frank discussion. The benefits of the program were striking: participants and managers reported substantial productivity increases in both star and average performers. The PEG program may not be a blueprint for other companies, but its message is clear: managers must focus on people, not on technology, to increase productivity in the knowledge economy.

Emphysematous pyelonephritis with calculus: Management strategies

PubMed Central

Goel, Tanmaya; Reddy, Sreedhar; Thomas, Joseph

2007-01-01

Objective: Emphysematous pyelonephritis (EPN) with calculus is well recognized but with very few reports on its treatment. Our aim is to elucidate our experience in its successful management. Materials and Methods: Over four years, we diagnosed seven cases (eight renal units) of EPN, out of which two patients (three renal units) had EPN with urinary calculi. After the initial conservative management of EPN, the stones were tackled appropriately. Results: EPN was initially managed effectively with antibiotics and supportive care. Once the patient was stable, the stones were cleared in a step-wise fashion. The associated postoperative complications were also tackled efficiently with preservation of renal function. Conclusion: In EPN with stones, nephrectomy is not the sole option available and they can be effectively managed with open / endoscopic measures. PMID:19718324

IWRM Policy in Colombia, drawbacks and strategies towards integration

NASA Astrophysics Data System (ADS)

Cardona, C. A.

2016-12-01

Since the establishment of the Integrated Water Resource Management National Policy in Colombia in 2010- IWRMNP, several initiatives has been developed in order to understand and manage water within the integration perspective. However, the Colombian institutional and legal frameworks do not favor the implementation of integrated management exercises, and many efforts have been fruitless in recent years. Additionally, there is an avalanche of techniques and available technologies to develop integrated models, analysis or assessments, which frequently are interpreted as the same tool. An analysis of the Colombian context in regulatory terms and institutions involved is carried out, as a prelude to address the topic of analysis modeling and integrated management. Moreover, in Colombian legislation there exists policies regarding integrated soil management, integrated biodiversity management, as well as several current international trends such as integrated landscape planning, integrated urban areas management etc. Therefore, and in light of the initial analysis, a discussion of redundancy or complementarity of such management it is carried out. Finally, a strategy is proposed for decision makers of local and regional level, trying to overcome technical gaps left by national policy and regulations. This is done from a discussion of the various anthropic damages to water resources systems. Also a classification of integrated models is proposed and a general approach to systems integrated resource management to finally present a state- management matrix methodology applicable to different cases and management requirements. The results of its implementation in a small basin is presented.

COPD and other health problems

MedlinePlus

... 105. Global Initiative for Chronic Obstructive Lung Disease (GOLD) website. Global strategy for the diagnosis, management, and ... report. goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS. ...

Update on Management of Cancer-Related Cachexia.

PubMed

Anderson, Lindsey J; Albrecht, Eliette D; Garcia, Jose M

2017-01-01

Cachexia is a metabolic syndrome driven by inflammation and characterized by loss of muscle with or without loss of fat mass. In cancer cachexia, the tumor burden and host response induce increased inflammation, decreased anabolic tone, and suppressed appetite leading to the clinical presentation of reduced body weight and quality of life (QOL). There is no approved treatment for cancer cachexia, and commonly used nutritional and anti-inflammatory strategies alone have proven ineffective for management of symptoms. Several other pharmacological agents are currently in development and have shown promise as a clinical strategy in early-phase trials. Recently, it has been proposed that multimodal strategies, with an anabolic focus, initiated early in the disease/treatment progression may provide the most therapeutic potential for symptom management. Here we review the data from recent clinical trials in cancer cachexia including pharmacological, exercise, and nutritional interventions.

American Society of Clinical Oncology Obesity Initiative: Rationale, Progress, and Future Directions.

PubMed

Ligibel, Jennifer A; Wollins, Dana

2016-12-10

Obesity is increasingly being linked to the risk of developing and dying from cancer. In recognition of the growing contribution of obesity to cancer risk and outcomes, ASCO made obesity and cancer one of its core initiatives in 2014. The goals of this initiative included raising awareness of the relationship between obesity and cancer, providing tools and resources to oncology providers and patients to help encourage conversations regarding weight management in cancer survivors, fostering a robust research agenda, and advocating for access to evidence-based weight management programs for cancer survivors. Efforts to date have included developing patient and provider toolkits focused on weight management and physical activity, publishing a policy statement outlining ASCO's initiatives in this area, and hosting a summit focused on obesity research in cancer populations. As ASCO has defined its priorities in the area of obesity and cancer, it has become increasingly clear that obesity is a problem that extends far beyond its impact on cancer risk and outcomes. Many groups, including those focused on heart disease, diabetes, and endocrinology, have been developing, testing, and implementing obesity prevention and treatment strategies for years. As ASCO moves forward with its obesity initiative, the next steps will focus on forging collaboration with groups working on obesity-related initiatives both within and outside of the field of cancer to learn from their efforts and to partner with them on efforts to increase the education of medical professionals; raising awareness in lay populations regarding the negative health consequences of obesity and effective strategies to foster weight loss; developing collaborative research initiatives; and working together to advocate for the societal changes that will be needed to combat the obesity epidemic in the United States and beyond.

A Qualitative Study of HR/OHS Stress Interventions in Australian Universities.

PubMed

Pignata, Silvia; Winefield, Anthony H; Boyd, Carolyn M; Provis, Chris

2018-01-09

To enhance the understanding of psychosocial factors and extend research on work stress interventions, we investigated the key human resource (HR)/occupational health and safety (OHS) stress interventions implemented at five Australian universities over a three-year period. Five senior HR Directors completed an online survey to identify the intervention strategies taken at their university in order to reduce stress and enhance employee well-being and morale. We also explored the types of individual-, organization-, and individual/organization-directed interventions that were implemented, and the strategies that were prioritized at each university. Across universities, the dominant interventions were strategies that aimed to balance the social exchange in the work contract between employee-organization with an emphasis on initiatives to: enhance training, career development and promotional opportunities; improve remuneration and recognition practices; and to enhance the fairness of organizational policies and procedures. Strategies to improve work-life balance were also prominent. The interventions implemented were predominantly proactive (primary) strategies focused at the organizational level and aimed at eliminating or reducing or altering work stressors. The findings contribute to the improved management of people at work by identifying university-specific HR/OHS initiatives, specifically leadership development and management skills programs which were identified as priorities at three universities.

A Qualitative Study of HR/OHS Stress Interventions in Australian Universities

PubMed Central

Winefield, Anthony H.; Boyd, Carolyn M.

2018-01-01

To enhance the understanding of psychosocial factors and extend research on work stress interventions, we investigated the key human resource (HR)/occupational health and safety (OHS) stress interventions implemented at five Australian universities over a three-year period. Five senior HR Directors completed an online survey to identify the intervention strategies taken at their university in order to reduce stress and enhance employee well-being and morale. We also explored the types of individual-, organization-, and individual/organization-directed interventions that were implemented, and the strategies that were prioritized at each university. Across universities, the dominant interventions were strategies that aimed to balance the social exchange in the work contract between employee-organization with an emphasis on initiatives to: enhance training, career development and promotional opportunities; improve remuneration and recognition practices; and to enhance the fairness of organizational policies and procedures. Strategies to improve work-life balance were also prominent. The interventions implemented were predominantly proactive (primary) strategies focused at the organizational level and aimed at eliminating or reducing or altering work stressors. The findings contribute to the improved management of people at work by identifying university-specific HR/OHS initiatives, specifically leadership development and management skills programs which were identified as priorities at three universities. PMID:29315278

Managing coastal recreation impacts and visitor experience using GIS

Treesearch

Anna M. T. Gajda; Judson Brown; Grant Peregoodoff; Patrick Bartier

2000-01-01

A campsite monitoring program was initiated in Gwaii Haanas National Park Reserve/Haida Heritage Site to determine baseline levels of visitor impacts. These data were necessary to evaluate visitor management strategies and to act as reference points to measure changes in impacts over time. Using GIS, survey data were integrated with an ecological land classification,...

Defense Acquisition Structures and Capabilities Review

DTIC Science & Technology

2007-06-01

systems to joint portfolio management Refinement of a human capital strategy Improvement of governance of the business transformation effort...Management, Senior- Level Tri-Chaired investment panel for the new Concept Decision process for major programs, and Defense Acquisition Executive Summary...establishment of centers of excellence. DLA reorganized to implement the Business Systems Modernization (BSM) initiative designed to improve end-to-end

A new image for long-term care.

PubMed

Wager, Richard; Creelman, William

2004-04-01

To counter widely held negative images of long-term care, managers in the industry should implement quality-improvement initiatives that include six key strategies: Manage the expectations of residents and their families. Address customers' concerns early. Build long-term customer satisfaction. Allocate resources to achieve exceptional outcomes in key areas. Respond to adverse events with compassion. Reinforce the facility's credibility.

Solid waste management in the hospitality industry: a review.

PubMed

Pirani, Sanaa I; Arafat, Hassan A

2014-12-15

Solid waste management is a key aspect of the environmental management of establishments belonging to the hospitality sector. In this study, we reviewed literature in this area, examining the current status of waste management for the hospitality sector, in general, with a focus on food waste management in particular. We specifically examined the for-profit subdivision of the hospitality sector, comprising primarily of hotels and restaurants. An account is given of the causes of the different types of waste encountered in this sector and what strategies may be used to reduce them. These strategies are further highlighted in terms of initiatives and practices which are already being implemented around the world to facilitate sustainable waste management. We also recommended a general waste management procedure to be followed by properties of the hospitality sector and described how waste mapping, an innovative yet simple strategy, can significantly reduce the waste generation of a hotel. Generally, we found that not many scholarly publications are available in this area of research. More studies need to be carried out on the implementation of sustainable waste management for the hospitality industry in different parts of the world and the challenges and opportunities involved. Copyright © 2014 Elsevier Ltd. All rights reserved.

Department of Defense Joint Technical Architecture, Version 6.0. Volume 2

DTIC Science & Technology

2003-10-03

information needs of our warfighters and the DoD enterprise. Information assurance will be integral to the GIG, and data management strategy initiatives will...IT investment strategy , and integration JTA Version 6.0, Final 3 October 2003 Vol. II–iv Executive Summaryoversight. DoDD 8100.1 establishes the GIG as... Strategy (May 9, 2003). In addition, numerous standards have been marked sunset, indicating deletion from the JTA on a future date to be determined by a

Public Health Nutrition: The Accord of Dietitian Providers in Managing Medicare Chronic Care Outpatients in Australia

PubMed Central

Cant, Robyn P.

2010-01-01

Medicare Australia: Chronic Disease Management program subsidizes allied health consultations for eligible outpatients with chronic disease or complex needs. In an evaluation study, private practice dietitians (n = 9) were interviewed to explore their patient management strategies including consultation time-allocation and fees. Time allocation was fee-based. Short first consultations were seen as meeting patients’ needs for low-cost services but were regarded by dietitians as ineffective, however longer initial consultations increased cost to patients. No strategy in use was optimal. There is a need for change in Medicare policy to meet the needs of both dietitians and patients in achieving the behaviour change goals of patients. PMID:20617063

44 CFR 204.51 - Application and approval procedures for a fire management assistance grant.

Code of Federal Regulations, 2012 CFR

2012-10-01

... part 201 that addresses wildfire risks and mitigation measures; or (ii) Incorporate wildfire mitigation... wildfire risk and contains a wildfire mitigation strategy and related mitigation initiatives. [66 FR 57347...

44 CFR 204.51 - Application and approval procedures for a fire management assistance grant.

Code of Federal Regulations, 2014 CFR

2014-10-01

... part 201 that addresses wildfire risks and mitigation measures; or (ii) Incorporate wildfire mitigation... wildfire risk and contains a wildfire mitigation strategy and related mitigation initiatives. [66 FR 57347...

44 CFR 204.51 - Application and approval procedures for a fire management assistance grant.

Code of Federal Regulations, 2011 CFR

2011-10-01

... part 201 that addresses wildfire risks and mitigation measures; or (ii) Incorporate wildfire mitigation... wildfire risk and contains a wildfire mitigation strategy and related mitigation initiatives. [66 FR 57347...

44 CFR 204.51 - Application and approval procedures for a fire management assistance grant.

Code of Federal Regulations, 2013 CFR

2013-10-01

... part 201 that addresses wildfire risks and mitigation measures; or (ii) Incorporate wildfire mitigation... wildfire risk and contains a wildfire mitigation strategy and related mitigation initiatives. [66 FR 57347...

What accounting leaves out of hospital financial management.

PubMed

Boles, K E; Glenn, J K

1986-01-01

As PPS and other fixed-price initiatives replace cost-based reimbursement in the hospital industry, the burden of assuming the risk for business success or failure shifts from the payor to the hospital. As a consequence, theories of risk to the business firm which have found application in other industries now deserve attention by hospital management. Incorporating such risk concepts into hospital strategies and actions requires a view of financial management that goes beyond the generally accepted accounting principles of managing and assigning costs for maximum revenue and profitability. This article examines the financial theory of risk in business firms, illustrates the various components of risk as they apply to a hospital business, and discusses how the hospital management strategies of cost-reduction, marketing, diversification, and multiorganizational affiliation can alter the risk characteristics of a hospital business.

FY 2013 INL SITE SUSTAINABILITY PLAN WITH THE FY 2012 ANNUAL REPORT

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

Ernest L. Fossum; Steve A. Birrer

2012-12-01

It is the policy of the Department of Energy (DOE) that sustainable energy and transportation fuels management will be integrated into DOE operations to meet obligations under Executive Order (EO) 13423 "Strengthening Federal Environmental, Energy, and Transportation Management," the Instructions for Implementation of EO 13423, as well as Guidance Documents issued in accordance thereto and any modifcations or amendments that may be issued from time to time. In furtherance of this obligation, DOE established strategic performance-based energy and transportation fuels goals and strategies through the Transformational Energy Action Management (TEAM) Initiative, which were incorporated into DOE Order 430.2B "Departmental Energy,more » Renewable energy, and Transportation Management" and were also identified in DOE Order 450.1A, "Environmental Protection Program." These goals and accompanying strategies are to be implemented by DOE sites through the integration of energy and transportation fuels management into site Environmental Management Systems (EMS).« less

Integrating clinical performance improvement across physician organizations: the PhyCor experience.

PubMed

Loeppke, R; Howell, J W

1999-02-01

There is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement; adopt local clinical and operational performance indicators; and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics. Key resources supporting CPI initiatives include information/knowledge management, education and training, and patient education and consumer decision support. Localized efforts in both the asthma care and diabetes management initiatives have led to some preliminary improvements in quality of care indicators. Physician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.

Implementation of real-time energy management strategy based on reinforcement learning for hybrid electric vehicles and simulation validation

PubMed Central

Kong, Zehui; Liu, Teng

2017-01-01

To further improve the fuel economy of series hybrid electric tracked vehicles, a reinforcement learning (RL)-based real-time energy management strategy is developed in this paper. In order to utilize the statistical characteristics of online driving schedule effectively, a recursive algorithm for the transition probability matrix (TPM) of power-request is derived. The reinforcement learning (RL) is applied to calculate and update the control policy at regular time, adapting to the varying driving conditions. A facing-forward powertrain model is built in detail, including the engine-generator model, battery model and vehicle dynamical model. The robustness and adaptability of real-time energy management strategy are validated through the comparison with the stationary control strategy based on initial transition probability matrix (TPM) generated from a long naturalistic driving cycle in the simulation. Results indicate that proposed method has better fuel economy than stationary one and is more effective in real-time control. PMID:28671967

Implementation of real-time energy management strategy based on reinforcement learning for hybrid electric vehicles and simulation validation.

PubMed

Kong, Zehui; Zou, Yuan; Liu, Teng

2017-01-01

To further improve the fuel economy of series hybrid electric tracked vehicles, a reinforcement learning (RL)-based real-time energy management strategy is developed in this paper. In order to utilize the statistical characteristics of online driving schedule effectively, a recursive algorithm for the transition probability matrix (TPM) of power-request is derived. The reinforcement learning (RL) is applied to calculate and update the control policy at regular time, adapting to the varying driving conditions. A facing-forward powertrain model is built in detail, including the engine-generator model, battery model and vehicle dynamical model. The robustness and adaptability of real-time energy management strategy are validated through the comparison with the stationary control strategy based on initial transition probability matrix (TPM) generated from a long naturalistic driving cycle in the simulation. Results indicate that proposed method has better fuel economy than stationary one and is more effective in real-time control.

Brainstorming for breakthrough thinking.

PubMed

Shirey, Maria R

2011-12-01

This department highlights change management strategies that may be used in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses brainstorming as a viable innovation technique and goal-based change intervention.

The Making of a Government LSI - From Warfare Capability to Operational System

DTIC Science & Technology

2015-04-30

continues to evolve and implement Lead System Integrator (LSI) acquisition strategies, they have started to define numerous program initiatives that...employ more integrated engineering and management processes and techniques. These initiatives are developing varying acquisition approaches that define (1...government LSI transformation. Navy Systems Commands have begun adding a higher level of integration into their acquisition process with the

Cultivating strategic thinking skills.

PubMed

Shirey, Maria R

2012-06-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author presents an overview of strategic leadership and offers approaches for cultivating strategic thinking skills.

Impact of Neurointensivist Co-management on the Clinical Outcomes of Patients Admitted to a Neurosurgical Intensive Care Unit

PubMed Central

2017-01-01

Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014. We compared the outcomes of neurosurgical patients before and after neurointensivist co-management. The primary outcome was ICU mortality. A total of 571 patients were admitted to the NSICU during the study period, 291 prior to the initiation of neurointensivist co-management and 280 thereafter. Intracranial hemorrhage (29.6%) and traumatic brain injury (TBI) (26.6%) were the most frequent reasons for ICU admission. TBI was the most common cause of death (39.0%). There were no significant differences in mortality rates and length of ICU stay before and after co-management. However, the rates of ICU and 30-day mortality among the TBI patients were significantly lower after compared to before initiation of neurointensivist co-management (8.5% vs. 22.9%; P = 0.014 and 11.0% vs. 27.1%; P = 0.010, respectively). Although overall outcomes were not different after neurointensivist co-management, initiation of a strategy of routine involvement of a neurointensivist significantly reduced the ICU and 30-day mortality rates of TBI patients. PMID:28480662

Strategies for data management engagement.

PubMed

Charbonneau, Deborah H

2013-01-01

The research landscape is growing dramatically, and librarians are examining new roles, services, and types of collaborations to support data-intensive research. This column describes curricular enhancements at one School of Library and Information Science in the United States. Several key areas of data management in which health sciences librarians may wish to build or enhance their skills are outlined. Possible roles and opportunities for health sciences librarians to strategically engage in data management initiatives are also presented.

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

Design and Implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART)

PubMed Central

Wang, Henry E.; Prince, David; Stephens, Shannon W.; Herren, Heather; Daya, Mohamud; Richmond, Neal; Carlson, Jestin; Warden, Craig; Colella, M. Riccardo; Brienza, Ashley; Aufderheide, Tom P.; Idris, Ahamed; Schmicker, Robert; May, Susanne; Nichol, Graham

2016-01-01

Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-hour survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include 1) initial airway management with ETI and 2) initial airway management with LT. The primary and secondary trial outcomes are 72-hour survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3,000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA. PMID:26851059

Managing bundled payments.

PubMed

Draper, Andrew

2011-04-01

Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

Management reporting on the Web.

PubMed Central

Narayanan, G.; McHolm, G.; Jones, D. T.

2000-01-01

Driven by easy-to-use World Wide Web technology and new information integration concepts that have proven their worth in business and industry, online management reporting is now becoming an important strategy for improving operational performance in health care organizations. In this article, we provide an overview of these new information management concepts and describe our experience in planning and executing an enterprise-wide Web-enabled management reporting initiative. We also offer an inventory of the key organizational capacities that we found essential for developing and sustaining Web-enabled reporting services for health care managers. PMID:11079955

Revisiting the approach to treatment of long-term illness: from the acute to the chronic state. A need for educational and managerial skills for long-term follow-up.

PubMed

Assal, J P

1999-06-01

The initial training of physicians and nurses is in the acute medical system, whether dealing with diagnosis or treatment of crises. This professional activity has gradually shaped the professional identity and is based on direct control, on avoiding risks and using therapeutic algorithms. When healthcare providers have to face chronic diseases and long-term follow-up strategies, this initial identity may often be counter-producing. This article describes the differences between the acute and chronic dimensions of diseases and treatments. Chronicity imposes on the healthcare provider a totally different way of functioning where he treats indirectly and should help the patient to manage the disease. Medical training has not put sufficient emphasis on the difference between those two approaches to disease. There is an urgent need for specific training in the strategies of management of long-term diseases.

A case study of polypharmacy management in nine European countries: Implications for change management and implementation

PubMed Central

MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F.; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Background Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Results Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives. PMID:29668763

Management of colonic injuries in the combat theater.

PubMed

Cho, S David; Kiraly, Laszlo N; Flaherty, Stephen F; Herzig, Daniel O; Lu, Kim C; Schreiber, Martin A

2010-05-01

Combat injuries are more often associated with blast, penetrating, and high-energy mechanisms than civilian trauma, generating controversy about the management of combat colonic injury. Despite implementation of mandatory colostomy in World War II, recent civilian data suggest that primary repair without diversion is safe and feasible. This study describes the modern management of battle-related colonic injuries and seeks to determine whether management strategy affects early complications. Records from the combat theater (downrange) and tertiary referral center in Germany were retrospectively reviewed from 2005 to 2006. Patient characteristics, management strategy, treatment course, and early complications were recorded. Comparison groups by management strategy were as follows: primary repair, diversion, and damage control. A total of 133 (97% male) patients sustained colonic injuries from penetrating (71%), blunt (5%), and blast (23%) mechanisms. Average injury severity score was 21 and length of stay in the referral center was 7.1 days. Injury distribution was 21% ascending, 21% descending, 15% transverse, 27% sigmoid, and 25% rectum. Downrange complications for primary repair, initial ostomy, and damage control groups were 14%, 15%, and 30%, respectively. On discharge from the center, 62% of patients had undergone a diversion. The complication rate was 18% overall and was unrelated to management strategy (P = .16). Multivariate analysis did not identify independent predictors of complications. Early complications were similar by mechanism, anatomic location, severity of injury, and management strategy. More diversions were performed for rectosigmoid injury. Good surgical judgment allows for low morbidity and supports primary repair in selected cases. Damage control surgery is effective in a multinational theater of operations.

Strategies for converting to a DBMS environment

NASA Technical Reports Server (NTRS)

Durban, D. M.

1984-01-01

The conversion to data base management systems processing techniques consists of three different strategies - one for each of the major stages in the development process. Each strategy was chosen for its approach in bringing about a smooth evolutionary type transition from one mode of operation to the next. The initial strategy of the indoctrination stage consisted of: (1) providing maximum access to current administrative data as soon as possible; (2) select and developing small prototype systems; (3) establishing a user information center as a central focal point for user training and assistance; and (4) developing a training program for programmers, management and ad hoc users in DBMS application and utilization. Security, the rate of the data dictionary, and data base tuning and capacity planning, and the development of a change of attitude in an automated office are issues meriting consideration.

Formal Developmental Relationships: A Survey of Organizational Practices. [and] Invited Reaction: Setting the Stage for Further Study of Developmental Relationships.

ERIC Educational Resources Information Center

Douglas, Christina A.; McCauley, Cynthia D.; Bierema, Laura L.

1999-01-01

Douglas and McCauley report on a survey of 246 managers about the management-development strategies used in their organizations. Results show that initiatives include mentoring, apprenticeships, coaching, and action learning. Bierema's reaction concurs in the need to widen the definition of relationships but suggests that methodological issues…

Exploring Senior Residents' Intraoperative Error Management Strategies: A Potential Measure of Performance Improvement.

PubMed

Law, Katherine E; Ray, Rebecca D; D'Angelo, Anne-Lise D; Cohen, Elaine R; DiMarco, Shannon M; Linsmeier, Elyse; Wiegmann, Douglas A; Pugh, Carla M

The study aim was to determine whether residents' error management strategies changed across 2 simulated laparoscopic ventral hernia (LVH) repair procedures after receiving feedback on their initial performance. We hypothesize that error detection and recovery strategies would improve during the second procedure without hands-on practice. Retrospective review of participant procedural performances of simulated laparoscopic ventral herniorrhaphy. A total of 3 investigators reviewed procedure videos to identify surgical errors. Errors were deconstructed. Error management events were noted, including error identification and recovery. Residents performed the simulated LVH procedures during a course on advanced laparoscopy. Participants had 30 minutes to complete a LVH procedure. After verbal and simulator feedback, residents returned 24 hours later to perform a different, more difficult simulated LVH repair. Senior (N = 7; postgraduate year 4-5) residents in attendance at the course participated in this study. In the first LVH procedure, residents committed 121 errors (M = 17.14, standard deviation = 4.38). Although the number of errors increased to 146 (M = 20.86, standard deviation = 6.15) during the second procedure, residents progressed further in the second procedure. There was no significant difference in the number of errors committed for both procedures, but errors shifted to the late stage of the second procedure. Residents changed the error types that they attempted to recover (χ 2 5 =24.96, p<0.001). For the second procedure, recovery attempts increased for action and procedure errors, but decreased for strategy errors. Residents also recovered the most errors in the late stage of the second procedure (p < 0.001). Residents' error management strategies changed between procedures following verbal feedback on their initial performance and feedback from the simulator. Errors and recovery attempts shifted to later steps during the second procedure. This may reflect residents' error management success in the earlier stages, which allowed further progression in the second simulation. Incorporating error recognition and management opportunities into surgical training could help track residents' learning curve and provide detailed, structured feedback on technical and decision-making skills. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.

PubMed

Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

2014-09-18

Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.

The 2011 revision of the global strategy for the diagnosis, management and prevention of COPD (GOLD)--why and what?

PubMed

Vestbo, Jørgen; Hurd, Suzanne S; Rodriguez-Roisin, Roberto

2012-10-01

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published a strategy for diagnosis and for management of chronic obstructive pulmonary disease (COPD) since 2001 and this has formed the basis for numerous national and regional guidelines. We describe the background for the 2011 revision of the GOLD document. The GOLD document is updated annually and revised every 5 years based on published research as well as an evaluation by an expert panel of how to best formulate and disseminate knowledge on COPD. The GOLD 2011 revision states that spirometry is required for making a clinical diagnosis of COPD. At the same time, the document has less emphasis on spirometric evaluation of disease severity and launches a combined assessment taking symptoms, spirometry and history of exacerbations into account. This is matched with initial treatment for COPD where smoking cessation, pulmonary rehabilitation and physical activity in general are given high priority followed by pharmacologic treatment guided by the novel assessment scheme. Comorbidities are often present in COPD and the GOLD 2011 revision gives some guidance in how to manage these as well as how to manage COPD in the presence of comorbidities. A more clinically oriented GOLD document will hopefully improve assessment and management of COPD. © 2012 Blackwell Publishing Ltd.

Change management and clinical engagement: critical elements for a successful clinical information system implementation.

PubMed

Detwiller, Maureen; Petillion, Wendy

2014-06-01

Moving a large healthcare organization from an old, nonstandardized clinical information system to a new user-friendly, standards-based system was much more than an upgrade to technology. This project to standardize terminology, optimize key processes, and implement a new clinical information system was a large change initiative over 4 years that affected clinicians across the organization. Effective change management and engagement of clinical stakeholders were critical to the success of the initiative. The focus of this article was to outline the strategies and methodologies used and the lessons learned.

Sustainable urban development in Brisbane City--the Holy Grail?

PubMed

Rahman, K; Weber, T

2003-01-01

Impacts from urban stormwater runoff on receiving environments have been well documented, particularly through specific regional scientific studies. Using various local government planning and management elements, urban developments in Brisbane City are now able to address stormwater management in an increasingly holistic context. One key initiative includes facilitating Water Sensitive Urban Design (WSUD) components within an Integrated Water Management Strategy that looks at policy formation, planning strategies, design option, community marketing and acceptance, maintenance programs and finally evaluation of various WSUD approaches. These can include the use of Natural Channel Designs, grassed swales, bio-filtration systems, porous pavements and roofwater tanks in several economic combinations. By linking with the Cooperative Research Centre for Catchment Hydrology, Brisbane City Council has influenced the design of WSUD planning tools and benefited the city with academic inputs into extensive evaluation programs. As well, it has also contributed to the Cooperative Research Centre's research outcomes. These evaluation programs are increasingly providing better understanding of various stormwater quality best management practices throughout Australia. As part of the overall implementation process, active involvement by a range of stakeholders has been crucial. These stakeholders have included internal planning, development assessment and design staff, external consultants, developers, and other local and state government agencies. The latter two groups are assisting in the important task of "regionalisation" of Brisbane City Council's policies and guidelines. Implementation of WSUD initiatives and stormwater re-use strategies under Council's new "Integrated Water Management" agenda are showing some excellent results, suggesting that sustainable urban development is no longer like the search for the Holy Grail.

Structural health and prognostics management for the enhancement of offshore wind turbine operations and maintenance strategies

DOE PAGES

Griffith, D. Todd; Yoder, Nathanael C.; Resor, Brian; ...

2013-09-19

Offshore wind turbines are an attractive source for clean and renewable energy for reasons including their proximity to population centers and higher capacity factors. One obstacle to the more widespread installation of offshore wind turbines in the USA, however, is that recent projections of offshore operations and maintenance costs vary from two to five times the land-based costs. One way in which these costs could be reduced is through use of a structural health and prognostics management (SHPM) system as part of a condition-based maintenance paradigm with smart loads management. Our paper contributes to the development of such strategies bymore » developing an initial roadmap for SHPM, with application to the blades. One of the key elements of the approach is a multiscale simulation approach developed to identify how the underlying physics of the system are affected by the presence of damage and how these changes manifest themselves in the operational response of a full turbine. A case study of a trailing edge disbond is analysed to demonstrate the multiscale sensitivity of damage approach and to show the potential life extension and increased energy capture that can be achieved using simple changes in the overall turbine control and loads management strategy. Finally, the integration of health monitoring information, economic considerations such as repair costs versus state of health, and a smart loads management methodology provides an initial roadmap for reducing operations and maintenance costs for offshore wind farms while increasing turbine availability and overall profit.« less

Establishing a sense of urgency for leading transformational change.

PubMed

Shirey, Maria R

2011-04-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses successful tactics for establishing a sense of urgency to facilitate organizational change.

Acquisition Management: Agencies Can Improve Training on New Initiatives. Report to the Chairman, Subcommittee on Technology and Procurement Policy, Committee on Government Reform, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

A study assessed strategies agencies use to ensure that their workforces are receiving the training necessary to implement acquisition initiatives. Focus was on the General Services Administration (GSA), National Aeronautics and Space Administration (NASA), and Department of Defense (DOD). Findings indicated that the critical elements important to…

Leaning in: lessons for leadership career development.

PubMed

Shirey, Maria R

2013-11-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author introduces the book Lean In and presents applicable lessons for nursing leadership career development.

Future management strategies for state maintained wetlands and stream mitigation sites.

DOT National Transportation Integrated Search

2008-06-01

This study was to identify existing wetland/stream mitigation sites owned by the Kentucky Transportation Cabinet (KYTC) and assess performance of those sites including problems encountered and maintenance costs. Initial work determined that KYTC Dist...

Road to School Reform: The Chicago Model.

ERIC Educational Resources Information Center

Crump, Debra

Growing dissatisfaction makes major structural changes requiring legislative, popular initiatives, or the approval of governing authorities possible in U.S. schools. Schools raising academic achievement emphasize high student expectations, classroom management, positive feedback, tailored teaching strategies, professional work environments, and…

Final Environmental Impact Statement Establishment and Operation of an Intelligence, Surveillance, Reconnaissance, and Strike Capability Andersen Air Force Base, Guam

DTIC Science & Technology

2007-01-01

Mariana Fruit Bat Pup Recruitment at Pati Point Colony; • Brown Tree Snake Interdiction and Control; and • Adaptive Management and Ground Track...establishment of a mitigation monitoring plan and adaptive management program. FUTURE ACTIONS As discussed in the Final EIS, the Air Force recognizes that...would initiate modifications to aircraft ground tracks and profiles over sensitive areas through an adaptive management strategy. This adaptive

Negotiating for more than a slice of the pie.

PubMed

Blair, J D; Savage, G T; Whitehead, C I; Dymond, S B

1991-01-01

Negotiation is an important way for physician executives to manage conflict and to accomplish new projects. Because of the rapidly changing nature of the health care environment, as well as conflicts and politics within their organizations, managers need to effectively negotiate with a wide range of other parties. Managers should consider the relative importance of both the substantive and relationship outcomes of any potential negotiation. These two factors may guide the executive's selection of initial negotiation strategies.

Using Concept Mapping to Develop a Strategy for Self-Management Support for Underserved Populations Living With Chronic Conditions, British Columbia, August 2013-June 2014.

PubMed

Mills, Susan L; Bergeron, Kim; Pérez, Guillermina

2015-10-08

Self-management support (SMS) is an essential component of public health approaches to chronic conditions. Given increasing concerns about health equity, the needs of diverse populations must be considered. This study examined potential solutions for addressing the gaps in self-management support initiatives for underserved populations. Stakeholders representing government, nongovernment organizations, Aboriginal communities, health authorities, medical practices, and research institutions generated, sorted, and rated ideas on what could be done to improve self-management support for underserved populations. Concept mapping was used to facilitate the collection and organization of the data and to generate conceptual maps. Participants generated 92 ideas that were sorted into 11 clusters (foster partnerships, promote integrated community care, enhance health care provider training, shift government policy, support community development, increase community education, enable client engagement, incorporate client support systems, recognize client capacity, tailor self-management support programs, and develop client skills, training, and tools) and grouped into system, community, and individual levels within a partnership framework. The strategy can stimulate public health dialogue and be a roadmap for developing SMS initiatives. It has the potential to address SMS and chronic condition inequities in underserved populations in several ways: 1) by targeting populations that have greater inequities, 2) by advocating for shifts in government policies that create and perpetuate inequities, 3) by promoting partnerships that may increase the number of SMS initiatives for underserved groups, and 4) by promoting training and engagement that increase the relevance, uptake, and overall effectiveness of SMS.

[Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].

PubMed

Baeza Román, Anna; Latour Pérez, Jaime; de Miguel Balsa, Eva; Pino Izquierdo, Karel; Coves Orts, Francisco Javier; García Ochando, Luis; de la Torre Fernández, Maria José

2014-05-20

In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy. Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression. We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel. The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Conceptual data modeling of wildlife response indicators to ecosystem change in the Arctic

USGS Publications Warehouse

Walworth, Dennis; Pearce, John M.

2015-08-06

Large research studies are often challenged to effectively expose and document the types of information being collected and the reasons for data collection across what are often a diverse cadre of investigators of differing disciplines. We applied concepts from the field of information or data modeling to the U.S. Geological Survey (USGS) Changing Arctic Ecosystems (CAE) initiative to prototype an application of information modeling. The USGS CAE initiative is collecting information from marine and terrestrial environments in Alaska to identify and understand the links between rapid physical changes in the Arctic and response of wildlife populations to these ecosystem changes. An associated need is to understand how data collection strategies are informing the overall science initiative and facilitating communication of those strategies to a wide audience. We explored the use of conceptual data modeling to provide a method by which to document, describe, and visually communicate both enterprise and study level data; provide a simple means to analyze commonalities and differences in data acquisition strategies between studies; and provide a tool for discussing those strategies among researchers and managers.

Discussing a sensitive topic: Nurse practitioners' and physician assistants' communication strategies in managing patients with erectile dysfunction.

PubMed

Green, Roger; Kodish, Slavica

2009-12-01

To examine strategies used by nurse practitioners (NPs) and physician assistants (PAs) when discussing the sensitive topic of erectile dysfunction (ED) with patients. A total of 456 NPs and PAs combined responded to a 22-item online survey posted on NP and PA association websites. Four derived categories reflect communication strategies that NPs and PAs applied when addressing ED: initiating the topic directly, initiating the topic with an introduction, initiating the topic when there is a high risk factor, and allowing the patient to bring up the topic. There was also interest in continuing education on the topic of ED and a perceived need for greater emphasis on developing communication strategies within the patient-provider relationship. There is no one best way to address the topic and different situations may require an approach best suited to the specifics of the situation. Therefore, no single "best practice" of discussing sensitive topics can be identified. Critical thinking skills and the ability to comprehend the totality of the situation are likely to be of higher importance.

A survey of managed care strategies for pregnant smokers.

PubMed

Barker, D C; Robinson, L A; Rosenthal, A C

2000-01-01

The purpose of this study was to measure the content and comprehensiveness of pregnancy specific smoking cessation strategies within managed care organisations (MCOs) responding affirmatively to the national 1997-98 Addressing Tobacco in Managed Care (ATMC) survey. This cross sectional follow up study consisted of a fax survey sent to medical directors and a 37 question telephone survey of program overseers about the smoking cessation strategy. 147 MCOs identifying a pregnancy specific smoking cessation strategy on the 1997-98 ATMC survey served as the initial sample; 88 MCOs of 128 eligible plans completed both components, with a response rate of 69%. Pregnancy specific smoking cessation strategies varied. 40% of respondents used the Agency for Health Care Policy and Research guidelines for clinical smoking cessation to design their strategy. Strategies included self help materials, quit classes, telephone support and brief counselling by providers, linkages to quality improvement efforts, and use of patient databases for outreach. Only 42% offered a postpartum relapse prevention element. Lack of patient interest, competing clinic priorities, and the lack of a smoker identification system were the most problematic barriers to implementing strategies, common to at least a quarter of respondents. A majority ranked best practice manuals and web site linkages as the most useful form of technical assistance, followed by peer-to-peer counselling, regional workshops, newsletters, on-site assistance, and national conferences. The survey provides the first profile of prenatal tobacco treatment strategies in managed care. While design limitations prevent generalisation of these results to all MCOs, such information can help guide technical assistance to plans interested in reducing smoking among pregnant women.

Is environmental management an economically sustainable business?

PubMed

Gotschol, Antje; De Giovanni, Pietro; Esposito Vinzi, Vincenzo

2014-11-01

This paper investigates whether environmental management is an economically sustainable business. While firms invest in green production and green supply chain activities with the primary purpose of reducing their environmental impact, the reciprocal relationships with economic performance need to be clarified. Would firms and suppliers adjust their environmental strategies if the higher economic value that environmental management generates is reinvested in greening actions? We found out that environmental management positively influences economic performance as second order (long term) target, to be reached conditioned by higher environmental performance; in addition, firms can increase their performance if they reinvest the higher economic value gained through environmental management in green practices: While investing in environmental management programs is a short term strategy, economic rewards can be obtained only with some delays. Consequently, environmental management is an economically sustainable business only for patient firms. In the evaluation of these reciprocal relationships, we discovered that green supply chain initiatives are more effective and more economically sustainable than internal actions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Strengthening the evidence and action on multi-sectoral partnerships in public health: an action research initiative

PubMed Central

Willis, C. D.; Greene, J. K.; Abramowicz, A.; Riley, B. L.

2016-01-01

Abstract Introduction: The Public Health Agency of Canada’s Multi-sectoral Partnerships Initiative, administered by the Centre for Chronic Disease Prevention (CCDP), brings together diverse partners to design, implement and advance innovative approaches for improving population health. This article describes the development and initial priorities of an action research project (a learning and improvement strategy) that aims to facilitate continuous improvement of the CCDP’s partnership initiative and contribute to the evidence on multi-sectoral partnerships. Methods: The learning and improvement strategy for the CCDP’s multi-sectoral partnership initiative was informed by (1) consultations with CCDP staff and senior management, and (2) a review of conceptual frameworks to do with multi-sectoral partnerships. Consultations explored the development of the multi-sectoral initiative, barriers and facilitators to success, and markers of effectiveness. Published and grey literature was reviewed using a systematic search strategy with findings synthesized using a narrative approach. Results: Consultations and the review highlighted the importance of understanding partnership impacts, developing a shared vision, implementing a shared measurement system and creating opportunities for knowledge exchange. With that in mind, we propose a six-component learning and improvement strategy that involves (1) prioritizing learning needs, (2) mapping needs to evidence, (3) using relevant data-collection methods, (4) analyzing and synthesizing data, (5) feeding data back to CCDP staff and teams and (6) taking action. Initial learning needs include investigating partnership reach and the unanticipated effects of multi-sectoral partnerships for individuals, groups, organizations or communities. Conclusion: While the CCDP is the primary audience for the learning and improvement strategy, it may prove useful for a range of audiences, including other government departments and external organizations interested in capturing and sharing new knowledge generated from multi-sectoral partnerships. PMID:27284702

Timeliness of lung cancer care in Victoria: a retrospective cohort study.

PubMed

Evans, Sue M; Earnest, Arul; Bower, Wendy; Senthuren, Meera; McLaughlin, Peta; Stirling, Rob

2016-02-01

To assess factors associated with second-line delays in the management of patients diagnosed with lung cancer. A retrospective cohort study, conducted in six public and two private Victorian hospitals, of 1417 patients aged 18 years or more who were diagnosed between July 2011 and October 2014 with an incident case of lung cancer identified by International Classification of Diseases, 10th revision codes (C34.0-C34.9, Z85.1, Z85.2) on the basis of either a clinical or pathological diagnosis. Time intervals between referral, diagnosis and initial definitive management. The median time from referral to diagnosis was 15 days (interquartile range [IQR], 5-36); from diagnosis to initial definitive management, 30 days (IQR, 6-84); and from referral to initial definitive management, 53 days (IQR, 25-106). Factors that were significantly associated with delay between referral and initial definitive management include declining or not being referred to palliative care (hazard ratio [HR], v patients referred for palliation, 0.73; 95% CI, 0.62-0.86; P < 0.001), and being treated in a public hospital (HR, v patients managed in a private hospital, 0.55; 95% CI, 0.48-0.64; P < 0.001). The median time from referral to initial definitive management in public and private hospitals was 61 days (IQR, 35-118) and 30 days (IQR, 13-76) respectively; 48% of patients in public hospitals waited longer than the British National Health Service target of a maximum 62 days between referral and first definitive treatment. There are significant delays at various stages of the patient journey after referral for initial definitive management. Having a greater understanding of these delays will enable strategies to be developed that improve the timeliness of care for patients with lung cancer.

[Diagnostics and treatment strategies for multiple trauma patients].

PubMed

Pfeifer, R; Pape, H-C

2016-02-01

Severe trauma is still one of the leading causes of death worldwide. The initial treatment and diagnostics are of immense importance in polytraumatized patients. The initial approach mainly focuses on the advanced trauma life support (ATLS) concept. This includes the identification of life-threatening conditions and application of life-saving interventions. Depending on the physiological condition of the patient, the surgical treatment strategies of early total care (ETC) or damage control orthopedics (DCO) can be chosen. Appropriate surgical management can reduce the incidence of associated delayed systemic complications. This review summarizes the most commonly used definitions of polytrauma (including the Berlin polytrauma definition) and classification systems of severely injured patients. Moreover, the recently introduced treatment strategy of the safe definitive surgery concept for severely injured patients is also discussed in this article.

Improving customer satisfaction: emerging lessons about strategy and implementation, Part 2.

PubMed

Morton, J

1995-01-01

This article describes a six-phase strategy designed to systematically improve customer satisfaction across an entire managed care system. Part 1 (Spring 1995) of this two-part series summarized the theoretical underpinnings of the approach and highlighted the first two phases of the improvement strategy. Those phases involve systematically listening to the organization's customers and using customer information to strategically target key areas for improvement. This article describes the specifics of the last four phases of the strategy; these phases involve achieving and sustaining unprecedented levels of improvement in targeted areas. Initial results and emerging lessons associated with the implementation of this strategy are summarized.

Diagnosing and Resolving Conflict Created by Strategic Plans: Where Outreach Strategies and Execution Meet at an Academic Health Center.

PubMed

Edwards, Robert L; Wollner, Samuel B; Weddle, Jessica; Zembrodt, James W; Birdwhistell, Mark D

2017-01-01

The imperative for strategic change at academic health centers has never been stronger. Underpinning the success of strategic change is an effective process to implement a strategy. Healthcare organizations, however, often fail to execute on strategy because they do not activate the requisite capabilities and management processes. The University of Kentucky HealthCare recently defined its 2020 strategic plan to adapt to emerging market conditions. The authors outline the strategic importance of strengthening partnership networks and the initial challenges faced in executing their strategy. The findings are a case study in how one academic health center has approached strategy implementation.

Integrating Environmental and Information Systems Management: An Enterprise Architecture Approach

NASA Astrophysics Data System (ADS)

Noran, Ovidiu

Environmental responsibility is fast becoming an important aspect of strategic management as the reality of climate change settles in and relevant regulations are expected to tighten significantly in the near future. Many businesses react to this challenge by implementing environmental reporting and management systems. However, the environmental initiative is often not properly integrated in the overall business strategy and its information system (IS) and as a result the management does not have timely access to (appropriately aggregated) environmental information. This chapter argues for the benefit of integrating the environmental management (EM) project into the ongoing enterprise architecture (EA) initiative present in all successful companies. This is done by demonstrating how a reference architecture framework and a meta-methodology using EA artefacts can be used to co-design the EM system, the organisation and its IS in order to achieve a much needed synergy.

Tokenism costs nothing.

PubMed

1990-09-19

It is not often that I find myself agreeing with the NHS Chief Executive but at last week's 'Strategy for nursing' conference his criticisms of health service management were well placed. According to Duncan Nichol, managers continue to pay lip service to recruitment and retention issues. He claimed there was no real commitment to initiatives such as flexible working hours and crèche facilities and he accused employers of tokenism.

Healthcare succession planning: an integrative review.

PubMed

Carriere, Brian K; Muise, Melanie; Cummings, Greta; Newburn-Cook, Chris

2009-12-01

Succession planning is a business strategy that has recently gained attention in the healthcare literature, primarily because of nursing shortage concerns and the demand for retaining knowledgeable personnel to meet organizational needs. Little research has been conducted in healthcare settings that clearly defines best practices for succession planning frameworks. To effectively carry out such organizational strategies during these challenging times, an integrative review of succession planning in healthcare was performed to identify consistencies in theoretical approaches and strategies for chief nursing officers and healthcare managers to initiate. Selected articles were compared with business succession planning to determine whether healthcare strategies were similar to best practices already established in business contexts. The results of this integrative review will aid leaders and managers to use succession planning as a tool in their recruitment, retention, mentoring, and administration activities and also provide insights for future development of healthcare succession planning frameworks.

Chronic Obstructive Pulmonary Disease and Heart Failure Self-Management Kits for Outpatient Transitions of Care.

PubMed

Boylan, Paul; Joseph, Tina; Hale, Genevieve; Moreau, Cynthia; Seamon, Matthew; Jones, Renee

2018-03-01

To develop heart failure (HF) and chronic obstructive pulmonary disease (COPD) self-management kits in an accountable care organization (ACO) to facilitate patients' self-care and prevent hospital readmissions. Pharmacists practice in an outpatient-based ACO. They participate in interprofessional office visits with providers and independently manage maintenance pharmacotherapies. Pharmacists collaborate with an interprofessional team within the ACO including physicians, nurses, case managers, and paramedics. Two commonly encountered diseases are chronic COPD and HF. Reducing preventable readmissions for these conditions are important quality benchmarks and cost-saving strategies. Pharmacists were responsible for developing HF and COPD self-management kits containing patient education materials and prescriptions to facilitate self-care. Prior to kit development, pharmacists performed a literature review to determine the presence of previously published findings on these topics. The interprofessional team continually evaluates the successes and limitations of this initiative. Pharmacists developed training and instructions for ACO allied health professionals in an effort to incorporate the self-management kits in clinical practice. The initial literature search revealed no studies describing the intervention of interest. Innovative programs designed to help reduce preventable readmissions are lacking in primary care. Implementation of the self-management kits was accepted by interprofessional ACO leadership and is currently being integrated into allied health workflow. Patients at risk for having an exacerbation of COPD or HF should receive self-management strategies. Prompt therapy prior to exacerbations reduces hospital admissions and readmissions, speeds recovery, and slows disease progression. Pharmacist-facilitated implementation of self-management kits may be developed by interprofessional health care teams.

Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

PubMed

Bernhard, Gerda; Ose, Dominik; Baudendistel, Ines; Seidling, Hanna M; Stützle, Marion; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

2017-04-01

Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

"Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis.

PubMed

Carr, Phyllis L; Rothberg, Michael B; Friedman, Robert H; Felsenstein, Donna; Pliskin, Joseph S

2005-09-01

Although vaginitis is a common outpatient problem, only 60% of patients can be diagnosed at the initial office visit of a primary care provider using the office procedures of pH testing, whiff tests, normal saline, and potassium hydroxide preps. To determine the most cost-effective diagnostic and treatment approach for the medical management of vaginitis. Decision and cost-effectiveness analyses. Healthy women with symptoms of vaginitis undiagnosed after an initial pelvic exam, wet mount preparations, pH, and the four criteria to diagnose bacterial vaginosis. General office practice. We evaluated 28 diagnostic strategies comprised of combinations of pH testing, vaginal cultures for yeast and Trichomonas vaginalis, Gram's stain for bacterial vaginosis, and DNA probes for Neisseria gonorrhoeae and Chlamydia. Data sources for the study were confined to English language literature. The outcome measures were symptom-days and costs. The least expensive strategy was to perform yeast culture, gonorrhoeae and Chlamydia probes at the initial visit, and Gram's stain and Trichomonas culture only when the vaginal pH exceeded 4.9 (330 dollars, 7.30 symptom days). Other strategies cost 8 dollars to 76 dollars more and increased duration of symptoms by up to 1.3 days. In probabilistic sensitivity analysis, this strategy was always the most effective strategy and was also least expensive 58% of the time. For patients with vaginitis symptoms undiagnosed by pelvic examination, wet mount preparations and related office tests, a comprehensive, pH-guided testing strategy at the initial office visit is less expensive and more effective than ordering tests sequentially.

Gendered vulnerabilities and grassroots adaptation initiatives in home gardens and small orchards in Northwest Mexico.

PubMed

Buechler, Stephanie

2016-12-01

With the retreat of the state under neoliberalism, the lack of (or negligible) government and non-governmental support reasserts grassroots initiatives as a global-change strategy. A feminist political ecology approach and the concept of adverse inclusion were used to facilitate an analysis of social differences shaping local-level adaptive responses. Adaptive responses of small farmers in the border village of San Ignacio, Sonora, Mexico, who are increasingly vulnerable to climate change, water scarcity, and changing labor markets were studied. Gender differences in production sites translate into diverse vulnerabilities and adaptive strategies. Local capacities and initiatives should be a focus of research and policy to avoid viewing women and men as passive in the face of global change. The dynamic strategies of San Ignacio women and men in home gardens and small orchards hold lessons for other regions particularly related to adaptation to climate change via agrobiodiversity, water resource management, and diversified agricultural livelihoods.

Facial fractures in children.

PubMed

Boyette, Jennings R

2014-10-01

Facial trauma in children differs from adults. The growing facial skeleton presents several challenges to the reconstructive surgeon. A thorough understanding of the patterns of facial growth and development is needed to form an individualized treatment strategy. A proper diagnosis must be made and treatment options weighed against the risk of causing further harm to facial development. This article focuses on the management of facial fractures in children. Discussed are common fracture patterns based on the development of the facial structure, initial management, diagnostic strategies, new concepts and old controversies regarding radiologic examinations, conservative versus operative intervention, risks of growth impairment, and resorbable fixation. Copyright © 2014 Elsevier Inc. All rights reserved.

Use of a business case model for organizational change.

PubMed

Shirey, Maria R

2011-01-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses the concept of a business case and introduces a 3-phase business case model for organizational change.

Change Strategies and Associated Implementation Challenges: An Analysis of Online Counselling Sessions.

PubMed

Rodda, Simone N; Hing, Nerilee; Hodgins, David C; Cheetham, Alison; Dickins, Marissa; Lubman, Dan I

2017-09-01

Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.

Early appendectomy reduces costs in children with perforated appendicitis.

PubMed

Church, Joseph T; Klein, Edwin J; Carr, Benjamin D; Bruch, Steven W

2017-12-01

Perforated appendicitis can be managed with early appendectomy, or nonoperative management followed by interval appendectomy. We aimed to identify the strategy with the lowest health care utilization and cost. We retrospectively reviewed the medical records of all children ≤18 years old with perforated appendicitis admitted to a single institution between January 2009 and March 2016. After excluding immunosuppressed patients and transfers from outside hospitals, we grouped the remaining patients by early or interval appendectomy. Cost accounting data were obtained from our institutional database. The primary outcome was total hospital cost over 2 y from initial admission for appendicitis. Other outcomes analyzed included initial admission costs, number of admissions, emergency room and clinic visits, percutaneous procedures, cross-sectional and overall imaging studies, and length of stay. A total of 203 children with perforated appendicitis were identified. After exclusion of immunosuppressed patients and outside hospital transfers, 94 patients were included in the study. Thirty-nine underwent early appendectomy and 55 initial nonoperative management; of these, 54 underwent elective interval appendectomy. Five of 55 patients (9%) failed initial nonoperative management and required earlier-than-planned appendectomy. Total cost over 2 y was significantly lower with early appendectomy than initial nonoperative management ($19,300 ± 14,300 versus $26,000 ± 17,500; P = 0.05). Early appendectomy resulted in fewer hospital admissions, clinic visits, invasive procedures, and imaging studies. Early appendectomy results in lower hospital costs and less health care utilization compared with initial nonoperative management with elective interval appendectomy. A prospective study will shed more light on this question and can assess the role of nonoperative management without interval appendectomy in children with perforated appendicitis. Copyright © 2017 Elsevier Inc. All rights reserved.

Highway safety data : costs, quality, and strategies for improvement, final report.

DOT National Transportation Integrated Search

1998-01-01

The goal of this project was to analyze the collection and management of highway safety data by identifying issues and costs, and proposing means of resolving those issues and reducing the costs. Initial emphasis addressed known elements of the highw...

Highway Safety Data : costs, quality, and strategies for improvement : research report

DOT National Transportation Integrated Search

1998-01-01

The goal of this project was to analyze the collection and management of highway safety data by identifying issues and costs, and proposing means of resolving those issues and reducing the costs. Initial emphasis addressed known elements of the highw...

Effective Organizational Structures and Processes: Addressing Issues of Change

ERIC Educational Resources Information Center

Andrade, Maureen Snow

2016-01-01

This chapter describes organizational structures and processes at the institutional and project levels for the development and support of distance learning initiatives. It addresses environmental and stakeholder issues and explores principles and strategies of effective leadership for change creation and management.

Utility of Risk Stratification for Paclitaxel Hypersensitivity Reactions.

PubMed

Otani, Iris M; Lax, Timothy; Long, Aidan A; Slawski, Benjamin R; Camargo, Carlos A; Banerji, Aleena

2017-10-03

Hypersensitivity reactions (HSRs) are a common impediment to paclitaxel therapy. Management strategies to guide care after a paclitaxel-induced HSR are needed. The objective was to evaluate the utility and safety of risk stratification on the basis of severity of the initial HSR. A risk stratification pathway was developed on the basis of a retrospective review of the management and outcome of 130 patients with paclitaxel-induced HSRs at Massachusetts General Hospital. This pathway was then studied prospectively in patients referred to Allergy/Immunology with paclitaxel-induced HSRs. The study population (n = 35) had a mean age of 56.1 ± 12 years and most were women (n = 33 [94%]). All 5 patients (15%) with grade 1 initial HSRs were successfully reexposed to paclitaxel, 1 patient at the standard infusion rate and 4 patients at 50% of the standard infusion rate. Thirty patients (85%) with grade 2 to 4 initial HSRs underwent initial paclitaxel desensitization based on the risk stratification pathway. No patients developed severe HSRs using the pathway. Eleven (31%) patients had HSRs that were mild to moderate in nature (grade 1, n = 4 [11%]; grade 2, n = 6 [17%]; grade 3, n = 1 [3%]) during their first desensitization. Sixteen (46%) of the 35 patients safely returned to the outpatient infusion setting for paclitaxel treatment at 50% of the standard infusion rate. Seven (20%) discontinued paclitaxel before the completion of the risk stratification pathway because of disease progression, completion of therapy, or death. A management strategy using the initial HSR severity for risk stratification allowed patients to receive paclitaxel safely. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Bladder Preservation for Localized Muscle-Invasive Bladder Cancer: The Survival Impact of Local Utilization Rates of Definitive Radiotherapy

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

Kozak, Kevin R.; Hamidi, Maryam; Manning, Matthew

2012-06-01

Purpose: This study examines the management and outcomes of muscle-invasive bladder cancer in the United States. Methods and Materials: Patients with muscle-invasive bladder cancer diagnosed between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified according to three mutually exclusive treatment categories based on the primary initial treatment: no local management, radiotherapy, or surgery. Overall survival was assessed with Kaplan-Meier analysis and Cox models based on multiple factors including treatment utilization patterns. Results: The study population consisted of 26,851 patients. Age, sex, race, tumor grade, histology, and geographic location were associated withmore » differences in treatment (all p < 0.01). Patients receiving definitive radiotherapy tended to be older and have less differentiated tumors than patients undergoing surgery (RT, median age 78 years old and 90.6% grade 3/4 tumors; surgery, median age 71 years old and 77.1% grade 3/4 tumors). No large shifts in treatment were seen over time, with most patients managed with surgical resection (86.3% for overall study population). Significant survival differences were observed according to initial treatment: median survival, 14 months with no definitive local treatment; 17 months with radiotherapy; and 43 months for surgery. On multivariate analysis, differences in local utilization rates of definitive radiotherapy did not demonstrate a significant effect on overall survival (hazard ratio, 1.002; 95% confidence interval, 0.999-1.005). Conclusions: Multiple factors influence the initial treatment strategy for muscle-invasive bladder cancer, but definitive radiotherapy continues to be used infrequently. Although patients who undergo surgery fare better, a multivariable model that accounted for patient and tumor characteristics found no survival detriment to the utilization of definitive radiotherapy. These results support continued research into bladder preservation strategies and suggest that definitive radiotherapy represents a viable initial treatment strategy for those who wish to attempt to preserve their native bladder.« less

Strategies for Revitalizing Organizations: Regaining the Competitive Edge

NASA Technical Reports Server (NTRS)

Nysmith, C. Robert

1987-01-01

During the last decade, the United States has lost competitive stature in the world. Challenged daily by a technically sophisticated and vitalized global economy, industry and Government are examining quality and productivity initiatives with which to meet the foreign competitive challenge. At stake are our quality of life and our standard of living for the remainder of this century and beyond. Being competitive is an ongoing process, tuned to an awareness and understanding of the dynamics of the world marketplace and to the changing nature of the work environment. Solutions to America's quality and productivity problems do not exist independently within any organization or industry or at any given level of society. Success depends on commitment, partnership, meshing of goals and responsibilities, mutual respect and understanding, and a desire to be first. A change in organizational management culture is required. Traditional authoritarian management practices must give way to enlightened leadership initiatives that stress employee involvement and participation. There must be a lessening of adversarial relationships between management and labor and between industry and Government. Quality and productivity are understood to be the end result of an integrated process which begins with vigorous, committed leadership and ends with a satisfied customer. The essential elements in the revitalization process are organized in this report into seven strategies which represent the major findings of the Second NASA Symposium on Quality and Productivity. Each strategy is then broken down into its principal themes which are presented as recommendations. No one strategy can stand apart from any other; all are interrelated and work together.

Successful healthcare programs and projects: organization portfolio management essentials.

PubMed

Pickens, Scott; Solak, Jamie

2005-01-01

Many healthcare organization projects take more time and resources than planned and fail to deliver desired business outcomes. Healthcare IT is a major component of many projects and often undeservedly receives the blame for failure. Poor results are often not a result of faulty healthcare IT or poor project management or poor project execution alone. Many projects fail because of poor portfolio management--poor planning and management of the portfolio of initiatives designed to meet an organization's strategic goals. Because resources are limited, portfolio management enables organizations to more strategically allocate and manage their resources so care delivery, service delivery, and initiatives that advance organizations toward their strategic goals, including healthcare IT initiatives, can be accomplished at the levels of quality and service desired by an organization. Proper portfolio management is the essential foundation for program and project success and supports overall organization success. Without portfolio management, even programs and projects that execute flawlessly may not meet desired objectives. This article discusses the essential requirements for porfolio management. These include opportunity identification, return on investment (ROI) forecast, project prioritization, capacity planning (inclusive of human, financial, capital, and facilities resources), work scheduling, program and project management and execution, and project performance and value assessment. Portfolio management is essential to successful healthcare project execution. Theories are drawn from the Organizational Project Management Maturity Model (OPM3) work of the Project Management Institute and other leading strategy, planning, and organization change management research institutes.

Loin Pain Haematuria Syndrome - A Narrative Review of Pain Management Strategies

PubMed Central

2016-01-01

Loin pain haematuria syndrome (LPHS) is an uncommon clinical entity that has divided renal physicians, pain practitioners, and even psychiatrists since its initial description. A relative paucity of data exists regarding the condition, with best practice guidelines lacking amid the existing threads of anecdotal experiences and variable follow-up observations. The aim of this article was to review the cumulative published experience of pain relief strategies for LPHS. PMID:27103962

Managing the Unexpected: Complexity as Distributed Sensemaking

NASA Astrophysics Data System (ADS)

Weick, Karl E.

In 1998 the Centers for Disease Control (CDC) published a statement of their strategy entitled "Preventing Emerging Infectious Diseases: A Strategy for the 21st Century." They described their central challenge this way: "because we do not know what new diseases will arise, we must always be prepared for the unexpected" (p. vii). Soon after they published that statement CDC was confronted with an unexpected emerging disease, the West Nile Virus, which they misdiagnosed initially.

Chemical & Material Risk Management Initiatives: Reach & Cr6+ Strategies (Briefing Charts)

DTIC Science & Technology

2011-02-01

Definition Acquisition, Technology and Logistics 17 DoD Hexavalent Chromium Minimization Strategy Non‐ Chrome  Primer Acquisition, Technology and...Logistics 18 Hexavalent Chromium (Cr6+) - Some Facts • Cr6+ compounds are wonderful corrosion inhibitors • Cr6+ compounds are highly toxic – We’ve learned...and Logistics 21 DoD Hexavalent Chromium Minimization Policy Acquisition, Technology and Logistics 22 Myth-busters • The DoD policy does not ban the

An Examination of the Department of Defense Financial Improvement and Audit Readiness Plan Using a Balanced Scorecard

DTIC Science & Technology

2011-06-01

BEIS Business Enterprise Information Services BEP Business Enterprise Priorities BMMP Business Management Modernization Program BTA Business...Scorecard framework . Initially published in December 2005, the FIAR is the DoD’s strategy towards achieving audit readiness. The FIAR provides a timeline and...Secretary of Defense Comptroller, n.d.). The Balanced Scorecard, a strategic management framework developed in 1987 by Arthur Schneiderman and popularized

Public sector energy management: A strategy for catalyzing energy efficiency in Malaysia

NASA Astrophysics Data System (ADS)

Roy, Anish Kumar

To date the public sector role in facilitating the transition to a sustainable energy future has been envisaged mainly from a regulatory perspective. In such a role, the public sector provides the push factors---enforcing regulations and providing incentives---to correct market imperfections that impede energy transitions. An alternative and complementary role of the public sector that is now gaining increasing attention is that of catalyzing energy transitions through public sector energy management initiatives. This dissertation offers a conceptual framework to rationalize such a role for the public sector by combining recent theories of sustainable energy transition and public management. In particular, the framework identifies innovative public management strategies (such as performance contracting and procurement) for effectively implementing sustainable energy projects in government facilities. The dissertation evaluates a model of sustainable public sector energy management for promoting energy efficiency in Malaysia. The public sector in Malaysia can be a major player in leading and catalyzing energy efficiency efforts as it is not only the largest and one of the most influential energy consumers, but it also plays a central role in setting national development strategy. The dissertation makes several recommendations on how a public sector energy management strategy can be implemented in Malaysia. The US Federal Energy Management Program (FEMP) is used as a practical model. The analysis, however, shows that in applying the FEMP model to the Malaysian context, there are a number of limitations that will have to be taken into consideration to enable a public sector energy management strategy to be effectively implemented. Overall the analysis of this dissertation contributes to a rethinking of the public sector role in sustainable energy development that can strengthen the sector's credibility both in terms of governance and institutional performance. In addition, it links theory with practice by offering a strategy that can effectively address critical issues arising from the energy-development-policy nexus of the sustainable energy development debate.

Multidisciplinary strategies in the management of early chronic kidney disease.

PubMed

Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura; Rojas-Campos, Enrique; Hernández-Herrera, Aurora; Cueto-Manzano, Alfonso M

2013-11-01

Chronic kidney disease (CKD) is a worldwide epidemic especially in developing countries, with clear deficiencies in identification and treatment. Better care of CKD requires more than only economic resources, utilization of health research in policy-making and health systems changes that produce better outcomes. A multidisciplinary approach may facilitate and improve management of patients from early CKD in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients (to increase their empowerment) and should be adapted to the resources and health systems prevailing in each country; its systematic implementation can help to improve patient care and slow the progression of CKD. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

Recruiting seniors with chronic low back pain for a randomized controlled trial of a self-management program.

PubMed

Groupp, Elyse; Haas, Mitchell; Fairweather, Alisa; Ganger, Bonnie; Attwood, Michael

2005-02-01

To identify recruitment challenges and elucidate specific strategies that enabled recruitment of seniors for a randomized trial on low back pain comparing the Chronic Disease Self-management Program of the Stanford University to a 6-month wait-list control group. Recruitment for a randomized controlled trial. Community-based program offered at 12 locations. Community-dwelling seniors 60 years and older with chronic low back pain of mechanical origin. Passive recruitment strategies included advertisement in local and senior newspapers, in senior e-mail newsletters and listservs, in local community centers and businesses. Active strategies included meeting seniors at health fairs, lectures to the public and organizational meetings, and the help of trusted professionals in the community. A total of 100 white and 20 African American seniors were recruited. The program seemed to have the most appeal to white, middle-class older adults, educated through high school level. Advertisement failed to attract any participants to the program. Successful strategies included interaction with seniors at health fairs and lectures on health care, especially when the program was endorsed by a trusted community professional. Generating interest in the self-management program required keen communication skills because the idea of "self-management" was met with a myriad of responses, ranging from disinterest to disbelief. Generating interest also required active participation within the communities. Initial contacts had to be established with trusted professionals, whose endorsement enabled the project managers to present the concept of self-management to the seniors. More complex recruitment strategies were required for this study involving the self-management approach to back pain than for studies involving treatment.

Development of the Champlain primary care cardiovascular disease prevention and management guideline

PubMed Central

Montoya, Lorraine; Liddy, Clare; Hogg, William; Papadakis, Sophia; Dojeiji, Laurie; Russell, Grant; Akbari, Ayub; Pipe, Andrew; Higginson, Lyall

2011-01-01

Abstract Problem addressed A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care. Objective of program As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors. Program description The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services. Conclusion Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care. PMID:21673196

NASA Symposium on Productivity and Quality: Strategies for Improving Operations in Government and Industry

NASA Technical Reports Server (NTRS)

1984-01-01

The purpose of the Symposium is to increase the awareness of productivity and quality issues in the United States, and to foster national initiatives through government and industry executive leadership. The Symposium will provide a forum for discussion of white-collar productivity issues by experienced executives from successful organizations and an opportunity to share information learned through Productivity initiatives in govemment, industry and academic organizations. It will focus on white-collar organizational issues that are common to large companies and technology oriented organizations. The Symposium program will include strategies for improving operations in government and industry and will be responsive to the management issues viewed necessary to increase our nation's productivity growth rate.

Excellent Beginnings: Evaluation of Phase I (1991-1994).

ERIC Educational Resources Information Center

Brickman, Alan

In 1991 the Plan for Social Excellence, Inc., funded three elementary schools to design and implement a comprehensive early childhood education program. This funding initiative, entitled "Excellent Beginnings," supports programs that include innovative curriculum and classroom-management strategies, extensive parent participation, the use of high…

Strategies to Foster Emotional Intelligence in Christian Higher Education

ERIC Educational Resources Information Center

Gliebe, Sudi Kate

2012-01-01

This article proposes five initiatives to foster emotional intelligence (EI) education throughout institutions of Christian higher education. Goleman (1995) identifies self-awareness, managing emotions, motivation, empathy, and social intelligence as the hallmark skills of emotional intelligence. The importance of mastering these skills and their…

Determining the appropriate strategies for emergency planning through AHP-SWOT.

PubMed

Kalatpour, Omid

2017-01-01

During an unexpected incident, companies should demonstrate appropriate behaviour based on predetermined and rehearsed emergency strategies. This paper describes how to select the proper strategies for emergency situations via means of the AHP-SWOT tool, where the initial SWOT analysis is conducted for the emergency management system, and the final strategies are selected via the analytic hierarchy process (AHP). Alternative response strategies comprise internal, shared and external responses. Most of the scenarios investigated for this study demanded a shared response. These findings highlight the importance of mutual aid agreements, cooperative exercises and the improvement of communication systems. Organisations can take advantage of integrated approaches to select the best strategies and tactics for normal situations in general and emergency situations in particular.

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

NASA Astrophysics Data System (ADS)

Thaler, Thomas; Fuchs, Sven

2015-04-01

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

Fabry nephropathy: a review - how can we optimize the management of Fabry nephropathy?

PubMed

Waldek, Stephen; Feriozzi, Sandro

2014-05-06

Fabry disease is a rare, X-linked, lysosomal storage disease caused by mutations in the gene encoding the enzyme alpha-galactosidase A. Complete or partial deficiency in this enzyme leads to intracellular accumulation of globotriaosylceramide (Gb3) and related glycosphingolipids in many cell types throughout the body, including the kidney. Progressive accumulation of Gb3 in podocytes, epithelial cells and the tubular cells of the distal tubule and loop of Henle contribute to the renal symptoms of Fabry disease, which manifest as proteinuria and reduced glomerular filtration rate leading to chronic kidney disease and progression to end-stage renal disease. Early diagnosis and timely initiation of treatment of Fabry renal disease is an important facet of disease management. Initiating treatment with enzyme replacement therapy (ERT; agalsidase alfa, Replagal®, Shire; agalsidase beta, Fabrazyme®, Genzyme) as part of a comprehensive strategy to prevent complications of the disease, may be beneficial in stabilizing renal function or slowing its decline. Early initiation of ERT may also be more effective than initiating therapy in patients with more advanced disease. Several strategies are required to complement the use of ERT and treat the myriad of associated symptoms and organ involvements. In particular, patients with renal Fabry disease are at risk of cardiovascular events, such as high blood pressure, cardiac arrhythmias and stroke. This review discusses the management of renal involvement in Fabry disease, including diagnosis, treatments, and follow-up, and explores recent advances in the use of biomarkers to assist with diagnosis, monitoring disease progression and response to treatment.

Fabry nephropathy: a review – how can we optimize the management of Fabry nephropathy?

PubMed Central

2014-01-01

Fabry disease is a rare, X-linked, lysosomal storage disease caused by mutations in the gene encoding the enzyme alpha-galactosidase A. Complete or partial deficiency in this enzyme leads to intracellular accumulation of globotriaosylceramide (Gb3) and related glycosphingolipids in many cell types throughout the body, including the kidney. Progressive accumulation of Gb3 in podocytes, epithelial cells and the tubular cells of the distal tubule and loop of Henle contribute to the renal symptoms of Fabry disease, which manifest as proteinuria and reduced glomerular filtration rate leading to chronic kidney disease and progression to end-stage renal disease. Early diagnosis and timely initiation of treatment of Fabry renal disease is an important facet of disease management. Initiating treatment with enzyme replacement therapy (ERT; agalsidase alfa, Replagal®, Shire; agalsidase beta, Fabrazyme®, Genzyme) as part of a comprehensive strategy to prevent complications of the disease, may be beneficial in stabilizing renal function or slowing its decline. Early initiation of ERT may also be more effective than initiating therapy in patients with more advanced disease. Several strategies are required to complement the use of ERT and treat the myriad of associated symptoms and organ involvements. In particular, patients with renal Fabry disease are at risk of cardiovascular events, such as high blood pressure, cardiac arrhythmias and stroke. This review discusses the management of renal involvement in Fabry disease, including diagnosis, treatments, and follow-up, and explores recent advances in the use of biomarkers to assist with diagnosis, monitoring disease progression and response to treatment. PMID:24886109

Emergency strategies and trends in the management of liver trauma.

PubMed

Jiang, Hongchi; Wang, Jizhou

2012-09-01

The liver is the most frequently injured organ during abdominal trauma. The management of hepatic trauma has undergone a paradigm shift over the past several decades, with mandatory operation giving way to nonoperative treatment. Better understanding of the mechanisms and grade of liver injury aids in the initial assessment and establishment of a management strategy. Hemodynamically unstable patients should undergo focused abdominal sonography for trauma, whereas stable patients may undergo computed tomography, the standard examination protocol. The grade of liver injury alone does not accurately predict the need for operation, and nonoperative management is rapidly becoming popular for high-grade injuries. Hemodynamic instability with positive focused abdominal sonography for trauma and peritonitis is an indicator of the need for emergent operative intervention. The damage control concept is appropriate for the treatment of major liver injuries and is associated with significant survival advantages compared with traditional prolonged surgical techniques. Although surgical intervention for hepatic trauma is not as common now as it was in the past, current trauma surgeons should be familiar with the emergency surgical skills necessary to manage complex hepatic injuries, such as packing, Pringle maneuver, selective vessel ligation, resectional debridement, and parenchymal sutures. The present review presents emergency strategies and trends in the management of liver trauma.

The AGU Data Management Maturity Model Initiative

NASA Astrophysics Data System (ADS)

Bates, J. J.

2015-12-01

In September 2014, the AGU Board of Directors approved two initiatives to help the Earth and space sciences community address the growing challenges accompanying the increasing size and complexity of data. These initiatives are: 1) Data Science Credentialing: development of a continuing education and professional certification program to help scientists in their careers and to meet growing responsibilities and requirements around data science; and 2) Data Management Maturity (DMM) Model: development and implementation of a data management maturity model to assess process maturity against best practices, and to identify opportunities in organizational data management processes. Each of these has been organized within AGU as an Editorial Board and both Boards have held kick off meetings. The DMM model Editorial Board will recommend strategies for adapting and deploying a DMM model to the Earth and space sciences create guidance documents to assist in its implementation, and provide input on a pilot appraisal process. This presentation will provide an overview of progress to date in the DMM model Editorial Board and plans for work to be done over the upcoming year.

HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia.

PubMed

Parcesepe, Angela; Tymejczyk, Olga; Remien, Robert; Gadisa, Tsigereda; Kulkarni, Sarah Gorrell; Hoffman, Susie; Melaku, Zenebe; Elul, Batya; Nash, Denis

2018-02-16

Recent World Health Organization HIV treatment guideline expansion may facilitate timely antiretroviral therapy (ART) initiation. However, large-scale success of universal treatment strategies requires a more comprehensive understanding of known barriers to early ART initiation. This work aims to advance a more comprehensive understanding of interrelationships among three known barriers to ART initiation: psychological distress, HIV-related stigma, and low social support. We analyzed cross-sectional interview data on 1175 adults initiating ART at six HIV treatment clinics in Ethiopia. Experience of each form of HIV-related stigma assessed (e.g., anticipatory, internalized, and enacted) was associated with increased odds of psychological distress. However, among those who reported enacted HIV-related stigma, there was no significant association between social support and psychological distress. Interventions to improve mental health among people living with HIV should consider incorporating components to address stigma, focusing on strategies to prevent or reduce the internalization of stigma, given the magnitude of the relationship between high internalized stigma and psychological distress. Interventions to increase social support may be insufficient to improve the mental health of people living with HIV who experienced enacted HIV-related stigma. Future research should examine alternative strategies to manage the mental health consequences of enacted HIV-related stigma, including coping skills training.

Micro practices of coordination based on complex adaptive systems: user needs and strategies for coordinating public health in Denmark.

PubMed

Terkildsen, Morten Deleuran; Wittrup, Inge; Burau, Viola

2015-01-01

Many highly formalised approaches to coordination poorly fit public health and recent studies call for coordination based on complex adaptive systems. Our contribution is two-fold. Empirically, we focus on public health, and theoretically we build on the patient perspective and treat coordination as a process of contingent, two-level negotiations of user needs. The paper draws on the concept of user needs-based coordination and sees coordination as a process, whereby needs emerging from the life world of the user are made amenable to the health system through negotiations. The analysis is based on an explorative case study of a health promotion initiative in Denmark. It adopts an anthropological qualitative approach and uses a range of qualitative data. The analysis identifies four strategies of coordination: the coordinator focusing on the individual user or on relations with other professionals; and the manager coaching the coordinator or providing structural support. Crucially, the coordination strategies by management remain weak as they do not directly relate to specific user needs. In process of bottom-up negotiations user needs become blurred and this is especially a challenge for management. The study therefore calls for an increased focus on the level nature of negotiations to bridge the gap that currently weakens coordination strategies by management.

Understanding and managing compliance in the nature conservation context.

PubMed

Arias, Adrian

2015-04-15

Nature conservation relies largely on peoples' rule adherence. However, noncompliance in the conservation context is common: it is one of the largest illegal activities in the world, degrading societies, economies and the environment. Understanding and managing compliance is key for ensuring effective conservation, nevertheless crucial concepts and tools are scattered in a wide array of literature. Here I review and integrate these concepts and tools in an effort to guide compliance management in the conservation context. First, I address the understanding of compliance by breaking it down into five key questions: who?, what?, when?, where? and why?. A special focus is given to 'why?' because the answer to this question explains the reasons for compliance and noncompliance, providing critical information for management interventions. Second, I review compliance management strategies, from voluntary compliance to coerced compliance. Finally, I suggest a system, initially proposed for tax compliance, to balance these multiple compliance management strategies. This paper differs from others by providing a broad yet practical scope on theory and tools for understanding and managing compliance in the nature conservation context. Copyright © 2015 Elsevier Ltd. All rights reserved.

Recurrent urinary tract infections in women.

PubMed

Aydin, Abdullatif; Ahmed, Kamran; Zaman, Iftikhar; Khan, Muhammad Shamim; Dasgupta, Prokar

2015-06-01

Recurrent urinary tract infections (UTIs) are more common in women and are frequently defined as ≥2 episodes in the last 6 months or ≥3 episodes in the last 12 months. In a primary care setting, 53 % of women above the age of 55 years and 36 % of younger women report a recurrence within 1 year. Thus, management and prevention of recurrent UTI is of utmost significance. This review aims to highlight the latest research in prevention strategies and suggest a management pathway. A search was conducted on MEDLINE, Embase and the Cochrane Database of Systematic Reviews databases for the latest systematic reviews and high-quality randomized controlled trials. Special emphasis was placed on the remit "recurrent" and strongly adhered to. Furthermore, a Google search was conducted for current guidelines on the management of UTIs. Current prevention strategies include eliminating risk factors that increase the risk of acquiring recurrent UTI and continuous, post-coital and self-initiated antimicrobial prophylaxis. Other prospective preventative strategies, currently under trial, include use of vaccinations, D-mannose and lactobacillus (probiotics). Although risk factors should be identified and addressed accordingly, individualized antibiotic prophylaxis remains the most effective method of management. Non-antibiotic prevention strategies such as cranberry, vitamin C and methenamine salts lack strong evidence to be introduced as routine management options and as alternatives to antibiotics. Based on current evidence and guidelines, a management pathway is recommended. Emerging therapies require further evaluation before they can be recommended.

Updates in the management of stable chronic obstructive pulmonary disease.

PubMed

Narsingam, Saiprasad; Bozarth, Andrew L; Abdeljalil, Asem

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory process. It is increasingly recognized as a major public health problem, affecting more than 20 million adults in the US. It is also recognized as a leading cause of hospitalizations and is the fourth leading cause of death in the US. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) operates to promote evidence-based management of COPD, increase awareness and encourage research. In 2011, GOLD published a consensus report detailing evidence-based management strategies for COPD, which were last updated in 2015. In recent years, newer strategies and a growing number of new pharmacologic agents to treat symptoms of COPD have also been introduced and show promise in improving the management of COPD. We aim to provide an evidence-based review of the available and upcoming pharmacologic and non-pharmacologic treatment options for stable COPD, with continued emphasis on evidence-based management.

Integrated Research on the Development of Global Climate Risk Management Strategies - Framework and Initial Results of the Research Project ICA-RUS

NASA Astrophysics Data System (ADS)

Emori, Seita; Takahashi, Kiyoshi; Yamagata, Yoshiki; Oki, Taikan; Mori, Shunsuke; Fujigaki, Yuko

2013-04-01

With the aim of proposing strategies of global climate risk management, we have launched a five-year research project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). In this project with the phrase "risk management" in its title, we aspire for a comprehensive assessment of climate change risks, explicit consideration of uncertainties, utilization of best available information, and consideration of every possible conditions and options. We also regard the problem as one of decision-making at the human level, which involves social value judgments and adapts to future changes in circumstances. The ICA-RUS project consists of the following five themes: 1) Synthesis of global climate risk management strategies, 2) Optimization of land, water and ecosystem uses for climate risk management, 3) Identification and analysis of critical climate risks, 4) Evaluation of climate risk management options under technological, social and economic uncertainties and 5) Interactions between scientific and social rationalities in climate risk management (see also: http://www.nies.go.jp/ica-rus/en/). For the integration of quantitative knowledge of climate change risks and responses, we apply a tool named AIM/Impact [Policy], which consists of an energy-economic model, a simplified climate model and impact projection modules. At the same time, in order to make use of qualitative knowledge as well, we hold monthly project meetings for the discussion of risk management strategies and publish annual reports based on the quantitative and qualitative information. To enhance the comprehensiveness of the analyses, we maintain an inventory of risks and risk management options. The inventory is revised iteratively through interactive meetings with stakeholders such as policymakers, government officials and industrial representatives.

Computer-Assisted, Programmed Text, and Lecture Modes of Instruction in Three Medical Training Courses: Comparative Evaluation

DTIC Science & Technology

1980-06-01

I.indslev was peerless in leadership and management support of this project. The in anscriPt benefited from the reviews of several individuals. and...i4 7 Medical L.aboratorv achievement as a function of learner strategy preference for processing information and CAI vs. lecture...characteristics ’were used to assist CAI authors in the initial development of instructional materials and strategies appropriate to the target population in each

The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada.

PubMed

Jaglal, S B; Hawker, G; Cameron, C; Canavan, J; Beaton, D; Bogoch, E; Jain, R; Papaioannou, A

2010-06-01

In the last decade, there have been a number of action plans published to highlight the importance of preventing osteoporosis and related fractures. In the province of Ontario Canada, the Ministry of Health provided funding for the Ontario Osteoporosis Strategy. The goal is to reduce morbidity, mortality, and costs from osteoporosis and related fractures through an integrated and comprehensive approach aimed at health promotion and disease management. This paper describes the components of the Ontario Osteoporosis Strategy and progress on implementation efforts as of March 2009. There are five main components: health promotion; bone mineral density testing, access, and quality; postfracture care; professional education; and research and evaluation. Responsibility for implementation of the initiatives within the components is shared across a number of professional and patient organizations and academic teaching hospitals with osteoporosis researchers. The lessons learned from each phase of the development, implementation, and evaluation of the Ontario Osteoporosis Strategy provides a tremendous opportunity to inform other jurisdictions embarking on implementing similar large-scale bone health initiatives.

MODELLING PHYTOPLANKTON IN LAKE MICHIGAN USING A HIGH RESULUTION CARBON-BASED FRAMEWORK

EPA Science Inventory

The Lake Michigan Mass Balance Project was initiated by the U.S. EPA Great Lakes National Program Office to determine strategies for managing toxic chemicals in the lake basin. The hydrophobicity of most of these chemicals necessitates a solid understanding of autochthonous produ...

Managing Postsocialist Transitions: Politicized Sense Making as a Facilitator of Organizational Change

ERIC Educational Resources Information Center

Tiplic, Dijana

2011-01-01

This study explores what organizational strategies are employed to initiate and facilitate organizational change in higher education institutions in the increasingly complex and competitive postsocialist environment of Bosnia-Herzegovina. By studying organizations trapped between their inert socialist-era legacies and desired organizational…

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

PubMed Central

2013-01-01

Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations. PMID:23742217

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

PubMed

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

2013-06-06

Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

Achieving effective staffing through a shared decision-making approach to open-shift management.

PubMed

Valentine, Nancy M; Nash, Jan; Hughes, Douglas; Douglas, Kathy

2008-01-01

Managing costs while retaining qualified nurses and finding workforce solutions that ensure the delivery of high-quality patient care is of primary importance to nurse leaders and executive management. Leading healthcare organizations are using open-shift management technology as a strategy to improve staffing effectiveness and the work environment. In many hospitals, open-shift management technology has become an essential workforce management tool, nursing benefit, and recruitment and retention incentive. In this article, the authors discuss how a successful nursing initiative to apply automation to open-shift scheduling and fulfillment across a 3-hospital system had a broad enterprise-wide impact resulting in dramatic improvements in nurse satisfaction, retention, recruitment, and the bottom line.

What is heartburn worth? A cost-utility analysis of management strategies.

PubMed

Heudebert, G R; Centor, R M; Klapow, J C; Marks, R; Johnson, L; Wilcox, C M

2000-03-01

To determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2 receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life.

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.

PubMed

Keurhorst, M; Anderson, P; Heinen, M; Bendtsen, Preben; Baena, Begoña; Brzózka, Krzysztof; Colom, Joan; Deluca, Paolo; Drummond, Colin; Kaner, Eileen; Kłoda, Karolina; Mierzecki, Artur; Newbury-Birch, Dorothy; Okulicz-Kozaryn, Katarzyna; Palacio-Vieira, Jorge; Parkinson, Kathryn; Reynolds, Jillian; Ronda, Gaby; Segura, Lidia; Słodownik, Luiza; Spak, Fredrik; van Steenkiste, Ben; Wallace, Paul; Wolstenholme, Amy; Wojnar, Marcin; Gual, Antoni; Laurant, M; Wensing, M

2016-07-16

Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. ClinicalTrials.gov: NCT01501552.

Developing strategic planning of green supply chain in refinery CPO company

NASA Astrophysics Data System (ADS)

Hidayati, J.; Mumtaz, G.; Hasibuan, S.

2018-02-01

We are conducted a research at the company of the manufacturing CPO into cooking oil, margarine and materials of oleochemical industries. Today palm oil based industries are facing global challenges related to environmental issues. To against these challenges, it is necessary to have an environmentally friendly supply chain. However, the limited resource owned by the company requires the integrated environmental strategy with the company’s business strategy. The model is developed based on management orientation towards external pressure, internal key resources and competitive advantage that can be obtained as the decision factor. The decision-making method used is Analytical Network Process (ANP). The results obtained institutional pressure becomes the criterion with the greatest influence on green supply chain initiatives and sub criteria of customer desires and stakeholder integration having the most significant influence on green supply chain initiatives. There are five green alternative initiatives that can be done: green product design, greening upstream, greening production, greening downstream and greening post use. For green supply chain initiative, greening upstream is the best priority.

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

PubMed Central

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. PMID:25018637

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives.

PubMed

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Potential Unintended Consequences of a Conservative Management Strategy for Patent Ductus Arteriosus.

PubMed

Elhoff, Justin J; Ebeling, Myla; Hulsey, Thomas C; Atz, Andrew M

2016-01-01

A recent review supports a strategy of deferring treatment of patent ductus arteriosus (PDA) in the preterm neonate until at least the second week after birth. In light of previous suggestion that later initiation of treatment may be less efficacious for closing PDAs it is reasonable to question if delayed treatment may be less effective. We conducted a single center retrospective review of a neonatal intensive care unit database of infants ≤37 weeks gestation with the diagnosis of PDA and treated with indomethacin from 1999 to 2007. We determined gestational age (GA), timing of indomethacin initiation, and status of the PDA at hospital discharge. Treatment failure was defined as neonates requiring further intervention to close their PDA or those who died without echo-proven PDA closure. Of the 341 infants meeting the study criteria, 77 (23%) had defined treatment failure. The failure group had a younger median GA of 25 weeks (interquartile range [IQR], 24-26) vs. 28 weeks (IQR, 26-30) for the successful group (P < .0001). The failure group had a median treatment initiation on day of life (DOL) 4 (IQR, 1-8) compared with DOL 3 (IQR, 1-6) for those in the successful group (P = .15). Taken as a whole, infants treated after DOL 5 were significantly more likely to have treatment failure (30.1% vs. 19.3% for those treated DOL 1-5, P = .03). Our study confirms that younger GA at birth is correlated with increased likelihood of failed PDA closure. We also show a trend indicating that later initiation of treatment may decrease the chances of successfully closing a PDA. Future examination of PDA management should consider the potential unintended consequences that may accompany a delayed treatment strategy. © 2015 Wiley Periodicals, Inc.

The menopause 'It's somewhere between a taboo and a joke'. A focus group study.

PubMed

Duffy, O; Iversen, L; Hannaford, P C

2011-08-01

To explore the menopause from the perspective of women in the community, with specific emphasis on their experience of menopausal symptoms, management strategies and support post the Women's Health Initiative trial. Four focus groups were conducted with 14 middle-aged women living in the Grampian region of Scotland. The groups lasted up to 2 hours and were analyzed using the framework approach. Symptom experience was multifaceted and varied, depending on factors such as embarrassment from symptoms, loss of identity, expectations, social support and effectiveness of management strategies. Lack of support was highlighted as a reason why some participants felt confused about the symptoms that they could attribute to the menopause and the management strategies available to them. A variety of management strategies had been used including hormone replacement therapy, herbal remedies and lifestyle changes, with varying levels of success. Some women who chose not to use hormone replacement therapy (HRT) preferred to use lifestyle changes or felt that their symptoms did not warrant hormonal therapy. Some women felt that they had to persuade their family doctor to prescribe HRT and felt that their doctors were too restrictive in prescribing this treatment. Although having good social support in general, some respondents felt less supported about the menopause and felt that improved support networks would diminish some of the confusion about symptoms experienced and management strategies available. In spite of the negative publicity surrounding HRT in recent years, a number of women perceived their family doctor as too restrictive when prescribing HRT.

The Integrated Scorecard in support of corporate sustainability strategies.

PubMed

Journeault, Marc

2016-11-01

Organizations have increasingly recognized the importance and benefits of developing a sustainability strategy that incorporates environmental and social responsibilities. However, the simultaneous integration of the economic, environmental and social aspects remains a major concern for organizations. The Sustainability Balanced Scorecard (SBSC) represents one of the most promising strategic tools to help organizations face these challenges and support their sustainability strategy. However, past research has provided unclear, incomplete and even contradictory SBSC frameworks while offering little knowledge about how to integrate stakeholder management as well as environmental and social performance within the balanced scorecard to successfully support a corporate sustainability strategy. The aim of this study is to address these issues and limitations by proposing the Integrated Scorecard, a specific SBSC that integrates the three pillars of sustainability performance within four different perspectives, namely environmental, social and economic performance, stakeholder management, internal business processes, and skills and capabilities. This study provides a conceptual approach to the Integrated Scorecard and illustrates, through the use of two practical illustrations, the ability of this framework to support the corporate sustainability strategy by identifying the core sustainability objectives that organizations should achieve when creating value, facilitating the understanding of the contribution of environmental and social initiatives on economic performance, allowing the monitoring and measurement of the strategy's level of achievement, and creating synergy between sustainability performance management and reporting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Kaiser Permanente's performance improvement system, Part 4: Creating a learning organization.

PubMed

Schilling, Lisa; Dearing, James W; Staley, Paul; Harvey, Patti; Fahey, Linda; Kuruppu, Francesca

2011-12-01

In 2006, recognizing variations in performance in quality, safety, service, and efficiency, Kaiser Permanente leaders initiated the development of a performance improvement (PI) system. Kaiser Permanente has implemented a strategy for creating the systemic capacity for continuous improvement that characterizes a learning organization. Six "building blocks" were identified to enable Kaiser Permanente to make the transition to becoming a learning organization: real-time sharing of meaningful performance data; formal training in problem-solving methodology; workforce engagement and informal knowledge sharing; leadership structures, beliefs, and behaviors; internal and external benchmarking; and technical knowledge sharing. Putting each building block into place required multiple complex strategies combining top-down and bottom-up approaches. Although the strategies have largely been successful, challenges remain. The demand for real-time meaningful performance data can conflict with prioritized changes to health information systems. It is an ongoing challenge to teach PI, change management, innovation, and project management to all managers and staff without consuming too much training time. Challenges with workforce engagement include low initial use of tools intended to disseminate information through virtual social networking. Uptake of knowledge-sharing technologies is still primarily by innovators and early adopters. Leaders adopt new behaviors at varying speeds and have a range of abilities to foster an environment that is psychologically safe and stimulates inquiry. A learning organization has the capability to improve, and it develops structures and processes that facilitate the acquisition and sharing of knowledge.

Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder.

PubMed

Chung, Eric; Lee, Dominic; Gani, Johan; Gillman, Michael; Maher, Christopher; Brennan, Janelle; Johns Putra, Lydia; Ahmad, Laura; Chan, Lewis Lw

2018-01-15

Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or β3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management.

A demonstration of expert systems applications in transportation engineering : volume II, TRANZ, a prototype expert system for traffic control in highway work zones.

DOT National Transportation Integrated Search

1988-01-01

The development of a prototype knowledge-based expert system (KBES) for selecting appropriate traffic control strategies and management techniques around highway work zones was initiated. This process was encompassed by the steps that formulate the p...

Application of GPS and Near-Surface Geophysical Methods to Evaluate Agricultural Test Plot Differences

USDA-ARS?s Scientific Manuscript database

A field research facility with two pairs of replicated agricultural test plots (four total) was established at a location in northwest Ohio during 2005 for the purpose of studying water table management strategies. Initial efforts at this field research facility were devoted to evaluating difference...

Chlorine Gas: An Evolving Hazardous Material Threat and Unconventional Weapon

PubMed Central

Jones, Robert; Wills, Brandon; Kang, Christopher

2010-01-01

Chlorine gas represents a hazardous material threat from industrial accidents and as a terrorist weapon. This review will summarize recent events involving chlorine disasters and its use by terrorists, discuss pre-hospital considerations and suggest strategies for the initial management for acute chlorine exposure events. PMID:20823965

Responsive Management: Practical Strategies for Avoiding Overreaction to Minor Misbehavior

ERIC Educational Resources Information Center

Allday, R. Allan

2011-01-01

Minor misbehavior causes frustration for many teachers and can serve as the catalyst for escalating into a public confrontation between student and teacher. This confrontation can be caused by teacher overreaction to minor misbehavior. When teachers take the initiative and predetermine their response to misbehavior, they reduce and possibly…

How Secondary School Principals Build Trust in Kenyan Secondary Schools

ERIC Educational Resources Information Center

Abaya, Joel Ondieki

2011-01-01

The most successful school leaders are those who have been able to transform their schools into centers of deep and ongoing learning by managing relationships (Kaser & Halbert, 2009). Consequently, strong levels of trust are preconditions for successful school improvement initiative. Research confirms that no cooperation strategy works in high…

Virulence of selected entomopathogenic fungi against the olive fruit fly and their potential for biocontrol

USDA-ARS?s Scientific Manuscript database

The olive fruit fly, Bactrocera oleae (Diptera: Tephritidae), is the most serious pest of cultivated olives worldwide. Its recent invasion into North America, specifically California, has initiated renewed interest in management strategies for this pest. Research into classical biological control ha...

Global Initiative for Chronic Obstructive Lung Disease strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: an Asia-Pacific perspective.

PubMed

2005-01-01

Chronic obstructive pulmonary disease (COPD) is a major public health problem and its prevalence and mortality are increasing throughout the world, including the Asia-Pacific region. To arrest these worldwide trends, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Expert Panel's global strategy for the diagnosis, management, and prevention of COPD was published in 2001. Based on recently published clinical trials, the GOLD statement was updated in 2003. The Asia-Pacific COPD Roundtable Group, a taskforce of expert respirologists from the Asia-Pacific region, has recently formulated a consensus statement on implementation of the GOLD strategy for COPD in the Asia-Pacific region. The key issues identified by the COPD Roundtable Group for comment are: (i) where there is no access to spirometry, diagnosis of COPD could be suspected on the basis of history, symptoms and physical signs; (ii) inhaled bronchodilators are the preferred regular treatment for COPD in the region, but oral bronchodilators may be considered if the cost of inhaled bronchodilators is a barrier to treatment; (iii) the use of a Metered Dose Inhaler with spacer in place of a nebulizer is recommended in the treatment of acute airflow obstruction in patients with COPD; (iv) influenza vaccination is recommended for all patients with COPD in communities where there is a high likelihood of Severe Acute Respiratory Syndrome; and (v) simplified pulmonary rehabilitation programmes should be established in areas where comprehensive programmes are unavailable. Physical exercise training and education on smoking cessation should be core elements of any rehabilitation program. In summary, the COPD Roundtable Group supports implementation of the GOLD strategy for the diagnosis, management and prevention of COPD in the Asia-Pacific region, subject to the additions and modifications to the guidelines suggested above.

Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases

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

Lester-Coll, Nataniel H., E-mail: nataniel.lester-coll@yale.edu; Rutter, Charles E.; Bledsoe, Trevor J.

Introduction: Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. Methods and Materials: A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemicmore » therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. Results: In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). Conclusions: Video-assisted thoracic surgery wedge resection or SBRT can be cost-effective in select patients with pulmonary oligometastases, depending on histology, efficacy, and tolerability of treatment and patient preferences.« less

INVESTIGATING THE MANAGEMENT OF CARIOUS PRIMARY TEETH IN GENERAL DENTAL PRACTICE: AN OVERVIEW OF THE DEVELOPMENT AND CONDUCT OF THE FICTION TRIAL.

PubMed

Stewart, Matthew; Keightley, Alexander; Maguire, Anne; Chadwick, Barbara; Vale, Luke; Homer, Tara; Douglas, Gail; Deery, Chris; Marshman, Zoe; Ryan, Vicky; Innes, Nicola

2015-11-01

The management of carious primary teeth is a challenge for patients, parents and clinicians. Most evidence supporting different management strategies originates from a specialist setting and therefore its relevance to the primary care setting is questionable. The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) has commissioned the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial; a multi-centre primary dental care randomised controlled trial (RCT) to determine the most clinically and cost- effective approach to managing caries in the primary dentition in the UK. This large trial began in 2012, is due to be completed in late 2017 and involves 72 practices and 1,124 children initially aged three to seven years with dentine caries, following randomisation to one of three caries management strategies. Clinical, radiographic, quality of life, treatment acceptability and health economics data are collected during the three-year follow up period. This article provides an overview of the development and conduct of FiCTION and discusses some approaches adopted to manage challenges and achieve the patient recruitment target.

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

Zoller, J.N.; Rosen, R.S.; Holliday, M.A.

With the publication of a Request for Recommendations and Advance Notice of Intent in the November 10, 1994 Federal Register, the Department of Energy initiated a program to assess alternative strategies for the long-term management or use of depleted uranium hexafluoride. This Request was made to help ensure that, by seeking as many recommendations as possible, Department management considers reasonable options in the long-range management strategy. The Depleted Uranium Hexafluoride Management Program consists of three major program elements: Engineering Analysis, Cost Analysis, and an Environmental Impact Statement. This Technology Assessment Report is the first part of the Engineering Analysis Project,more » and assesses recommendations from interested persons, industry, and Government agencies for potential uses for the depleted uranium hexafluoride stored at the gaseous diffusion plants in Paducah, Kentucky, and Portsmouth, Ohio, and at the Oak Ridge Reservation in Tennessee. Technologies that could facilitate the long-term management of this material are also assessed. The purpose of the Technology Assessment Report is to present the results of the evaluation of these recommendations. Department management will decide which recommendations will receive further study and evaluation.« less

Managing the clinical setting for best nursing practice: a brief overview of contemporary initiatives.

PubMed

Henderson, Amanda; Winch, Sarah

2008-01-01

Leadership strategies are important in facilitating the nursing profession to reach their optimum standards in the practice environment. To compare and contrast the central tenets of contemporary quality initiatives that are commensurate with enabling the environment so that best practice can occur. Democratic leadership, accessible and relevant education and professional development, the incorporation of evidence into practice and the ability of facilities to be responsive to change are core considerations for the successful maintenance of practice standards that are consistent with best nursing practice. While different concerns of management drive the adoption of contemporary approaches, there are many similarities in the how these approaches are translated into action in the clinical setting. Managers should focus on core principles of professional nursing that add value to practice rather than business processes.

Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care

PubMed Central

2013-01-01

Background A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists’ (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. Methods A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. Results The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs’ skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of expertise or not their responsibility. All professionals perceived inter-professional collaboration to be a facilitator for effective implementation, and general practitioners were perceived as key partners in this collaboration. However, collaboration was not always optimal. OTs indicated that increasing the referral rate was most effective when promoting OT via other disciplines within a physician’s network. Conclusion Our data suggests that a first step in successful implementation should be to make sure that individual and organizational barriers are resolved. In addition, implementation should be network-based and encourage inter-professional collaboration. Initial promotion of COTiD should focus on physicians that have a positive attitude toward non-pharmacological interventions. PMID:24195975

Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care.

PubMed

Döpp, Carola M E; Graff, Maud J L; Rikkert, Marcel G M Olde; Nijhuis van der Sanden, Maria W G; Vernooij-Dassen, Myrra J F J

2013-11-07

A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists' (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs' skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of expertise or not their responsibility. All professionals perceived inter-professional collaboration to be a facilitator for effective implementation, and general practitioners were perceived as key partners in this collaboration. However, collaboration was not always optimal. OTs indicated that increasing the referral rate was most effective when promoting OT via other disciplines within a physician's network. Our data suggests that a first step in successful implementation should be to make sure that individual and organizational barriers are resolved. In addition, implementation should be network-based and encourage inter-professional collaboration. Initial promotion of COTiD should focus on physicians that have a positive attitude toward non-pharmacological interventions.

Management of recurrent depression.

PubMed

Howell, Cate; Marshall, Charlotte; Opolski, Melissa; Newbury, Wendy

2008-09-01

Depression is a potentially recurring or chronic disorder. The provision of evidence based treatment and effective practice organisation is central to chronic disease management, and these principles can be applied to managing depression. This article outlines the principles of chronic disease management, including the use of management plans and a team care approach, and their application to the management of depression. Treatment approaches that systematically assist patients in managing their chronic disease are more effective than those based on acute care. Depression treatment guidelines are available, as well as primary care initiatives which facilitate comprehensive and long term mental health care, including relapse prevention strategies. A number of risk factors for depression relapse have been identified, and research has recommended that novel intensive relapse prevention programs need to be developed.

Reflections on a community and university research collaboration.

PubMed

Mayo, Kevin; Tsey, Komla

2009-08-01

This paper reflects on the collaborative research relationship between university and community researchers. It identifies emergent themes expressed in the words of researchers and recommends strategies to assist with other research collaborations. Emergent themes included: Initial reticence by community members followed by positive experiences; the value of empowerment frameworks in research; building trust between community and university researchers; capacity building, management, and workloads; and community politics, misunderstandings and wealth disparity. The paper recommends strategies for successful research collaborations and identifies challenges to research collaborations.

Management of recent-onset sustained atrial fibrillation: pharmacologic and nonpharmacologic strategies.

PubMed

Lau, Dennis H; Kalman, Jonathan; Sanders, Prashanthan

2014-09-01

Recent studies have highlighted significant variations in the management of recent-onset sustained atrial fibrillation (AF). We aim to provide a succinct and clear management algorithm for physicians treating patients with recent-onset sustained AF. We performed a comprehensive search of the literature on the management of recent-onset sustained AF with focus on studies reporting cardioversion of AF, antiarrhythmic agents, and anticoagulation. We also reviewed recent practice guidelines on AF management. This review provides a guide on a tailored management approach of patients with recent-onset sustained AF. After initial detailed clinical assessment, optimal rate and rhythm control options can be provided, depending on hemodynamic stability, duration of AF episode, and AF stroke risk. Issues surrounding electrical and pharmacologic cardioversion are discussed in detail. We emphasize the importance of thromboembolic risk assessment and appropriate anticoagulation surrounding the point of cardioversion. Last, we highlighted the need for appropriate specialized follow-up care after acute AF management. Despite the highly heterogeneous clinical presentations, management of recent-onset sustained AF must include stroke risk assessment, appropriate anticoagulation, and follow-up care in all patients beyond optimum rate and rhythm control strategies. Copyright © 2014. Published by Elsevier Inc.

Managing the interface between medical schools, hospitals, and clinical research.

PubMed

Gallin, J I; Smits, H L

1997-02-26

To review how academic health centers are coping with the changing environment of health care delivery with special emphasis on the impact of the changing health care system on clinical research. In response to Health and Human Services Secretary Donna Shalala's 1995 mandated review of the National Institutes of Health (NIH) Warren Grant Magnuson Clinical Center, an NIH review team visited 30 health facilities and government-owned organizations throughout the country. The review team determined what strategies are used by academic health centers to survive and thrive in the changing health care marketplace. The findings have implications for the NIH Clinical Center as well as academic health centers. Management strategies in successful academic health centers include streamlined governance structures whereby small groups of highly empowered group leaders allow institutions to move quickly and decisively; an active strategic planning process; close integration of hospital and medical school management; heavy investment in information systems; and new structures for patient care delivery. Successful centers are initiating discussions with third-party payers and are implementing new initiatives, such as establishing their own managed care organizations, purchasing physician practices, or owning hospitals. Other approaches include establishing revenue-generating centers for clinical research and new relations with industry. Attention to the infrastructure required to support the training and conduct of clinical research is essential for the future vitality of medical schools.

Impacts of short-rotation early-growing season prescribed fire on a ground nesting bird in the central hardwoods region of North America

USGS Publications Warehouse

Pittman, H. Tyler; Krementz, David G.

2016-01-01

Landscape-scale short-rotation early-growing season prescribed fire, hereafter prescribed fire, in upland hardwood forests represents a recent shift in management strategies across eastern upland forests. Not only does this strategy depart from dormant season to growing season prescriptions, but the strategy also moves from stand-scale to landscape-scale implementation (>1,000 ha). This being so, agencies are making considerable commitments in terms of time and resources to this management strategy, but the effects on wildlife in upland forests, especially those dominated by hardwood canopy species, are relatively unknown. We initiated our study to assess whether this management strategy affects eastern wild turkey reproductive ecology on the Ozark-St. Francis National Forest. We marked 67 wild turkey hens with Global Positioning System (GPS) Platform Transmitting Terminals in 2012 and 2013 to document exposure to prescribed fire, and estimate daily nest survival, nest success, and nest-site selection. We estimated these reproductive parameters in forest units managed with prescribed fire (treated) and units absent of prescribed fire (untreated). Of 60 initial nest attempts monitored, none were destroyed or exposed to prescribed fire because a majority of fires occurred early than a majority of the nesting activity. We found nest success was greater in untreated units than treated units (36.4% versus 14.6%). We did not find any habitat characteristic differences between successful and unsuccessful nest-sites. We found that nest-site selection criteria differed between treated and untreated units. Visual concealment and woody ground cover were common selection criteria in both treated and untreated units. However, in treated units wild turkey selected nest-sites with fewer small shrubs (<5 cm ground diameter) and large trees (>20 cm DBH) but not in untreated units. In untreated units wild turkey selected nest-sites with more large shrubs (≥5cm ground diameter) but did not select for small shrubs or large trees. Our findings suggest that wild turkey have not benefited from the reintroduction of prescribed fire to the WRERA.

Impacts of Short-Rotation Early-Growing Season Prescribed Fire on a Ground Nesting Bird in the Central Hardwoods Region of North America

PubMed Central

2016-01-01

Landscape-scale short-rotation early-growing season prescribed fire, hereafter prescribed fire, in upland hardwood forests represents a recent shift in management strategies across eastern upland forests. Not only does this strategy depart from dormant season to growing season prescriptions, but the strategy also moves from stand-scale to landscape-scale implementation (>1,000 ha). This being so, agencies are making considerable commitments in terms of time and resources to this management strategy, but the effects on wildlife in upland forests, especially those dominated by hardwood canopy species, are relatively unknown. We initiated our study to assess whether this management strategy affects eastern wild turkey reproductive ecology on the Ozark-St. Francis National Forest. We marked 67 wild turkey hens with Global Positioning System (GPS) Platform Transmitting Terminals in 2012 and 2013 to document exposure to prescribed fire, and estimate daily nest survival, nest success, and nest-site selection. We estimated these reproductive parameters in forest units managed with prescribed fire (treated) and units absent of prescribed fire (untreated). Of 60 initial nest attempts monitored, none were destroyed or exposed to prescribed fire because a majority of fires occurred early than a majority of the nesting activity. We found nest success was greater in untreated units than treated units (36.4% versus 14.6%). We did not find any habitat characteristic differences between successful and unsuccessful nest-sites. We found that nest-site selection criteria differed between treated and untreated units. Visual concealment and woody ground cover were common selection criteria in both treated and untreated units. However, in treated units wild turkey selected nest-sites with fewer small shrubs (<5 cm ground diameter) and large trees (>20 cm DBH) but not in untreated units. In untreated units wild turkey selected nest-sites with more large shrubs (≥5cm ground diameter) but did not select for small shrubs or large trees. Our findings suggest that wild turkey have not benefited from the reintroduction of prescribed fire to the WRERA. PMID:26795913

Impacts of Short-Rotation Early-Growing Season Prescribed Fire on a Ground Nesting Bird in the Central Hardwoods Region of North America.

PubMed

Pittman, H Tyler; Krementz, David G

2016-01-01

Landscape-scale short-rotation early-growing season prescribed fire, hereafter prescribed fire, in upland hardwood forests represents a recent shift in management strategies across eastern upland forests. Not only does this strategy depart from dormant season to growing season prescriptions, but the strategy also moves from stand-scale to landscape-scale implementation (>1,000 ha). This being so, agencies are making considerable commitments in terms of time and resources to this management strategy, but the effects on wildlife in upland forests, especially those dominated by hardwood canopy species, are relatively unknown. We initiated our study to assess whether this management strategy affects eastern wild turkey reproductive ecology on the Ozark-St. Francis National Forest. We marked 67 wild turkey hens with Global Positioning System (GPS) Platform Transmitting Terminals in 2012 and 2013 to document exposure to prescribed fire, and estimate daily nest survival, nest success, and nest-site selection. We estimated these reproductive parameters in forest units managed with prescribed fire (treated) and units absent of prescribed fire (untreated). Of 60 initial nest attempts monitored, none were destroyed or exposed to prescribed fire because a majority of fires occurred early than a majority of the nesting activity. We found nest success was greater in untreated units than treated units (36.4% versus 14.6%). We did not find any habitat characteristic differences between successful and unsuccessful nest-sites. We found that nest-site selection criteria differed between treated and untreated units. Visual concealment and woody ground cover were common selection criteria in both treated and untreated units. However, in treated units wild turkey selected nest-sites with fewer small shrubs (<5 cm ground diameter) and large trees (>20 cm DBH) but not in untreated units. In untreated units wild turkey selected nest-sites with more large shrubs (≥5 cm ground diameter) but did not select for small shrubs or large trees. Our findings suggest that wild turkey have not benefited from the reintroduction of prescribed fire to the WRERA.

Management of Post-Traumatic Rectovesical/Rectourethral Fistulas: Case Series of Complicated Injuries in Wounded Warriors and Review of the Literature.

PubMed

Kucera, Walter B; Jezior, James R; Duncan, James E

2017-03-01

Penetrating injuries to the pelvis and perineum can result in fistulas between the rectum and lower urinary tract. These injuries are often complicated, which creates challenges for successful repair. Operative strategies may include initial fecal and/or urinary diversion combined with an eventual trans-perineal, trans-anal, or posterior/transrectal approach, but the selected approach should be guided by precise anatomic localization of the injury. We aim to discuss different possible repair strategies as well as the relevant data surrounding gastrointestinal-genitourinary (GI-GU) fistula management. We present this series of three post-traumatic rectovesical and rectourethral fistulas to illustrate the surgical options for treatment of these conditions. In this series, we have retrospectively reviewed our experience at Walter Reed National Military Medical Center in caring for three Wounded Warriors who had suffered these types of injuries. The study was exempt from institutional review board approval because of the size of the series. Our three patients all were managed with initial urinary and fecal diversion before an eventual trans-perineal, trans-anal, or posterior/transrectal approach. All three patients ultimately underwent reversal of diverting ostomies with good functional results and successful resolution of their GI-GU fistulas. This series demonstrates the complexity of traumatic GI-GU fistulas. Successful management depended on early diversion of both urine and feces, localization of the fistula, and an interdisciplinary surgical approach specifically tailored to each patient. All three patients had favorable overall functional outcomes despite their devastating injuries. This review should help to illustrate some of the possible repair strategies for these difficult surgical problems. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

U.S. Geological Survey Science Strategy for the Wyoming Landscape Conservation Initiative

USGS Publications Warehouse

Bowen, Zachary H.; Aldridge, Cameron L.; Anderson, Patrick J.; Chong, Geneva W.; Drummond, Mark A.; Homer, Collin G.; Johnson, Ronald C.; Kauffman, Matthew J.; Knick, Steven T.; Kosovich, John J.; Miller, Kirk A.; Owens, Tom; Shafer, Sarah L.; Sweat, Michael J.

2009-01-01

Southwest Wyoming's wildlife and habitat resources are increasingly affected by energy and urban/exurban development, climate change, and other key drivers of ecosystem change. To ensure that southwest Wyoming's wildlife populations and habitats persist in the face of development and other changes, a consortium of public resource-management agencies proposed the Wyoming Landscape Conservation Initiative (WLCI), the overall goal of which is to implement conservation actions. As the principal agency charged with conducting WLCI science, the U.S. Geological Survey (USGS) has developed a Science Strategy for the WLCI. Workshops were held for all interested parties to identify and refine the most pressing management needs for achieving WLCI goals. Research approaches for addressing those needs include developing conceptual models for understanding ecosystem function, identifying key drivers of change affecting WLCI ecosystems, and conducting scientific monitoring and experimental studies to better understand ecosystems processes, cumulative effects of change, and effectiveness of habitat treatments. The management needs drive an iterative, three-phase framework developed for structuring and growing WLCI science efforts: Phase I entails synthesizing existing information to assess current conditions, determining what is already known about WLCI ecosystems, and providing a foundation for future work; Phase II entails conducting targeted research and monitoring to address gaps in data and knowledge during Phase I; and Phase III entails integrating new knowledge into WLCI activities and coordinating WLCI partners and collaborators. Throughout all three phases, information is managed and made accessible to interested parties and used to guide and improve management and conservation actions, future habitat treatments, best management practices, and other conservation activities.

Fuelwood, agro-forestry, and natural resource management: the development significance of land tenure and other resource management/utilization systems

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

Brokensha, D.; Castro, A.P.; Kundu, M.

1984-04-01

Using a systems approach and focusing on the social context, the study examines natural resource management in relation to fuelwood production and agroforestry. An initial section describing the use and interlinkage of the concepts of ecozone and ecosystem is followed by a discussion of problem ecozones, human use of ecozones, agricultural ecosystems, resource competition, uses of trees and forest products, and tree planting. Rural resource management strategies at the household, community, local, and state levels are discussed in the context of political economy, land tenure and rights, tenancy and sharecropping, group or public landholding, and acquisition and transfer of land.

The activities of a dietitian-led gastroenterology clinic using extended scope of practice.

PubMed

Ryan, Dominique; Pelly, Fiona; Purcell, Elizabeth

2016-10-21

Extending the scope of practice of allied health professionals has been a strategy adopted in the United Kingdom to address issues within the health system. Australia's health system is currently undermined by similar issues, heightening government interest in adopting the extended scope health care model. The aim of the current study was to describe the activities and outcomes of a dietitian-led gastroenterology clinic which operated under an extended scope of practice model in an outpatient gastroenterology department at a tertiary hospital in regional Queensland, Australia, and to assess patient satisfaction with the initiative. A descriptive, cross-sectional case series undertaken over 50 clinics involving 82 category 2 and 3 patients with suspected/confirmed coeliac disease or inflammatory bowel disease; low haemoglobin; gastroesophageal reflux disease, or; malnutrition. Data was analysed using Microsoft Excel 2010, and presented as descriptive statistics. Sixty out of 82 selected patients (median age 51 years) attended an initial appointment with the dietitian. Twenty-four review appointments were attended. Average waiting period for an initial appointment was 148 days (range 31-308 days). A total of 149 management strategies were provided, and 94 (63 %) of these involved the dietitian utilising extended scope of practice. The dietitian managed 47 (78 %) patients without need for gastroenterologist referral, and 25 (42 %) were discharged after dietetic management. Patients reported high levels of satisfaction with the clinic. Seventy-eight percent of category 2 and 3 patients referred to the gastroenterologist could be managed exclusively in the dietitian-led clinic. This extended scope model of care could potentially benefit the efficiency and acceptability of Australia's public health system.

Pain management: new initiatives arise to provide quality care.

PubMed

Simmons, J C

2001-06-01

During the past decade, many advances have been made in the diagnosis, treatment, and management of pain. However, undertreatment of pain among all population groups is still a nationwide problem. Changes, though, are occurring this year, with many hospitals, health systems, and health plans placing pain management on the top of their patient agendas--due in part to the introduction of new pain management standards by the Joint Commission on Accreditation of Healthcare Organizations. This issue looks at how health care providers are working together across the country to make those changes--and meet JCAHO standards--while fulfilling the needs of their patient populations through innovative pain assessment and management strategies.

Advanced life support technology development for the Space Exploration Initiative

NASA Technical Reports Server (NTRS)

Evanich, Peggy L.; Voecks, Gerald E.; Seshan, P. K.

1990-01-01

An overview is presented of NASA's advanced life support technology development strategy for the Space Exploration Initiative. Three basic life support technology areas are discussed in detail: air revitalization, water reclamation, and solid waste management. It is projected that regenerative life support systems will become increasingly more complex as system closure is maximized. Advanced life support technology development will utilize three complementary elements, including the Research and Technology Program, the Regenerative Life Support Program, and the Technology Testbed Validations.

Strategies for Improving Diversity at Bell Labs, Lucent Technologies

NASA Astrophysics Data System (ADS)

Murray, Cherry A.

2001-03-01

Over the last quarter century, top management in Bell Labs Research has initiated efforts to train, recruit, and encourage underrepresented minorities into science and engineering positions, and in hiring and retaining underrepresented minority scientists and engineers. I will give some historical background of some of the programs which have worked over the years and some of the new programs in recruiting, mentoring and career planning that we have recently initiated in order to better create a workplace that is accepting and even welcoming of diversity.

Local Gov`t assistance in commercial waste reduction & recycling

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

Hannah, C.W.

This paper outlines programs and strategies for reducing the waste stream by targeting the commercial, industrial and institutional sectors. The programs described are implemented by the Wake County Solid Waste Management Division, North Carolina. Findings and recommendations of a task force focusing on the role of the private sector in meeting state waste reduction mandates are summarized. Commercial initiatives, educational initiatives, and a grant program are described. Several case studies are provided which overview the variety of businesses and waste materials addressed.

Preventing Rehospitalization through effective home health nursing care.

PubMed

Vasquez, Monica S

2009-01-01

To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare. PRIMARY PRACTICE SETTINGS(S): Primarily for home healthcare but can also be a tool for all other fields in nursing. Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system. The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.

Effective communication during difficult conversations.

PubMed

Polito, Jacquelyn M

2013-06-01

A strong interest and need exist in the workplace today to master the skills of conducting difficult conversations. Theories and strategies abound, yet none seem to have found the magic formula with universal appeal and success. If it is such an uncomfortable skill to master is it better to avoid or initiate such conversations with employees? Best practices and evidence-based management guide us to the decision that quality improvement dictates effective communication, even when difficult. This brief paper will offer some suggestions for strategies to manage difficult conversations with employees. Mastering the skills of conducting difficult conversations is clearly important to keeping lines of communication open and productive. Successful communication skills may actually help to avert confrontation through employee engagement, commitment and appropriate corresponding behavior

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

PubMed Central

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-01-01

Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. PMID:29179292

Advanced Donation Programs and Deceased Donor-Initiated Chains-2 Innovations in Kidney Paired Donation.

PubMed

Wall, Anji E; Veale, Jeffrey L; Melcher, Marc L

2017-12-01

Kidney paired donation (KPD) strategies have facilitated compatible living-donor kidney transplants for end-stage renal disease patients with willing but incompatible living donors. Success has inspired further innovations that expand opportunities for kidney-paired donation. Two such innovations are the advanced donation strategy in which a donor provides a kidney before their recipient is matched, or even in need of, a kidney transplant, and deceased donor initiated chains in which chains are started with deceased donors rather than altruistic living donors. Although these innovations may expand KPD, they raise several ethical issues. Specific concerns raised by advanced donation include the management of uncertainty, the extent of donor and recipient consent, the scope of the obligation that the organization has to the kidney exchange paired recipient, the naming of alternative recipients, and the potential to unfairly advantage the recipient. Use of deceased donors for chain-initiating kidneys raises ethical issues concerning the consent process for each involved party, the prioritization of deceased donor kidneys, the allocation of chain ending kidneys, and the value of a living donor kidney versus a deceased donor kidney. We outline each ethical issue and discuss how it can be conceptualized and managed so that these KPD innovations programs are ultimately successful.

Partnerships: One Strategy for Meeting Big Data Challenges

NASA Astrophysics Data System (ADS)

Chandler, C. L.; Groman, R. C.; Kinkade, D.; Shepherd, A.; Allison, M. D.; Rauch, S.; Wiebe, P. H.; Glover, D. M.

2014-12-01

In late 2006 staff members from the previously independent US Joint Global Ocean Flux Study (US JGOFS) and US GLOBal Ocean ECosystems Dynamics (US GLOBEC) data management offices joined forces and received funding from the US National Science Foundation to provide data management support to ocean science researchers. The transition from providing dedicated, project-specific data management services to supporting a broader research community data facility has necessitated understanding of and adaptation to evolving needs. One of the strategies that has proven to be very effective is the formation of partnerships with other groups doing complementary work. Staff members at BCO-DMO have formed collaborative partnerships with others to support our primary research community efficiently and in a way that covers the full research data life cycle. Examples will be provided that highlight ways in which such partnerships have enhanced the work done by BCO-DMO, and also ways in which BCO-DMO activities have contributed to broader national and global initiatives. One of the clear benefits of collaboration with other groups is the opportunity for identification of shared challenges, strategies and solutions and the increased likelihood of developing interoperable systems.

[Strategy Development for International Cooperation in the Clinical Laboratory Field].

PubMed

Kudo, Yoshiko; Osawa, Susumu

2015-10-01

The strategy of international cooperation in the clinical laboratory field was analyzed to improve the quality of intervention by reviewing documents from international organizations and the Japanese government. Based on the world development agenda, the target of action for health has shifted from communicable diseases to non-communicable diseases (NCD). This emphasizes the importance of comprehensive clinical laboratories instead of disease-specific examinations in developing countries. To achieve this goal, the World Health Organization (WHO) has disseminated to the African and Asian regions the Laboratory Quality Management System (LQMS), which is based on the same principles of the International Organization of Standardization (ISO) 15189. To execute this strategy, international experts must have competence in project management, analyze information regarding the target country, and develop a strategy for management of the LQMS with an understanding of the technical aspects of laboratory work. However, there is no appropriate pre- and post-educational system of international health for Japanese international workers. Universities and academic organizations should cooperate with the government to establish a system of education for international workers. Objectives of this education system must include: (1) training for the organization and understanding of global health issues, (2) education of the principles regarding comprehensive management of clinical laboratories, and (3) understanding the LQMS which was employed based on WHO's initiative. Achievement of these objectives will help improve the quality of international cooperation in the clinical laboratory field.

Salamander chytrid fungus (Batrachochytrium salamandrivorans) in the United States—Developing research, monitoring, and management strategies

USGS Publications Warehouse

Grant, Evan H. Campbell; Muths, Erin L.; Katz, Rachel A.; Canessa, Stefano; Adams, Michael J.; Ballard, Jennifer R.; Berger, Lee; Briggs, Cheryl J.; Coleman, Jeremy; Gray, Matthew J.; Harris, M. Camille; Harris, Reid N.; Hossack, Blake R.; Huyvaert, Kathryn P.; Kolby, Jonathan E.; Lips, Karen R.; Lovich, Robert E.; McCallum, Hamish I.; Mendelson, Joseph R.; Nanjappa, Priya; Olson, Deanna H.; Powers, Jenny G.; Richgels, Katherine L. D.; Russell, Robin E.; Schmidt, Benedikt R.; Spitzen-van der Sluijs, Annemarieke; Watry, Mary Kay; Woodhams, Douglas C.; White, C. LeAnn

2016-01-20

The recently (2013) identified pathogenic chytrid fungus, Batrachochytrium salamandrivorans (Bsal), poses a severe threat to the distribution and abundance of salamanders within the United States and Europe. Development of a response strategy for the potential, and likely, invasion of Bsal into the United States is crucial to protect global salamander biodiversity. A formal working group, led by Amphibian Research and Monitoring Initiative (ARMI) scientists from the U.S. Geological Survey (USGS) Patuxent Wildlife Research Center, Fort Collins Science Center, and Forest and Rangeland Ecosystem Science Center, was held at the USGS Powell Center for Analysis and Synthesis in Fort Collins, Colorado, United States from June 23 to June 25, 2015, to identify crucial Bsal research and monitoring needs that could inform conservation and management strategies for salamanders in the United States. Key findings of the workshop included the following: (1) the introduction of Bsal into the United States is highly probable, if not inevitable, thus requiring development of immediate short-term and long-term intervention strategies to prevent Bsal establishment and biodiversity decline; (2) management actions targeted towards pathogen containment may be ineffective in reducing the long-term spread of Bsal throughout the United States; and (3) early detection of Bsal through surveillance at key amphibian import locations, among high-risk wild populations, and through analysis of archived samples is necessary for developing management responses. Top research priorities during the preinvasion stage included the following: (1) deployment of qualified diagnostic methods for Bsal and establishment of standardized laboratory practices, (2) assessment of susceptibility for amphibian hosts (including anurans), and (3) development and evaluation of short- and long-term pathogen intervention and management strategies. Several outcomes were achieved during the workshop, including development of an organizational structure with working groups for a Bsal Task Force, creation of an initial influence diagram to aid in identifying effective management actions in the face of uncertainty, and production of a list of potential management actions and key research uncertainties. Additional products under development include a Bsal Strategic Action plan, an emergency response plan, a monitoring and surveillance program, a standardized diagnostic approach, decision models for natural resource agencies, and a reporting database for salamander mortalities. This workshop was the first international meeting to address the threat of Bsal to salamander populations in the United States, with more than 30 participants from U.S. conservation and resource management agencies (U.S. Fish and Wildlife Service, U.S. Forest Service, U.S. Department of Defense, U.S. National Park Service, and Association of Fish and Wildlife Agencies) and academic research institutions in Australia, the Netherlands, Switzerland, the United Kingdom, and the United States.

Managing physical and mental health conditions: Consumer perspectives on integrated care.

PubMed

Rollins, Angela L; Wright-Berryman, Jennifer; Henry, Nancy H; Quash, Alicia M; Benbow, Kyle; Bonfils, Kelsey A; Hedrick, Heidi; Miller, Alex P; Firmin, Ruthie; Salyers, Michelle P

2017-01-01

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.

Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment.

PubMed

Smith, T O; Postle, K; Penny, F; McNamara, I; Mann, C J V

2014-03-01

The purpose of this study was to determine the optimal clinical and cost-effective strategy for managing people following ACL rupture. A systematic review of the published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, psycINFO and the Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research Register Archive) was conducted on April 2013. All randomised and non-randomised controlled trials evaluating clinical or health economic outcomes of isolated ligament reconstruction versus non-surgical management following ACL rupture were included. Methodological quality was assessed using the PEDro appraisal tool. When appropriate, meta-analysis was conducted to pool data. From a total of 943 citations, sixteen studies met the eligibility criteria. These included 1397 participants, 825 who received ACL reconstruction versus 592 who were managed non-surgically. The methodological quality of the literature was poor. The findings indicated that whilst reconstructed ACL offers significantly greater objective tibiofemoral stability (p<0.001), there appears limited evidence to suggest a superiority between reconstruction versus non-surgical management in functional outcomes. There was a small difference between the management strategies in respect to the development of osteoarthritis during the initial 20 years following index management strategy (Odds Ratio 1.56; p=0.05). The current literature is insufficient to base clinical decision-making with respect to treatment opinions for people following ACL rupture. Whilst based on a poor evidence, the current evidence would indicate that people following ACL rupture should receive non-operative interventions before surgical intervention is considered. © 2013.

The Adaptation for Conservation Targets (ACT) framework: a tool for incorporating climate change into natural resource management.

PubMed

Cross, Molly S; Zavaleta, Erika S; Bachelet, Dominique; Brooks, Marjorie L; Enquist, Carolyn A F; Fleishman, Erica; Graumlich, Lisa J; Groves, Craig R; Hannah, Lee; Hansen, Lara; Hayward, Greg; Koopman, Marni; Lawler, Joshua J; Malcolm, Jay; Nordgren, John; Petersen, Brian; Rowland, Erika L; Scott, Daniel; Shafer, Sarah L; Shaw, M Rebecca; Tabor, Gary M

2012-09-01

As natural resource management agencies and conservation organizations seek guidance on responding to climate change, myriad potential actions and strategies have been proposed for increasing the long-term viability of some attributes of natural systems. Managers need practical tools for selecting among these actions and strategies to develop a tailored management approach for specific targets at a given location. We developed and present one such tool, the participatory Adaptation for Conservation Targets (ACT) framework, which considers the effects of climate change in the development of management actions for particular species, ecosystems and ecological functions. Our framework is based on the premise that effective adaptation of management to climate change can rely on local knowledge of an ecosystem and does not necessarily require detailed projections of climate change or its effects. We illustrate the ACT framework by applying it to an ecological function in the Greater Yellowstone Ecosystem (Montana, Wyoming, and Idaho, USA)--water flows in the upper Yellowstone River. We suggest that the ACT framework is a practical tool for initiating adaptation planning, and for generating and communicating specific management interventions given an increasingly altered, yet uncertain, climate.

Building co-management as a process: problem solving through partnerships in Aboriginal country, Australia.

PubMed

Zurba, Melanie; Ross, Helen; Izurieta, Arturo; Rist, Philip; Bock, Ellie; Berkes, Fikret

2012-06-01

Collaborative problem solving has increasingly become important in the face of the complexities in the management of resources, including protected areas. The strategy undertaken by Girringun Aboriginal Corporation in north tropical Queensland, Australia, for developing co-management demonstrates the potential for a problem solving approach involving sequential initiatives, as an alternative to the more familiar negotiated agreements for co-management. Our longitudinal case study focuses on the development of indigenous ranger units as a strategic mechanism for the involvement of traditional owners in managing their country in collaboration with government and other interested parties. This was followed by Australia's first traditional use of marine resources agreement, and development of a multi-jurisdictional, land to sea, indigenous protected area. In using a relationship building approach to develop regional scale co-management, Girringun has been strengthening its capabilities as collaborator and regional service provider, thus, bringing customary decision-making structures into play to 'care for country'. From this evolving process we have identified the key components of a relationship building strategy, 'the pillars of co-management'. This approach includes learning-by-doing, the building of respect and rapport, sorting out responsibilities, practical engagement, and capacity-building.

Building Co-Management as a Process: Problem Solving Through Partnerships in Aboriginal Country, Australia

NASA Astrophysics Data System (ADS)

Zurba, Melanie; Ross, Helen; Izurieta, Arturo; Rist, Philip; Bock, Ellie; Berkes, Fikret

2012-06-01

Collaborative problem solving has increasingly become important in the face of the complexities in the management of resources, including protected areas. The strategy undertaken by Girringun Aboriginal Corporation in north tropical Queensland, Australia, for developing co-management demonstrates the potential for a problem solving approach involving sequential initiatives, as an alternative to the more familiar negotiated agreements for co-management. Our longitudinal case study focuses on the development of indigenous ranger units as a strategic mechanism for the involvement of traditional owners in managing their country in collaboration with government and other interested parties. This was followed by Australia's first traditional use of marine resources agreement, and development of a multi-jurisdictional, land to sea, indigenous protected area. In using a relationship building approach to develop regional scale co-management, Girringun has been strengthening its capabilities as collaborator and regional service provider, thus, bringing customary decision-making structures into play to `care for country'. From this evolving process we have identified the key components of a relationship building strategy, `the pillars of co-management'. This approach includes learning-by-doing, the building of respect and rapport, sorting out responsibilities, practical engagement, and capacity-building.

The Adaptation for Conservation Targets (ACT) Framework: A tool for incorporating climate change into natural resource management

USGS Publications Warehouse

Cross, Molly S.; Zavaleta, Erika S.; Bachelet, Dominique; Brooks, Marjorie L.; Enquist, Carolyn A.F.; Fleishman, Erica; Graumlich, Lisa J.; Groves, Craig R.; Hannah, Lee; Hansen, Lara J.; Hayward, Gregory D.; Koopman, Marni; Lawler, Joshua J.; Malcolm, Jay; Nordgren, John R.; Petersen, Brian; Rowland, Erika; Scott, Daniel; Shafer, Sarah L.; Shaw, M. Rebecca; Tabor, Gary

2012-01-01

As natural resource management agencies and conservation organizations seek guidance on responding to climate change, myriad potential actions and strategies have been proposed for increasing the long-term viability of some attributes of natural systems. Managers need practical tools for selecting among these actions and strategies to develop a tailored management approach for specific targets at a given location. We developed and present one such tool, the participatory Adaptation for Conservation Targets (ACT) framework, which considers the effects of climate change in the development of management actions for particular species, ecosystems and ecological functions. Our framework is based on the premise that effective adaptation of management to climate change can rely on local knowledge of an ecosystem and does not necessarily require detailed projections of climate change or its effects. We illustrate the ACT framework by applying it to an ecological function in the Greater Yellowstone Ecosystem (Montana, Wyoming, and Idaho, USA)—water flows in the upper Yellowstone River. We suggest that the ACT framework is a practical tool for initiating adaptation planning, and for generating and communicating specific management interventions given an increasingly altered, yet uncertain, climate.

[Treatment of the first episode of spontaneous pneumothorax].

PubMed

Moubachir, H; Zaghba, N; Benjelloun, H; Bakhatar, A; Yassine, N

2016-11-01

The management of a first episode of spontaneous pneumothorax is controversial and the best technique to be used as an initial intervention, aspiration or intercostal drainage, is still debated. We present a retrospective case series during two and a half consecutive years describing the immediate management of spontaneous pneumothoraces, comparing aspiration versus thoracic drainage. One hundred and thirty-three clinical files from patients with spontaneous pneumothoraces were analyzed (17 primary and 116 secondary). The pneumothoraces were of varying size and different etiologies. Patients were initially treated with simple aspiration in 68 cases, with an immediate success rate of 37.5%, intercostal drainage in 49 cases, and by rest alone in 16 cases. In case of secondary pneumothorax, aspiration appeared to offer advantages as an initial strategy over intercostal drainage in terms of hospital stay (11 versus 22 days), and with significant effectiveness (37.5%). Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

[The subject repositories of strategy of the Open Access initiative].

PubMed

Soares Guimarães, M C; da Silva, C H; Horsth Noronha, I

2012-11-01

The subject repositories are defined as a set of digital objects resulting from the research related to a specific disciplinary field and occupy a still restricted space in the discussion agenda of the Free Access Movement when compared to amplitude reached in the discussion of Institutional Repositories. Although the Subject Repository comes to prominence in the field, especially for the success of initiatives such as the arXiv, PubMed and E-prints, the literature on the subject is recognized as very limited. Despite its roots in the Library and Information Science, and focus on the management of disciplinary collections (subject area literature), there is little information available about the development and management of subject repositories. The following text seeks to make a brief summary on the topic as a way to present the potential to develop subject repositories in order to strengthen the initiative of open access.

Using economic instruments to develop effective management of invasive species: insights from a bioeconomic model.

PubMed

McDermott, Shana M; Irwin, Rebecca E; Taylor, Brad W

2013-07-01

Economic growth is recognized as an important factor associated with species invasions. Consequently, there is increasing need to develop solutions that combine economics and ecology to inform invasive species management. We developed a model combining economic, ecological, and sociological factors to assess the degree to which economic policies can be used to control invasive plants. Because invasive plants often spread across numerous properties, we explored whether property owners should manage invaders cooperatively as a group by incorporating the negative effects of invader spread in management decisions (collective management) or independently, whereby the negative effects of invasive plant spread are ignored (independent management). Our modeling approach used a dynamic optimization framework, and we applied the model to invader spread using Linaria vulgaris. Model simulations allowed us to determine the optimal management strategy based on net benefits for a range of invader densities. We found that optimal management strategies varied as a function of initial plant densities. At low densities, net benefits were high for both collective and independent management to eradicate the invader, suggesting the importance of early detection and eradication. At moderate densities, collective management led to faster and more frequent invader eradication compared to independent management. When we used a financial penalty to ensure that independent properties were managed collectively, we found that the penalty would be most feasible when levied on a property's perimeter boundary to control spread among properties. At the highest densities, the optimal management strategy was "do nothing" because the economic costs of removal were too high relative to the benefits of removal. Spatial variation in L. vulgaris densities resulted in different optimal management strategies for neighboring properties, making a formal economic policy to encourage invasive species removal critical. To accomplish the management and enforcement of these economic policies, we discuss modification of existing agencies and infrastructure. Finally, a sensitivity analysis revealed that lowering the economic cost of invader removal would strongly increase the probability of invader eradication. Taken together, our results provide quantitative insight into management decisions and economic policy instruments that can encourage invasive species removal across a social landscape.

A Principal Components Analysis and Validation of the Coping with the College Environment Scale (CWCES)

ERIC Educational Resources Information Center

Ackermann, Margot Elise; Morrow, Jennifer Ann

2008-01-01

The present study describes the development and initial validation of the Coping with the College Environment Scale (CWCES). Participants included 433 college students who took an online survey. Principal Components Analysis (PCA) revealed six coping strategies: planning and self-management, seeking support from institutional resources, escaping…

Stand maintenance and genetic diversity of bermudagrass pastures under different stocking intensities during a 38 year period

USDA-ARS?s Scientific Manuscript database

Stocking management strategies can affect production and persistence of bermudagrass [Cynodon dactylon (L) Pers] (BG) pastures. ‘Coastal’ (COS) and common (COM) bermudagrass (BG) pastures were stocked at different controlled intensities (STK) during a 38-yr period which was initiated in 1969. On ave...

Application of GPS and Near-Surface Geophysical Methods to Evaluate Differences Between Agricultural Test Plots

USDA-ARS?s Scientific Manuscript database

A field research facility with two pairs of replicated agricultural test plots (four total) was established at a location in northwest Ohio during 2005 for the purpose of studying water table management strategies. Initial efforts at this field research facility were devoted to evaluating difference...

Reflection--A Method for Organisational and Individual Development

ERIC Educational Resources Information Center

Randle, Hanne; Tilander, Kristian

2007-01-01

This paper presents how organisational development can be the results when politicians, managers, social workers and teaching staff take part in reflection. The results are based on a government-funded initiative in Sweden for lowering sick absenteeism. Three local governments introduced reflection as a strategy to combat work related stress and a…

Deferred Capital Renewal as a Spoiler for Campus Programs

ERIC Educational Resources Information Center

Whitefield, Joe

2010-01-01

For facilities managers, deferred capital renewal (DCR) is the issue that, in many ways, can play the role of spoiler for other programs and initiatives are that important to their campuses. In particular, operations and maintenance programs, campus growth strategies, and even sustainability programs can suffer setbacks caused by the unplanned…

Managing the Transformation to an E-Learning Organisation.

ERIC Educational Resources Information Center

Simpson, Janet

The Douglas Mawson Institute (DMI) of TAFE (technical and further education), which operates more than four campuses in Australia with a diverse student body numbering approximately 17,000 (78 percent studying part-time), has initiated strategies to support the transformation to an e-learning organization. Major elements in the change model are…

Connecting Research to Teaching: Lenses for Examining Students' Mathematical Thinking

ERIC Educational Resources Information Center

Linsenmeier, Katherine A.; Sherin, Miriam; Walkoe, Janet; Mulligan, Martha

2014-01-01

The authors present three strategies for making sense of students' mathematical thinking. These lenses make the abstract idea of "making sense of student thinking" more manageable and concrete. We start by taking an initial look at a student's idea, going deeper, and finally looking across several ideas.

How Is a Chinese Student Like a Thermos Bottle?

ERIC Educational Resources Information Center

van Naerssen, Margaret; And Others

A study of classroom communication skills and strategies initiated in an effort to enhance the experience of Chinese graduate students visiting the United States had two parts. In the first, communications in a sampling of U.S. graduate science courses were examined, resulting in information about the language of classroom conversation management.…

Preliminary silvicultural recommendations and an updated annotated bibliography for birdseye sugar maple

Treesearch

Don C. Bragg

2008-01-01

The birdseye grain abnormality in sugar maple can greatly enhance its commercial appeal. However, birdseye has been opportunistically exploited, without exploring management strategies that can improve its potential. Even though the initiation and development processes of birdseye maple are still largely unknown, useful silvicultural advice can still be provided for...

The Elyria Schools First: An Initiative To Unleash a Community's Potential Empowering Children To Learn.

ERIC Educational Resources Information Center

Elyria City Board of Education, OH.

Total Quality Management (TQM) is a process and strategy designed to improve an organization's effectiveness and efficiency. The Elyria Schools, named as Ohio's model urban school district in 1991, uses TQM to implement updated strategic goals through a process emphasizing teamwork, best knowledge, prevention, and commitment to continuous…

Training ELF Teachers to Create a Blended Learning Environment: Encouraging CMS Adoption and Implementation

ERIC Educational Resources Information Center

Cote, Travis; Milliner, Brett

2015-01-01

E-learning has become a crucial component of most tertiary institution's education initiatives (Park, Lee, & Cheong, 2007) and core to most e-learning strategies is the institution's Content Management System (CMS). A CMS has the potential to enhance language courses by facilitating engagement with class content, providing students with…

Selling and Building Linked Data: Drive Value and Gain Momentum

NASA Astrophysics Data System (ADS)

Harris, Kristen

Data inside enterprises is exploding. Routinely key decision makers state, "one of the most valuable assets of our organization is actionable information." Paradoxically, it is often challenging to gather the necessary metrics to build a business case to justify a Linked Data initiative for improved data quality in the face of the well-documented shortcomings of traditional enterprise approaches to data management. Internet standards have matured considerably in the last decade. The number of linked data sets is growing daily and already exceeds well in excess of ten thousand data sets, over 400 of which are published via the US Government at gov as of April 2010. Many of these linked data sets are high quality. Best practices for linking data within the enterprise are increasingly being published in articles, blogs and technical books. One of the pioneering linked enterprise data projects was undertaken by a Fortune 500 company in the early 2000 timeframe. The lessons learned about how to navigate the management and organizational dynamics are relevant today. This chapter outlines the successful strategies for a linked enterprise data initiative, including a consistent metadata management strategy across lines of business, definition and documentation of data ownership and the value of cross-functional teams in the definition, development and deployment of the project.

Understanding Organizational Learning via Knowledge Management in Government-Link Companies in Malaysia

NASA Astrophysics Data System (ADS)

Helmi, Asleena; Ahmad, Zainal Ariffin; Hung, Daisy Kee Mui

The knowledge management or KM discipline conjures a host of understanding and impact upon the global business community albeit commercially or socially. Regardless of the different approach to KM, it has inarguably brought about changes in viewing the knowledge capabilities and capacities of organizations. Peter Drucker (1998) argued that knowledge has become the key economic resource and the only source of competitive advantage. Hence organizational learning is an integral part of KM initiatives and has been widely practiced in many large organizations and across nations such as Europe, North America and Asia Pacific. Thus, this paper explores the KM initiatives of government link companies (GLCs) in Malaysia via synergizing knowledge strategy and capabilities in order to achieve competitive advantage.

Dynamical stabilization of grazing systems: An interplay among plant-water interaction, overgrazing and a threshold management policy.

PubMed

Costa, Michel Iskin da Silveira; Meza, Magno Enrique Mendoza

2006-12-01

In a plant-herbivore system, a management strategy called threshold policy is proposed to control grazing intensity where the vegetation dynamics is described by a plant-water interaction model. It is shown that this policy can lead the vegetation density to a previously chosen level under an overgrazing regime. This result is obtained despite both the potential occurrence of vegetation collapse due to overgrazing and the possibility of complex dynamics sensitive to vegetation initial densities and parameter uncertainties.

Air quality management in Mexico.

PubMed

Fernández-Bremauntz, Adrián

2008-01-01

Several significant program and policy measures have been implemented in Mexico over the past 15 yr to improve air quality. This article provides an overview of air quality management strategies in Mexico, including (1) policy initiatives such as vehicle use restrictions, air quality standards, vehicle emissions, and fuel quality standards, and (2) supporting programs including establishment of a national emission inventory, an air pollution episodes program, and the implementation of exposure and health effects studies. Trends in air pollution episodes and ambient air pollutant concentrations are described.

The process of managerial control in quality improvement initiatives.

PubMed

Slovensky, D J; Fottler, M D

1994-11-01

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

Beyond PARR - PMEL's Integrated Data Management Strategy

NASA Astrophysics Data System (ADS)

Burger, E. F.; O'Brien, K.; Manke, A. B.; Schweitzer, R.; Smith, K. M.

2016-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a wide range of scientific projects that span a number of scientific and environmental research disciplines. Each of these 14 research projects have their own data streams that are as diverse as the research. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data management landscape for Federal agencies. In 2015, with support from the PMEL Director, Dr. Christopher Sabine, PMEL's Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. Instead of using external requirements, such as PARR, to define our approach, we focussed on strategies to provide PMEL science projects with a unified framework for data submission, interoperable data access, data storage, and easier data archival to National Data Centers. This improves data access to PMEL scientists, their collaborators, and the public, and also provides a unified lab framework that allows our projects to meet their data management objectives, as well as those required by the PARR. We are implementing this solution in stages that allows us to test technology and architecture choices before comitting to a large scale implementation. SDIG developers have completed the first year of development where our approach is to reuse and leverage existing frameworks and standards. This presentation will describe our data management strategy, explain our phased implementation approach, the software and framework choices, and how these elements help us meet the objectives of this strategy. We will share the lessons learned in dealing with diverse and complex datasets in this first year of implementation and how these outcomes will shape our decisions for this ongoing effort. The data management capabilities now available to scientific projects, and other services being developed to manage and preserve PMEL's scientific data assets for our researchers, their collaborators, and future generations, will be described.

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement.

PubMed

Savage, Carl; Parke, Louise; von Knorring, Mia; Mazzocato, Pamela

2016-10-19

Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand.

Management Strategies for CLN2 Disease.

PubMed

Williams, Ruth E; Adams, Heather R; Blohm, Martin; Cohen-Pfeffer, Jessica L; de Los Reyes, Emily; Denecke, Jonas; Drago, Kristen; Fairhurst, Charlie; Frazier, Margie; Guelbert, Norberto; Kiss, Szilárd; Kofler, Annamaria; Lawson, John A; Lehwald, Lenora; Leung, Mary-Anne; Mikhaylova, Svetlana; Mink, Jonathan W; Nickel, Miriam; Shediac, Renée; Sims, Katherine; Specchio, Nicola; Topcu, Meral; von Löbbecke, Ina; West, Andrea; Zernikow, Boris; Schulz, Angela

2017-04-01

CLN2 disease (neuronal ceroid lipofuscinosis type 2) is a rare, autosomal recessive, pediatric-onset, rapidly progressive neurodegenerative lysosomal storage disorder caused by tripeptidyl peptidase 1 (TPP1) enzyme deficiency, and is characterized by language delay, seizures, rapid cognitive and motor decline, blindness, and early death. No management guidelines exist and there is a paucity of published disease-specific evidence to inform clinical practice, which currently draws upon experience from the field of childhood neurodisability. Twenty-four disease experts were surveyed on CLN2 disease management and a subset met to discuss current practice. Management goals and strategies are consistent among experts globally and are guided by the principles of pediatric palliative care. Goals and interventions evolve as the disease progresses, with a shift in focus from maintenance of function early in the disease to maintenance of quality of life. A multidisciplinary approach is critical for optimal patient care. This work represents an initial step toward the development of consensus-based management guidelines for CLN2 disease. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Quantifying the Implications of Different Land Users' Priorities in the Management of Boreal Multiple-Use Forests

NASA Astrophysics Data System (ADS)

Horstkotte, Tim; Lind, Torgny; Moen, Jon

2016-04-01

In the management of natural resources, conflicting interests and objectives among different stakeholders often need to be considered. Here, we examine how two contrasting management scenarios of boreal forests in northern Sweden differ in their consequences on forest structural composition and the economic gains at harvest. Management strategies prioritize either (i) forest characteristics that promote grazing resources for reindeer herded by the indigenous Sámi, or (ii) timber production as practiced in Sweden today. When prioritizing reindeer grazing, forest stands develop a higher abundance of older age classes with larger trees and lower stem density, which reduces harvest and revenue levels by approximately 20 % over a 100-year period. The differences between these strategies illustrate the complexity in finding a trade-off for coexistence between industrial land users and other livelihoods that share the same landscape. Political support and institutional solutions are necessary to initiate changes in policy in finding such trade-offs in the management of environmental resources and thereby influence the optimal distribution of costs and benefits between different actors.

Quantifying the Implications of Different Land Users' Priorities in the Management of Boreal Multiple-Use Forests.

PubMed

Horstkotte, Tim; Lind, Torgny; Moen, Jon

2016-04-01

In the management of natural resources, conflicting interests and objectives among different stakeholders often need to be considered. Here, we examine how two contrasting management scenarios of boreal forests in northern Sweden differ in their consequences on forest structural composition and the economic gains at harvest. Management strategies prioritize either (i) forest characteristics that promote grazing resources for reindeer herded by the indigenous Sámi, or (ii) timber production as practiced in Sweden today. When prioritizing reindeer grazing, forest stands develop a higher abundance of older age classes with larger trees and lower stem density, which reduces harvest and revenue levels by approximately 20% over a 100-year period. The differences between these strategies illustrate the complexity in finding a trade-off for coexistence between industrial land users and other livelihoods that share the same landscape. Political support and institutional solutions are necessary to initiate changes in policy in finding such trade-offs in the management of environmental resources and thereby influence the optimal distribution of costs and benefits between different actors.

Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care.

PubMed

Jarbol, Dorte Ejg; Bech, Mickael; Kragstrup, Jakob; Havelund, Troels; Schaffalitzky de Muckadell, Ove B

2006-01-01

An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

Barriers to diagnosing and managing hypertension - a qualitative study in Australian general practice.

PubMed

Howes, Faline; Hansen, Emily; Williams, Danielle; Nelson, Mark

2010-07-01

Elevated blood pressure (BP) is a major modifiable risk factor. However hypertension still remains underdiagnosed, untreated or suboptimally treated. This study aimed to identify and explore barriers to initiating medication and treating elevated BP to target levels in the general practice setting. Six focus groups involving 30 clinicians were audio recorded, transcribed in full and analysed for common emerging themes using an iterative thematic analysis. After making the decision to commence treatment, medication initiation was relatively straightforward. Clinical uncertainty about true underlying BP, distrust of measurement technology, and distrust of the evidence underpinning hypertension management were expressed. Patient age, gender and comorbidity influenced treatment strategy. Related themes included perceived patient attitude, clinical inertia, and patient centred care. Systems issues included lack of resources and lack of time. The management of an asymptomatic chronic disease within a patient centred, encounter based primary care context can be challenging.

A model to evaluate quality and effectiveness of disease management.

PubMed

Lemmens, K M M; Nieboer, A P; van Schayck, C P; Asin, J D; Huijsman, R

2008-12-01

Disease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control healthcare costs. So far, however, the effects of this strategy remain unclear. Although current models define the concept of disease management, they do not provide a systematic development or an explanatory theory of how disease management affects the outcomes of care. The objective of this paper is to present a framework for valid evaluation of disease-management initiatives. The evaluation model is built on two pillars of disease management: patient-related and professional-directed interventions. The effectiveness of these interventions is thought to be affected by the organisational design of the healthcare system. Disease management requires a multifaceted approach; hence disease-management programme evaluations should focus on the effects of multiple interventions, namely patient-related, professional-directed and organisational interventions. The framework has been built upon the conceptualisation of these disease-management interventions. Analysis of the underlying mechanisms of these interventions revealed that learning and behavioural theories support the core assumptions of disease management. The evaluation model can be used to identify the components of disease-management programmes and the mechanisms behind them, making valid comparison feasible. In addition, this model links the programme interventions to indicators that can be used to evaluate the disease-management programme. Consistent use of this framework will enable comparisons among disease-management programmes and outcomes in evaluation research.

Micro-Credit and Community Wildlife Management: Complementary Strategies to Improve Conservation Outcomes in Serengeti National Park, Tanzania

NASA Astrophysics Data System (ADS)

Kaaya, Emmanuel; Chapman, Margaret

2017-09-01

Community wildlife management programs in African protected areas aim to deliver livelihood and social benefits to local communities in order to bolster support for their conservation objectives. Most of these benefits are delivered at the community level. However, many local people are also seeking more individual or household-level livelihood benefits from community wildlife management programs because it is at this level that many of the costs of protected area conservation are borne. Because community wildlife management delivers few benefits at this level, support for their conservation objectives amongst local people often declines. The study investigated the implications of this for reducing poaching in Serengeti National Park, Tanzania. Three community wildlife management initiatives undertaken by Park management were compared with regard to their capacity to deliver the individual and household-level benefits sought by local people: community conservation services, wildlife management areas and community conservation banks. Interviews were carried out with poachers and local people from four villages in the Western Serengeti including members of village conservation banks, as well as a number of key informants. The results suggest that community conservation banks could, as a complementary strategy to existing community wildlife management programs, potentially provide a more effective means of reducing poaching in African protected areas than community wildlife management programs alone.

Understanding the scale of Marine protection in Hawai'i: from community-based management to the remote Northwestern Hawaiian Islands.

PubMed

Friedlander, Alan M; Stamoulis, Kostantinos A; Kittinger, John N; Drazen, Jeffrey C; Tissot, Brian N

2014-01-01

Ancient Hawaiians developed a sophisticated natural resource management system that included various forms of spatial management. Today there exists in Hawai'i a variety of spatial marine management strategies along a range of scales, with varying degrees of effectiveness. State-managed no-take areas make up less than 0.4% of nearshore waters, resulting in limited ecological and social benefits. There is increasing interest among communities and coastal stakeholders in integrating aspects of customary Hawaiian knowledge into contemporary co-management. A network of no-take reserves for aquarium fish on Hawai'i Island is a stakeholder-driven, adaptive management strategy that has been successful in achieving ecological objectives and economic benefits. A network of large-scale no-take areas for deepwater (100-400m) bottomfishes suffered from a lack of adequate data during their initiation; however, better technology, more ecological data, and stakeholder input have resulted in improvements and the ecological benefits are becoming clear. Finally, the Papahānaumokuākea Marine National Monument (PMNM) is currently the single largest conservation area in the United States, and one of the largest in the world. It is considered an unqualified success and is managed under a new model of collaborative governance. These case studies allow an examination of the effects of scale on spatial marine management in Hawai'i and beyond that illustrate the advantages and shortcomings of different management strategies. Ultimately a marine spatial planning framework should be applied that incorporates existing marine managed areas to create a holistic, regional, multi-use zoning plan engaging stakeholders at all levels in order to maximize resilience of ecosystems and communities.

The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada

PubMed Central

Hawker, G.; Cameron, C.; Canavan, J.; Beaton, D.; Bogoch, E.; Jain, R.; Papaioannou, A.

2016-01-01

In the last decade, there have been a number of action plans published to highlight the importance of preventing osteoporosis and related fractures. In the province of Ontario Canada, the Ministry of Health provided funding for the Ontario Osteoporosis Strategy. The goal is to reduce morbidity, mortality, and costs from osteoporosis and related fractures through an integrated and comprehensive approach aimed at health promotion and disease management. This paper describes the components of the Ontario Osteoporosis Strategy and progress on implementation efforts as of March 2009. There are five main components: health promotion; bone mineral density testing, access, and quality; postfracture care; professional education; and research and evaluation. Responsibility for implementation of the initiatives within the components is shared across a number of professional and patient organizations and academic teaching hospitals with osteoporosis researchers. The lessons learned from each phase of the development, implementation, and evaluation of the Ontario Osteoporosis Strategy provides a tremendous opportunity to inform other jurisdictions embarking on implementing similar large-scale bone health initiatives. PMID:20309525

Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

PubMed

Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

2017-03-01

Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness. © 2016 Nordic College of Caring Science.

A Foundation for Enterprise Imaging: HIMSS-SIIM Collaborative White Paper.

PubMed

Roth, Christopher J; Lannum, Louis M; Persons, Kenneth R

2016-10-01

Care providers today routinely obtain valuable clinical multimedia with mobile devices, scope cameras, ultrasound, and many other modalities at the point of care. Image capture and storage workflows may be heterogeneous across an enterprise, and as a result, they often are not well incorporated in the electronic health record. Enterprise Imaging refers to a set of strategies, initiatives, and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record. This paper is intended to introduce Enterprise Imaging as an important initiative to clinical and informatics leadership, and outline its key elements of governance, strategy, infrastructure, common multimedia content, acquisition workflows, enterprise image viewers, and image exchange services.

The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence.

PubMed

Evans, Catrin; Nalubega, Sylivia; McLuskey, John; Darlington, Nicola; Croston, Michelle; Bath-Hextall, Fiona

2016-01-15

Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure. Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines. The Joanna Briggs Institute.

An adaptive, comprehensive monitoring strategy for chemicals of emerging concern (CECs) in California's Aquatic Ecosystems.

PubMed

Maruya, Keith A; Schlenk, Daniel; Anderson, Paul D; Denslow, Nancy D; Drewes, Jörg E; Olivieri, Adam W; Scott, Geoffrey I; Snyder, Shane A

2014-01-01

A scientific advisory panel was convened by the State of California to recommend monitoring for chemicals of emerging concern (CECs) in aquatic systems that receive discharge of municipal wastewater treatment plant (WWTP) effluent and stormwater runoff. The panel developed a risk-based screening framework that considered environmental sources and fate of CECs observed in receiving waters across the State. Using existing occurrence and risk threshold data in water, sediment, and biological tissue, the panel applied the framework to identify a priority list of CECs for initial monitoring in three representative receiving water scenarios. The initial screening list of 16 CECs identified by the panel included consumer and commercial chemicals, flame retardants, pesticides, pharmaceuticals and personal care products, and natural hormones. The panel designed an iterative, phased strategy with interpretive guidelines that direct and update management actions commensurate with potential risk identified using the risk-based framework and monitoring data. Because of the ever-changing nature of chemical use, technology, and management practices, the panel offered recommendations to improve CEC monitoring, including development of bioanalytical screening methods whose responses integrate exposure to complex mixtures and that can be linked to higher-order effects; development or refinement of models that predict the input, fate, and effects of future chemicals; and filling of key data gaps on CEC occurrence and toxicity. Finally, the panel stressed the need for adaptive management, allowing for future review of, and if warranted, modifications to the strategy to incorporate the latest science available to the water resources community. © 2013 SETAC.

Cost-effectiveness of different strategies to manage patients with sciatica.

PubMed

Fitzsimmons, Deborah; Phillips, Ceri J; Bennett, Hayley; Jones, Mari; Williams, Nefyn; Lewis, Ruth; Sutton, Alex; Matar, Hosam E; Din, Nafees; Burton, Kim; Nafees, Sadia; Hendry, Maggie; Rickard, Ian; Wilkinson, Claire

2014-07-01

The aim of this paper is to estimate the relative cost-effectiveness of treatment regimens for managing patients with sciatica. A deterministic model structure was constructed based on information from the findings from a systematic review of clinical effectiveness and cost-effectiveness, published sources of unit costs, and expert opinion. The assumption was that patients presenting with sciatica would be managed through one of 3 pathways (primary care, stepped approach, immediate referral to surgery). Results were expressed as incremental cost per patient with symptoms successfully resolved. Analysis also included incremental cost per utility gained over a 12-month period. One-way sensitivity analyses were used to address uncertainty. The model demonstrated that none of the strategies resulted in 100% success. For initial treatments, the most successful regime in the first pathway was nonopioids, with a probability of success of 0.613. In the second pathway, the most successful strategy was nonopioids, followed by biological agents, followed by epidural/nerve block and disk surgery, with a probability of success of 0.996. Pathway 3 (immediate surgery) was not cost-effective. Sensitivity analyses identified that the use of the highest cost estimates results in a similar overall picture. While the estimates of cost per quality-adjusted life year are higher, the economic model demonstrated that stepped approaches based on initial treatment with nonopioids are likely to represent the most cost-effective regimens for the treatment of sciatica. However, development of alternative economic modelling approaches is required. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Successful introduction and audit of a step-down oral antibiotic strategy for low risk paediatric febrile neutropaenia in a UK, multicentre, shared care setting.

PubMed

Dommett, R; Geary, J; Freeman, S; Hartley, J; Sharland, M; Davidson, A; Tulloh, R; Taj, M; Stoneham, S; Chisholm, J C

2009-11-01

Patients with febrile neutropaenia (FN) can be stratified according to their risk of significant complications, allowing reduced intensity therapy for low risk (LR) episodes. Serious events are very rare in low risk episodes making randomised trials difficult. Introduction of new evidence-based guidelines followed by re-auditing of the outcome is an alternative strategy. New guidelines for the management of LR FN were implemented in 4 specialist paediatric oncology centres (POCs) and in their associated shared care units (POSCUs). All patients commenced empirical intravenous antibiotic therapy and after 48h those with blood culture negative episodes designated LR were eligible for discharge on oral co-amoxiclav. Prospective data collection on FN episodes in all treatment centres was undertaken over a 1-year period. Seven hundred and sixty two eligible episodes of FN were recorded in 368 patients; 213 episodes were initiated in POCs and 549 episodes were initiated in POSCUs. In 40% of episodes no clinical or microbiological focus of infection was found. At 48h, 212 (27%) episodes were classified as LR and 143 of these (19%) were managed on the LR protocol. There was a low hospital readmission rate (8/143 episodes; 5.6%), no intensive care admissions and no deaths in LR episodes. Almost all LR episodes (209/212) occurred in the shared care setting. Rapid step-down to oral antibiotics was a feasible and safe management strategy for LR FN in the shared care setting in England.

Peer-Delivered Linkage Case Management and Same-Day ART Initiation for Men and Young Persons with HIV Infection - Eswatini, 2015-2017.

PubMed

MacKellar, Duncan; Williams, Daniel; Bhembe, Bonsile; Dlamini, Makhosazana; Byrd, Johnita; Dube, Lenhle; Mazibuko, Sikhathele; Ao, Trong; Pathmanathan, Ishani; Auld, Andrew F; Faura, Pamela; Lukhele, Nomthandazo; Ryan, Caroline

2018-06-15

To achieve epidemic control of human immunodeficiency virus (HIV) infection, sub-Saharan African countries are striving to diagnose 90% of HIV infections, initiate and retain 90% of HIV-diagnosed persons on antiretroviral therapy (ART), and achieve viral load suppression* for 90% of ART recipients (90-90-90) (1). In Eswatini (formerly Swaziland), the country with the world's highest estimated HIV prevalence (27.2%), achieving 90-90-90 depends upon improving access to early ART for men and young adults with HIV infection, two groups with low ART coverage (1-3). Although community-based strategies test many men and young adults with HIV infection in Eswatini, fewer than one third of all persons who test positive in community settings enroll in HIV care within 6 months of diagnosis after receiving standard referral services (4,5). To evaluate the effectiveness of peer-delivered linkage case management † in improving early ART initiation for persons with HIV infection diagnosed in community settings in Eswatini, CDC analyzed data on 651 participants in CommLink, a community-based, mobile HIV-testing, point-of-diagnosis HIV care, and peer-delivered linkage case management demonstration project, and found that after diagnosis, 635 (98%) enrolled in care within a median of 5 days (interquartile range [IQR] = 2-8 days), and 541 (83%) initiated ART within a median of 6 days (IQR = 2-14 days), including 402 (74%) on the day of their first clinic visit (same-day ART). After expanding ART eligibility to all persons with HIV infection on October 1, 2016, 96% of 225 CommLink clients initiated ART, including 87% at their first clinic visit. Compared with women and adult clients aged ≥30 years, similar high proportions of men and persons aged 15-29 years enrolled in HIV care and received same-day ART. To help achieve 90-90-90 by 2020, the United States President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the national scale-up of CommLink in Eswatini and recommending peer-delivered linkage case management as a potential strategy for countries to achieve >90% early enrollment in care and ART initiation after diagnosis of HIV infection (6).

Government conservation policies on Mexican coastal areas: is "top-down" management working?

PubMed

Nava, Héctor; Ramírez-Herrera, M Teresa

2011-12-01

Marine and terrestrial ecosystems are declining globally due to environmental degradation and poorly planned resource use. Traditionally, local government agencies have been responsible of the management of natural reserves to preserve biodiversity. Nonetheless, much of these approaches have failed, suggesting the development of more integrative strategies. In order to discuss the importance of a holistic approach in conservation initiatives, coastal and underwater landscape value and biological/environmental indicators of coral reef degradation were assessed using the study case of Zihuatanejo, Guerrero coastal area. This area shelters representative coral reef structures of the Eastern Pacific coast and its terrestrial biodiversity and archaeology enhance the high value of its coastal area. This study explored the landscape value of both terrestrial and marine ecosystems using the geomorphosite approach in two sites on the Zihuatanejo coastal area: Caleta de Chon and Manzanillo Beach. Sedimentation rate, water transparency, chlorophyll and total suspended solids were recorded underwater in each site for environmental characterization. 50 photo-quadrants on five transects were surveyed between 3-4m depth to record coverage (%) of living corals, dead corals, algae, sand and rocks. The conservation status of coral reefs was assessed by the coral mortality index (MI). Landscape values showed that both terrestrial and marine ecosystems had important scientific and aesthetic values, being Manzanillo Beach the site with the highest potential for conservation initiatives (TtV = 14.2). However, coral reefs face elevated sedimentation rates (up to 1.16 kg/m2d) and low water transparency (less of 5m) generated by coastal land use changes that have increased soil erosion in the adjacent coastal area. High coverage of dead corals (23.6%) and algae (up to 29%) confirm the low values in conservation status of coral reefs (MI = 0.5), reflecting a poorly-planned management. Current conditions are the result of "top-down" conservation strategies in Zihuatanejo, as Federal and Municipal authorities do not coordinate, disregard local community in coral reef management, and ignore the intimate relationship between the coastal and marine realms. This work confirms the importance of conservation strategies with a holistic approach, considering both terrestrial and marine ecosystems in coastal areas; and that these initiatives should include local coastal communities in management and decision-taking processes done by government authorities.

The introduction of new vaccines into developing countries. III. The role of intellectual property.

PubMed

Mahoney, Richard T; Pablos-Mendez, Ariel; Ramachandran, S

2004-01-26

The development of new vaccines that address the particular needs of developing countries has been proceeding slowly. A number of new public sector vaccine research and development initiatives have been launched to address this problem. These new initiatives find that they often wish to collaborate with the private sector and, in collaborating with the private sector, they must address issues of intellectual property (IP) management. It has not been well understood why IP management is important and how such management by public sector groups can best be conducted. IP management has become very important because vaccine research and development is driven by the regulatory process. The regulatory process has increased the cost of vaccine development to very high levels especially for the highly sophisticated new vaccines currently under development. Thus, investors seek IP protection for the required large investments. Conversely, we assert this concept as a new insight, IP rights are essential for mobilizing the significant funds necessary to meet regulatory requirements. Thus, IP rights are of value not only for investors but also for the public at large. In the absence of public sector mechanisms to carry out the functions that the private sector currently conducts, the public sector needs to increase its sophistication in IP management and needs to identify and implement strategies that will help the public sector to achieve its public health goals, especially for the poor and, among these individuals, the poor in developing countries. This paper suggests some strategies that might be used by the public sector to help achieve its public health goals, especially for the poor.

A Water Demand Management Strategy For The Namibian Tourism Sector

NASA Astrophysics Data System (ADS)

Schachtschneider, K.; Winter, K.

The arid conditions of Namibia are forcing its decision-makers to resort to new wa- ter resource management approaches, including Water Demand Management (WDM). When Namibia achieved its independence from South Africa 1990, a new opportunity arose to rewrite certain restrictive laws and policies in order to bring about redress, development and transformation. The new Water Policy is one example in which the mindset is changed from a supply to a demand oriented water management ap- proach. Legal support for WDM within the new Water Act is a critical component that will support the implementation of WDM in all economic sectors, such as agri- culture, mining and tourism. It is argued that an appropriate WDM strategy should be designed specifically for each sector, once the typical water use patterns in a sec- tor are understood and key water resource managers at all levels are identified. The Namibian tourism sector is geographically dispersed and control over its operations is compounded by the fact that it is frequently located in extremely remote areas that are arid and ecologically sensitive. In general, WDM is rarely practised, because it is not yet supported by law and there are currently no institutional arrangements to con- trol water use in this geographically dispersed industrial sector through which WDM could be enforced either through metering and/or payments. Managers of tourist en- terprises undertake most of the water management themselves, and have been identi- fied as being crucial to the implementation of WDM strategies. A study of six tourist facilities determined the willingness and motivation of these managers to undertake various WDM initiatives. The study identified three factors which appear to influence the actions of managers, namely external controls, economics and company ethics. It is recommended that a tourism sector WDM strategy should focus on these three factors in order to transform the WDM aims and objectives on the policy level into practical implementation at the tourist facility level.

[Management of coronary artery disease at the acute phase].

PubMed

Chatot, Marion; Schiele, François

2015-03-01

In patients with acute coronary syndrome (ACS), early management is of prime importance. However, the median time taken by the patient to call the emergency services is often very long, up to 2 hours. The presence of a physician as first responder ensures good quality resuscitation in case of cardiac arrest, and allows recording of a first ECG, which can be very informative, especially in ACS without ST segment elevation. Treatment at this stage is limited to sublingual nitroglycerin and aspirin. If the first ECG shows ST segment elevation, the patient should be immediately oriented for reperfusion, usually by percutaneous coronary intervention. in the absence of ST segment elevation, the diagnosis of ACS remains unconfirmed. This does not imply that the risk is lesser, but rather that the risk cannot be evaluated accurately in the pre-hospital setting. The use of risk scores can guide the choice of management towards an invasive strategy, including coronary angiography (immediately, or within 24-72 hours). Low-risk patients are candidates for an invasive strategy, provided non-invasive tests demonstrate the presence of ischemia. During the hospital phase, antiplatelet treatment should be initiated and must be adapted to the patient bleeding and thrombotic risk. Clopidogrel is recommended only in patients who are not amenable to prasugrel or ticagrelor. Statin therapy should be initiated from day one, regardless of the initial cholesterol level, preferably with 80 mg atorvastatin. Angiotensin-converting enzyme inhibitors and beta-blockers should also be prescribed to complete the medical prescription both in-hospital and in the long term.

Information management strategies within conversations about cigarette smoking: parenting correlates and longitudinal associations with teen smoking.

PubMed

Metzger, Aaron; Wakschlag, Lauren S; Anderson, Ryan; Darfler, Anne; Price, Juliette; Flores, Zujeil; Mermelstein, Robin

2013-08-01

The present study examined smoking-specific and general parenting predictors of in vivo observed patterns of parent-adolescent discussion concerning adolescents' cigarette smoking experiences and associations between these observed patterns and 24-month longitudinal trajectories of teen cigarette smoking behavior (nonsmokers, current experimenters, escalators). Parental solicitation, adolescent disclosure, and adolescent information management were coded from direct observations of 528 video-recorded parent-adolescent discussions about cigarette smoking with 344 teens (M age = 15.62 years) with a history of smoking experimentation (321 interactions with mothers, 207 interactions with fathers). Adolescent initiation of discussions concerning their own smoking behavior (21% of interactions) was predicted by lower levels of maternal observed disapproval of cigarette smoking and fewer teen-reported communication problems with mothers. Maternal initiation in discussions (35% of interactions) was associated with higher levels of family rules about illicit substance use. Three categories of adolescent information management (full disclosure, active secrecy, incomplete strategies) were coded by matching adolescents' confidential self-reported smoking status with their observed spontaneous disclosures and responses to parental solicitations. Fully disclosing teens reported higher quality communication with their mothers (more open, less problematic). Teens engaged in active secrecy with their mothers when families had high levels of parental rules about illicit substance use and when mothers expressed lower levels of expectancies that their teen would smoke in the future. Adolescents were more likely to escalate their smoking over 2 years if their parents initiated the discussion of adolescent smoking behavior (solicited) and if adolescents engaged in active secrecy. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Information Management Strategies Within Conversations About Cigarette Smoking: Parenting Correlates and Longitudinal Associations With Teen Smoking

PubMed Central

Metzger, Aaron; Wakschlag, Lauren S.; Anderson, Ryan; Darfler, Anne; Price, Juliette; Flores, Zujeil; Mermelstein, Robin

2013-01-01

The present study examined smoking-specific and general parenting predictors of in vivo observed patterns of parent–adolescent discussion concerning adolescents’ cigarette smoking experiences and associations between these observed patterns and 24-month longitudinal trajectories of teen cigarette smoking behavior (nonsmokers, current experimenters, escalators). Parental solicitation, adolescent disclosure, and adolescent information management were coded from direct observations of 528 video-recorded parent–adolescent discussions about cigarette smoking with 344 teens (M age = 15.62 years) with a history of smoking experimentation (321 interactions with mothers, 207 interactions with fathers). Adolescent initiation of discussions concerning their own smoking behavior (21% of interactions) was predicted by lower levels of maternal observed disapproval of cigarette smoking and fewer teen-reported communication problems with mothers. Maternal initiation in discussions (35% of interactions) was associated with higher levels of family rules about illicit substance use. Three categories of adolescent information management (full disclosure, active secrecy, incomplete strategies) were coded by matching adolescents’ confidential self-reported smoking status with their observed spontaneous disclosures and responses to parental solicitations. Fully disclosing teens reported higher quality communication with their mothers (more open, less problematic). Teens engaged in active secrecy with their mothers when families had high levels of parental rules about illicit substance use and when mothers expressed lower levels of expectancies that their teen would smoke in the future. Adolescents were more likely to escalate their smoking over 2 years if their parents initiated the discussion of adolescent smoking behavior (solicited) and if adolescents engaged in active secrecy. PMID:23148939

Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project.

PubMed

Van den Broucke, S; Van der Zanden, G; Chang, P; Doyle, G; Levin, D; Pelikan, J; Schillinger, D; Schwarz, P; Sørensen, K; Yardley, L; Riemenschneider, H

2014-12-01

Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes. Although national programs exist, there is no EU-wide strategy for diabetes self-management education, and patients with limited literacy face barriers to effective self-management. The Diabetes Literacy project, initiated with the support of the European Commission, aims to fill this gap. The project investigates the effectiveness of diabetes self-management education, targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States, as part of a comprehensive EU-wide diabetes strategy. National diabetes strategies in the EU, US, Taiwan, and Israel are compared, and diabetes self-management programs inventorized. The costs of the diabetes care pathway are assessed on a per person basis at national level. A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support, and the moderating role of health literacy, organization of the health services, and implementation fidelity of education programs are considered. Web-based materials are developed and evaluated by randomized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy. The 3-year project started in December 2012. Several literature reviews have been produced and protocol development and research design are in the final stages. Primary and secondary data collection and analysis take place in 2014. The results will inform policy decisions on improving the prevention, treatment, and care for persons with diabetes across literacy levels. © Georg Thieme Verlag KG Stuttgart · New York.

A science-based, watershed strategy to support effective remediation of abandoned mine lands

USGS Publications Warehouse

Buxton, Herbert T.; Nimick, David A.; Von Guerard, Paul; Church, Stan E.; Frazier, Ann G.; Gray, John R.; Lipin, Bruce R.; Marsh, Sherman P.; Woodward, Daniel F.; Kimball, Briant A.; Finger, Susan E.; Ischinger, Lee S.; Fordham, John C.; Power, Martha S.; Bunch, Christine M.; Jones, John W.

1997-01-01

A U.S. Geological Survey Abandoned Mine Lands Initiative will develop a strategy for gathering and communicating the scientific information needed to formulate effective and cost-efficient remediation of abandoned mine lands. A watershed approach will identify, characterize, and remediate contaminated sites that have the most profound effect on water and ecosystem quality within a watershed. The Initiative will be conducted during 1997 through 2001 in two pilot watersheds, the Upper Animas River watershed in Colorado and the Boulder River watershed in Montana. Initiative efforts are being coordinated with the U.S. Forest Service, Bureau of Land Management, National Park Service, and other stakeholders which are using the resulting scientific information to design and implement remediation activities. The Initiative has the following eight objective-oriented components: estimate background (pre-mining) conditions; define baseline (current) conditions; identify target sites (major contaminant sources); characterize target sites and processes affecting contaminant dispersal; characterize ecosystem health and controlling processes at target sites; develop remediation goals and monitoring network; provide an integrated, quality-assured and accessible data network; and document lessons learned for future applications of the watershed approach.

An environmental scan of policies in support of chronic disease self-management in Canada.

PubMed

Liddy, C; Mill, K

2014-02-01

The evidence supporting chronic disease self-management warrants further attention. Our aim was to identify existing policies, strategies and frameworks that support self-management initiatives. This descriptive study was conducted as an environmental scan, consisting of an Internet search of government and other publicly available websites, and interviews with jurisdictional representatives identified through the Health Council of Canada and academic networking. We interviewed 16 representatives from all provinces and territories in Canada and found 30 publicly available and relevant provincial and national documents. Most provinces and territories have policies that incorporate aspects of chronic disease self-management. Alberta and British Columbia have the most detailed policies. Both feature primary care prominently and are not disease specific. Both also have provincial level implementation of chronic disease self-management programming. Canada's northern territories all lacked specific policies supporting chronic disease self-management despite a significant burden of disease. Engaging patients in self-management of their chronic diseases is important and effective. Although most provinces and territories have policies that incorporate aspects of chronic disease self-management, they were often embedded within other initiatives and/or policy documents framed around specific diseases or populations. This approach could limit the potential reach and effect of self-management.

Cognitive load during route selection increases reliance on spatial heuristics.

PubMed

Brunyé, Tad T; Martis, Shaina B; Taylor, Holly A

2018-05-01

Planning routes from maps involves perceiving the symbolic environment, identifying alternate routes and applying explicit strategies and implicit heuristics to select an option. Two implicit heuristics have received considerable attention, the southern route preference and initial segment strategy. This study tested a prediction from decision-making theory that increasing cognitive load during route planning will increase reliance on these heuristics. In two experiments, participants planned routes while under conditions of minimal (0-back) or high (2-back) working memory load. In Experiment 1, we examined how memory load impacts the southern route heuristic. In Experiment 2, we examined how memory load impacts the initial segment heuristic. Results replicated earlier results demonstrating a southern route preference (Experiment 1) and initial segment strategy (Experiment 2) and further demonstrated that evidence for heuristic reliance is more likely under conditions of concurrent working memory load. Furthermore, the extent to which participants maintained efficient route selection latencies in the 2-back condition predicted the magnitude of this effect. Together, results demonstrate that working memory load increases the application of heuristics during spatial decision making, particularly when participants attempt to maintain quick decisions while managing concurrent task demands.

Sustainability of depression care improvements: success of a practice change improvement collaborative.

PubMed

Nease, Donald E; Nutting, Paul A; Graham, Deborah G; Dickinson, W Perry; Gallagher, Kaia M; Jeffcott-Pera, Michelle

2010-01-01

Long-term sustainment of improvements in care continues to challenge primary care practices. During the 2 years after of our Improving Depression Care collaborative, we examined how well practices were sustaining their depression care improvements. Our study design used a qualitative interview follow-up of a modified learning collaborative intervention. We conducted telephone interviews with practice champions from 15 of the original 16 practices. Interviews were conducted during a 3-month period in 2008, and were recorded and professionally transcribed. Data on each of the depression care improvements and the change management strategy emphasized during the learning collaborative were summarized after review of the primary data and a consensus process to resolve differing interpretations. During the period from 15 months to 3 years since our project began, depression screening or case finding was sustained in 14 of 15 practices. Thirteen practices sustained use of the 9-item Patient Health Questionnaire for depression monitoring, and one additional practice initiated it. Seven practices initiated self-management support and 2 of 3 practices sustained it. In contrast, tracking and case management proved difficult to sustain, with only 4 of 8 practices continuing this activity. Diffusion of use of the 9-item Patient Health Questionnaire to other clinicians in the practice was maintained in all but 3 practices and expanded in one practice. Six of the practices continued to use the change management strategy, including all 4 of the practices that sustained tracking. Practices demonstrated long-term sustained improvement in depression care with the exception of tracking and care management, which may be a more challenging innovation to sustain. We hypothesize that sustaining complex depression care innovations may require active management by the practice.

The relative value of growth.

PubMed

Mass, Nathaniel J

2005-04-01

Most executives would say that adding a point of growth and gaining a point of operating-profit margin contribute about equally to shareholder value. Margin improvements hit the bottom line immediately, while growth compounds value over time. But the reality is that the two are rarely equivalent. Growth often is far more valuable than managers think. For some companies, convincing the market that they can grow by just one additional percentage point can be worth six, seven, or even ten points of margin improvement. This article presents a new strategic metric, called the relative value of growth (RVG), which gives managers a clear picture of how growth projects and margin improvement initiatives affect shareholder value. Using basic balance sheet and income sheet data, managers can determine their companies' RVGs, as well as those of their competitors. Calculating RVGs gives managers insights into which corporate strategies are working to deliver value and whether their companies are pulling the most powerful value-creation levers. The author examines a number of well-known companies and explains what their RVG numbers say about their strategies. He reviews the unspoken assumption that growth and profits are incompatible over the long term and shows that a fair number of companies are effective at delivering both. Finally, he explains how managers can use the RVG framework to help them define strategies that balance growth and profitability at both the corporate and business unit levels.

Is environmental sustainability a strategic priority for logistics service providers?

PubMed

Evangelista, Pietro; Colicchia, Claudia; Creazza, Alessandro

2017-08-01

Despite an increasing number of third-party logistics service providers (3PLs) regard environmental sustainability as a key area of management, there is still great uncertainty on how 3PLs implement environmental strategies and on how they translate green efforts into practice. Through a multiple case study analysis, this paper explores the environmental strategies of a sample of medium-sized 3PLs operating in Italy and the UK, in terms of environmental organizational culture, initiatives, and influencing factors. Our analysis shows that, notwithstanding environmental sustainability is generally recognised as a strategic priority, a certain degree of diversity in the deployment of environmental strategies still exists. This paper is original since the extant literature on green strategies of 3PLs provides findings predominantly from a single country perspective and mainly investigates large/multinational organizations. It also provides indications to help managers of medium-sized 3PLs in positioning their business. This is particularly meaningful in the 3PL industry, where medium-sized organizations significantly contribute to the generated turnover and market value. Copyright © 2017 Elsevier Ltd. All rights reserved.

Joining forces: collaborating internationally to deliver high-quality, online postgraduate education in pain management.

PubMed

Devonshire, Elizabeth; Siddall, Philip

2011-01-01

The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia) has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives.

Survival models for harvest management of mourning dove populations

USGS Publications Warehouse

Otis, D.L.

2002-01-01

Quantitative models of the relationship between annual survival and harvest rate of migratory game-bird populations are essential to science-based harvest management strategies. I used the best available band-recovery and harvest data for mourning doves (Zenaida macroura) to build a set of models based on different assumptions about compensatory harvest mortality. Although these models suffer from lack of contemporary data, they can be used in development of an initial set of population models that synthesize existing demographic data on a management-unit scale, and serve as a tool for prioritization of population demographic information needs. Credible harvest management plans for mourning dove populations will require a long-term commitment to population monitoring and iterative population analysis.

Joining forces: Collaborating internationally to deliver high-quality, online postgraduate education in pain management

PubMed Central

Devonshire, Elizabeth; Siddall, Philip J

2011-01-01

The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high-quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia) has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives. PMID:22184549

Modeling the Potential Economic Impact of the Medicare Comprehensive Care for Joint Replacement Episode-Based Payment Model.

PubMed

Maniya, Omar Z; Mather, Richard C; Attarian, David E; Mistry, Bipin; Chopra, Aneesh; Strickland, Matt; Schulman, Kevin A

2017-11-01

The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting. For each of 798 hospitals included in CJR, we used hospital-specific volume, cost, and quality data to determine the hospital's economically dominant strategy. We aggregated data to assess the percentage of hospitals pursuing each strategy; savings to the health care system; and costs and percentages of CJR-derived revenues gained or lost for Medicare, hospitals, and postacute care facilities. In the model, 83.1% of hospitals (range 55.0%-100.0%) were expected to take no action in response to CJR, and 16.1% of hospitals (range 0.0%-45.0%) were expected to pursue heavy care management with contracting. Overall, CJR is projected to reduce health care expenditures by 0.5% (range 0.0%-4.1%) or $14 million (range $0-$119 million). Medicare is expected to save 2.2% (range 2.2%-2.2%), hospitals are projected to lose 3.7% (range 4.7% loss to 3.8% gain), and postacute care facilities are expected to lose 6.5% (range 0.0%-12.8%). Hospital administrative costs are projected to increase by $63 million (range $0-$148 million). CJR is projected to have a negligible impact on total health care expenditures for lower extremity joint replacements. Further research will be required to assess the actual care management strategies adopted by CJR hospitals. Copyright © 2017 Elsevier Inc. All rights reserved.

Strategies to enhance waste minimization and energy conservation within organizations: a case study from the UK construction sector.

PubMed

Jones, Jo; Jackson, Janet; Tudor, Terry; Bates, Margaret

2012-09-01

Strategies for enhancing environmental management are a key focus for the government in the UK. Using a manufacturing company from the construction sector as a case study, this paper evaluates selected interventionist techniques, including environmental teams, awareness raising and staff training to improve environmental performance. The study employed a range of methods including questionnaire surveys and audits of energy consumption and generation of waste to examine the outcomes of the selected techniques. The results suggest that initially environmental management was not a focus for either the employees or the company. However, as a result of employing the techniques, the company was able to reduce energy consumption, increase recycling rates and achieve costs savings in excess of £132,000.

Risk evaluation mitigation strategies: the evolution of risk management policy.

PubMed

Hollingsworth, Kristen; Toscani, Michael

2013-04-01

The United States Food and Drug Administration (FDA) has the primary regulatory responsibility to ensure that medications are safe and effective both prior to drug approval and while the medication is being actively marketed by manufacturers. The responsibility for safe medications prior to marketing was signed into law in 1938 under the Federal Food, Drug, and Cosmetic Act; however, a significant risk management evolution has taken place since 1938. Additional federal rules, entitled the Food and Drug Administration Amendments Act, were established in 2007 and extended the government's oversight through the addition of a Risk Evaluation and Mitigation Strategy (REMS) for certain drugs. REMS is a mandated strategy to manage a known or potentially serious risk associated with a medication or biological product. Reasons for this extension of oversight were driven primarily by the FDA's movement to ensure that patients and providers are better informed of drug therapies and their specific benefits and risks prior to initiation. This article provides an historical perspective of the evolution of medication risk management policy and includes a review of REMS programs, an assessment of the positive and negative aspects of REMS, and provides suggestions for planning and measuring outcomes. In particular, this publication presents an overview of the evolution of the REMS program and its implications.

Out of control little-used clinical assets are draining healthcare budgets.

PubMed

Horblyuk, Ruslan; Kaneta, Kristopher; McMillen, Gary L; Mullins, Christopher; O'Brien, Thomas M; Roy, Ankita

2012-07-01

To improve utilization and reduce the cost of maintaining mobile clinical equipment, healthcare organization leaders should do the following: Select an initial asset group to target. Conduct a physical inventory. Evaluate the organization's asset "ecosystem." Optimize workflow processes. Phase in new processes, and phase out inventory. Devote time to change management. Develop a replacement strategy.

Autonomy and School Improvement: What Do We Know and Where Do We Go from Here?

ERIC Educational Resources Information Center

Honig, Meredith I.; Rainey, Lydia R.

2012-01-01

New "autonomy initiatives" aim to increase schools' decision-making authority as a strategy to leverage school improvement. These policies build on lessons of previous reforms such as site-based management in ways that bode well for their success. However, how are these policies actually faring in implementation? The authors addressed that…

Connecting with Others: Lessons for Teaching Social and Emotional Competence, Grades K-2 [and] Grades 3-5.

ERIC Educational Resources Information Center

Richardson, Rita C.

The Connecting with Others program, initially developed to teach prosocial skills to special-needs students within regular classroom settings, offers an alternative strategy to classroom management and discipline through instruction in self-regulation skills and conflict resolution. The program for elementary grades consists of a K-2 volume and…

Portfolio District Reform Meets School Turnaround: Early Implementation Findings from the Los Angeles Public School Choice Initiative

ERIC Educational Resources Information Center

Marsh, Julie A.; Strunk, Katharine O.; Bush, Susan

2013-01-01

Purpose: Despite the popularity of school "turnaround" and "portfolio district" management as solutions to low performance, there has been limited research on these strategies. The purpose of this paper is to address this gap by exploring the strategic case of Los Angeles Unified School District's Public School Choice…

Successful Negotiation in Schools: Management, Unions, Employees, and Citizens.

ERIC Educational Resources Information Center

Herman, Jerry J.; Herman, Janice L.

This book is a how-to-do-it roadmap that presents practical details on the important aspects of collective bargaining at the local school district level. It details all of the strategies, tasks, events, and influences that bear on the collective bargaining process from the initial certification election of a union through the preparation for…

Phytophthora ramorum and sudden oak death in California: III. preliminary studies in pathogen genetics

Treesearch

Matteo Garbelotto; David M. Rizzo; Katie Hayden; Monica Meija-Chang; Jennifer M. Davidson; Steven Tjosvold

2002-01-01

Sudden oak death (SOD) has been shown to be caused by a new species of Phytophthora, P. ramorum. A basic understanding of the genetics of P. ramorum is critical to any management strategy. We have initiated a number of studies to examine species concepts, population biology and mating behavior of the pathogen....

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

PubMed

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

2017-09-07

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

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria

PubMed Central

Folayan, Morenike Oluwatoyin

2016-01-01

Objectives Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. Methods We analyzed data from 436 sexually active 10–19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman’s conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Results Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14–11.87), and transactional sex (OR: 2.80; 95% CI: 1.56–4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96–1.11) and loss and grief (OR: 1.34; 95% CI: 0.73–2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34–1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62–3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49–1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09–0.83). Conclusion History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries. PMID:27163436

Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.

PubMed

Folayan, Morenike Oluwatoyin; Harrison, Abigail; Brown, Brandon; Odetoyinbo, Morolake; Stockman, Jamila K; Ajuwon, Ademola J; Cáceres, Carlos F

2016-01-01

Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status. We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies. Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83). History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.

Lewin's Theory of Planned Change as a strategic resource.

PubMed

Shirey, Maria R

2013-02-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author explores the use of the Lewin's Theory of Planned Change as a strategic resource to mobilize the people side of change. An overview of the theory is provided along with a discussion of its strengths, limitations, and targeted application.

[Strategies to prevent the transmission of multidrug-resistant pathogens and their practical implementation in oupatient care].

PubMed

Adler, A C; Spegel, H; Wilke, J; Höller, C; Herr, C

2012-10-01

Multidrugresistant pathogens which are highly relevant for infection control in hospitals and other health-care facilities are a serious public health problem and a big challenge for all players in the health sector. In order to prevent the spread of multi-resistant pathogens the Commission for Hospital Hygiene of the Robert Koch-Institute (RKI) has published guidelines. These recommendations refer to the consequent implementation of an infection control management in all health care settings, including outpatient care. In Germany there are only few data available concerning infection control management and the implementation of preventive strategies in outpatient care. To what extent are national guidelines concerning infection control of multidrugresistant pathogens (i.e. methicillin-resistant Staphylococcus aureus, MRSA) feasible and practicable in outpatient care? And what are the reasons not to practice these strategies. In outpatient care the status of the infection control management and the implementation of prevention strategies was surveyed and assessed. Data were collected by structured interviews - a face to face method. Guidelines concerning infection control management are not always sufficiently implemented in outpatient care. There are multiple reasons for this, such as, e.g., lack of compliance with the recommendations as well as structural problems in the health-care system, and special challenges of outpatient care. Implementation of an infection control management concerning multidrug-resistant pathogens in outpatient care is problematic. Prevention strategies are commonly not known or not adequately implemented into daily practice. Actions to improve the situation should focus at the individual level (e.g., trainings in the context of the initiative "clean hands" ), the institutional level (improving networking, bonus schemes) and the social level (financial and legal support for outpatient care centres to bear the expenses of infection control management, "search and destroy"). © Georg Thieme Verlag KG Stuttgart · New York.

Review of Strategies to Enhance Outcomes for Patients with Type 2 Diabetes: Payers' Perspective

PubMed Central

Greenapple, Rhonda

2011-01-01

Background Diabetes and its clinical consequences exact a great toll on patients and on society in terms of its effects on morbidity and mortality and its staggering economic impact. Objective To review various programs and strategies that aim at enhancing adherence to antihyperglycemic therapy and suggest the best approach to improving patient outcomes and reducing healthcare costs. Discussion Treatment goals for patients with diabetes have been defined, and multiple safe and effective medications are available. Nevertheless, the majority of patients with diabetes fail to achieve treatment goals, because of difficulty with adherence to medication regimens and lifestyle modifications, and because of economic barriers. This article discusses various initiatives developed to improve patient outcomes, including consumer-driven health plans and wellness and prevention programs. Furthermore, economic incentives to patients, such as value-based insurance design, may increase adherence; nevertheless, evidence suggests that such programs alone provide only modest gains. Primary providers in disease management programs can include nurses, case managers, or pharmacists. Supportive interventions across several modalities have been shown to be effective. Conclusion An approach that uses a combination of strategies designed to impact patients' health-related behaviors across a variety of modalities may help to improve outcomes and reduce costs. Additional novel, innovative interdisciplinary initiatives are necessary to effect meaningful change that can facilitate improved health outcomes for patients with diabetes and maximize cost-effectiveness approaches for payers. PMID:25126364

Gathering, organizing and accessing data for use in bird conservation across the Americas

USGS Publications Warehouse

Martin, Elizabeth; Peterjohn, Bruce G.; Kelling, Steve; Rich, Terrell D.

2008-01-01

The U.S. North American Bird Conservation Initiative (NABCI) Monitoring Subcommittee (2007) identified the need for a comprehensive plan for integrating and managing bird population monitoring data, and to adapt this as an integral component for improving monitoring activities across North America. While the Subcommittee provided a basic framework to begin development of this data management strategy, input from stakeholders is needed to identify data management needs and the technical capacity necessary to solve those challenges. We organized a session at the Fourth International Partners in Flight Conference to solicit input from session participants from across the Americas and identify their data management needs. Session speakers and participants provided examples of the challenges encountered with data management and how the Internet is increasingly used to provide access to the data needed for bird conservation decisions. Input provided during the session indicated that data management needs extended beyond technology to include scientifi c, conservation, social, institutional, and cultural issues. Because data management is intricately related to all aspects of bird conservation, a coordination process that elevates the importance of data management within the bird conservation community is needed, in addition to improving data management associated with bird population monitoring programs. Development of a comprehensive data management strategy for bird population monitoring data would help address the needs and challenges identified during this session.

Controlling inpatient psychiatric utilization through managed care.

PubMed

Wickizer, T M; Lessler, D; Travis, K M

1996-03-01

There is little current understanding of how managed care strategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, utilization management, which reviews requests for psychiatric care and authorizes provision of care deemed appropriate and clinically necessary. The authors analyzed data on 2,265 utilization management reviews conducted during 1989-1992 for patients insured by a single large commercial insurance company. Three utilization management procedures were examined: preadmission review, continued-stay review, and case management. The performance indicators analyzed included percent of admission requests granted, number of days requested and approved, and number of treatment extensions granted. Utilization management initially approved inpatient psychiatric treatment for nearly all (98.8%) of the patients but authorized, on average, only one-third of the days requested (6.9 versus 19.0). On average, 23.5 (total) days of care were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was care for other patients. These data suggest that managed care does restrict inpatient psychiatric care, primarily by managing length of stay. The fact that almost all patients were approved for the same initial length of stay implies adherence to strict treatment protocols that do not distinguish among different clinical or patient factors. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

Strategies for ensuring global consistency/comparability of water-quality data

USGS Publications Warehouse

Klein, J.M.

1999-01-01

In the past 20 years the water quality of the United States has improved remarkably-the waters are safer for drinking, swimming, and fishing. However, despite many accomplishments, it is still difficult to answer such basic questions as: 'How clean is the water?' and 'How is it changing over time?' These same questions exist on a global scale as well. In order to focus water-data issues in the United States, a national Intergovernmental Task Force on Monitoring Water Quality (ITFM) was initiated for public and private organizations, whereby key elements involved in data collection, analysis, storage, and management could be made consistent and comparable. The ITFM recommended and its members are implementing a nationwide strategy to improve water-quality monitoring, assessment, and reporting activities. The intent of this paper is to suggest that a voluntary effort be initiated to ensure the comparability and utility of hydrological data on a global basis. Consistent, long-term data sets that are comparable are necessary in order to formulate ideas regarding regional and global trends in water quantity and quality. The author recommends that a voluntary effort similar to the ITFM effort be utilized. The strategy proposed would involve voluntary representation from countries and international organizations (e.g. World Health Organization) involved in drinking-water assessments and/or ambient water-quality monitoring. Voluntary partnerships such as this will improve curability to reduce health risks and achieve a better return on public and private investments in monitoring, environmental protection, and natural resource management, and result in a collaborative process that will save millions of dollars.In this work it is suggested that a voluntary effort be initiated to ensure the comparability and utility of hydrological data on a global basis. The strategy proposed would involve voluntary representation from countries and international organizations involved in drinking-water assessments and/or ambient water-quality monitoring.

Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

PubMed

Eiamcharoenwit, Jatuporn; Akavipat, Phuping; Ariyanuchitkul, Thidarat; Wirachpisit, Nichawan; Pulnitiporn, Aksorn; Pongraweewan, Orawan

2018-01-01

The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

Endovascular Treatment of Pulsatile Tinnitus by Sigmoid Sinus Aneurysm: Technical Note and Review of the Literature.

PubMed

Cuellar, Hugo; Maiti, Tanmoy; Patra, Devi Prasad; Savardekar, Amey; Sun, Hai; Nanda, Anil

2018-05-01

Pulse-synchronous tinnitus is rare, and it almost always points toward a vascular pathology. We encountered a 56-year-old patient presenting with a 3-month history of right-side tinnitus who was found to have a sigmoid sinus aneurysm after initial imaging. The patient was managed successfully with dual endovascular access and stent placement across the aneurysm, with a subsequent complete symptomatic relief. Description of the endovascular management of sigmoid sinus aneurysm is not infrequent in the literature. This report provides a brief review of the available literature specifically addressing the management strategies. Copyright © 2018 Elsevier Inc. All rights reserved.

Post-Polio Syndrome and the Late Effects of Poliomyelitis: Part 2. Treatment, Management and Prognosis.

PubMed

Lo, Julian K; Robinson, Lawrence R

2018-05-12

Post-Polio Syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years following the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

Biological effects-based tools for monitoring impacted surface waters in the Great Lakes: a multiagency program in support of the Great Lakes Restoration Initiative

USGS Publications Warehouse

Ekman, Drew R.; Ankley, Gerald T.; Blazer, Vicki; Collette, Timothy W.; Garcia-Reyero, Natàlia; Iwanowicz, Luke R.; Jorgensen, Zachary G.; Lee, Kathy E.; Mazik, Pat M.; Miller, David H.; Perkins, Edward J.; Smith, Edwin T.; Tietge, Joseph E.; Villeneuve, Daniel L.

2013-01-01

There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.

Perspectives, perceptions and experiences in postoperative pain management in developing countries: A focus group study conducted in Rwanda

PubMed Central

Johnson, Ana P; Mahaffey, Ryan; Egan, Rylan; Twagirumugabe, Theogene; Parlow, Joel L

2015-01-01

BACKGROUND: Access to postoperative acute pain treatment is an important component of perioperative care and is frequently managed by a multidisciplinary team of anesthesiologists, surgeons, pharmacists, technicians and nurses. In some developing countries, treatment modalities are often not performed due to scarce health care resources, knowledge deficiencies and cultural attitudes. OBJECTIVES: In advance of a comprehensive knowledge translation initiative, the present study aimed to determine the perspectives, perceptions and experiences of anesthesia residents regarding postoperative pain management strategies. METHODS: The present study was conducted using a qualitative assessment strategy in a large teaching hospital in Rwanda. During two sessions separated by seven days, a 10-participant semistructured focus group needs analysis was conducted with anesthesia residents at the Centre Hospitalier Universitaire de Kigali (Kigali, Rwanda). Field notes were analyzed using interpretative and descriptive phenomenological approaches. Participants were questioned regarding their perspectives, perceptions and experiences in pain management. RESULTS: The responses from the focus groups were related to five general areas: general patient and medical practice management; knowledge base regarding postoperative pain management; pain evaluation; institutional/system issues related to protocol implementation; and perceptions about resource allocation. Within these areas, challenges (eg, communication among stakeholders and with patients) and opportunities (eg, on-the-job training, use of protocols, routine pain assessment, participation in resource allocation decisions) were identified. CONCLUSIONS: The present study revealed the prevalent challenges residents perceive in implementing postoperative pain management strategies, and offers practical suggestions to overcoming them, primarily through training and the implementation of practice recommendations. PMID:26448971

Evaluation of the sustained implementation of a mental health learning initiative in long-term care.

PubMed

McAiney, Carrie A; Stolee, Paul; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

2007-10-01

This paper describes an innovative education program for the management of mental health problems in long-term care (LTC) homes and the evaluation of its longer-term sustainability. Since 1998, the "Putting the P.I.E.C.E.S. Together" learning initiative has been providing education sessions and related learning strategies aimed at developing the knowledge and skills of health professionals who care for older persons with complex physical and mental health needs and associated behaviors, in Ontario, Canada. A major focus of this province-wide initiative was the development of in-house Psychogeriatric Resource Persons (PRPs). Evaluation of this initiative included the completion of pre- and post-education questionnaires (over three data collection time periods) assessing learner confidence (N = 1,024 and 792, for pre- and post-education, respectively) and session evaluation questionnaires gathering feedback on the session (N = 2,029 across all sessions). A survey of LTC homes in Ontario (N = 439, 79% of the homes in the province) was conducted to assess longer-term sustainability. Ratings of the sessions indicated that they were relevant to learners' clinical practice. There were significant increases in ratings of ability to recognize and understand challenging behaviors and mental health problems, and in ability to use a variety of assessment tools. Few homes (15%) do not have a PRP; over 50% of the staff who completed the first session in 1999 continue to serve as a PRP and to apply learned skills. A learning initiative with supportive and reinforcing strategies can develop in-house PRPs to enhance the care of the elderly in LTC. Incorporation of PRP functions into job descriptions and management support contributed to the success of this initiative. This study highlights the importance of work environments that support and reinforce the use of learned skills to the success of continuing education and quality improvement initiatives in LTC.

Lean Six Sigma implementation and organizational culture.

PubMed

Knapp, Susan

2015-01-01

The purpose of this paper is to examine the relationship between four organizational cultural types defined by the Competing Values Framework and three Lean Six Sigma implementation components - management involvement, use of Lean Six Sigma methods and Lean Six Sigma infrastructure. The study involved surveying 446 human resource and quality managers from 223 hospitals located in Maine, New Hampshire, Vermont, Massachusetts and Rhode Island using the Organizational Culture Assessment Instrument. Findings - In total, 104 completed responses were received and analyzed using multivariate analysis of variance. Follow-up analysis of variances showed management support was significant, F(3, 100)=4.89, p < 0.01, η2=1.28; infrastructure was not significant, F(3, 100)=1.55, p=0.21, η2=0.05; and using Lean Six Sigma methods was also not significant, F(3, 100)=1.34, p=0.26, η2=0.04. Post hoc analysis identified group and development cultures having significant interactions with management support. The relationship between organizational culture and Lean Six Sigma in hospitals provides information on how specific cultural characteristics impact the Lean Six Sigma initiative key components. This information assists hospital staff who are considering implementing quality initiatives by providing an understanding of what cultural values correspond to effective Lean Six Sigma implementation. Managers understanding the quality initiative cultural underpinnings, are attentive to the culture-shared values and norm's influence can utilize strategies to better implement Lean Six Sigma.

Adaptive management for subsurface pressure and plume control in application to geological CO2 storage

NASA Astrophysics Data System (ADS)

Gonzalez-Nicolas, A.; Cihan, A.; Birkholzer, J. T.; Petrusak, R.; Zhou, Q.; Riestenberg, D. E.; Trautz, R. C.; Godec, M.

2016-12-01

Industrial-scale injection of CO2 into the subsurface can cause reservoir pressure increases that must be properly controlled to prevent any potential environmental impact. Excessive pressure buildup in reservoir may result in ground water contamination stemming from leakage through conductive pathways, such as improperly plugged abandoned wells or distant faults, and the potential for fault reactivation and possibly seal breaching. Brine extraction is a viable approach for managing formation pressure, effective stress, and plume movement during industrial-scale CO2 injection projects. The main objectives of this study are to investigate suitable different pressure management strategies involving active brine extraction and passive pressure relief wells. Adaptive optimized management of CO2 storage projects utilizes the advanced automated optimization algorithms and suitable process models. The adaptive management integrates monitoring, forward modeling, inversion modeling and optimization through an iterative process. In this study, we employ an adaptive framework to understand primarily the effects of initial site characterization and frequency of the model update (calibration) and optimization calculations for controlling extraction rates based on the monitoring data on the accuracy and the success of the management without violating pressure buildup constraints in the subsurface reservoir system. We will present results of applying the adaptive framework to test appropriateness of different management strategies for a realistic field injection project.

HIV-1 tropism testing and clinical management of CCR5 antagonists: Quebec review and recommendations.

PubMed

Tremblay, Cécile; Hardy, Isabelle; Lalonde, Richard; Trottier, Benoit; Tsarevsky, Irina; Vézina, Louis-Philippe; Roger, Michel; Wainberg, Mark; Baril, Jean-Guy

2013-01-01

HIV-1 tropism assays play a crucial role in determining the response to CCR5 receptor antagonists. Initially, phenotypic tests were used, but limited access to these tests prompted the development of alternative strategies. Recently, genotyping tropism has been validated using a Canadian technology in clinical trials investigating the use of maraviroc in both experienced and treatment-naive patients. The present guidelines review the evidence supporting the use of genotypic assays and provide recommendations regarding tropism testing in daily clinical management.

2017 European guidelines for the management of genital herpes.

PubMed

Patel, Rajul; Kennedy, Oliver J; Clarke, Emily; Geretti, Anna; Nilsen, Arvid; Lautenschlager, Stephan; Green, John; Donders, Gilbert; van der Meijden, Willem; Gomberg, Mikhail; Moi, Harald; Foley, Elizabeth

2017-12-01

Genital herpes is one of the commonest sexually transmitted infections worldwide. Using the best available evidence, this guideline recommends strategies for diagnosis, management, and follow-up of the condition as well as for minimising transmission. Early recognition and initiation of therapy is key and may reduce the duration of illness or avoid hospitalisation with complications, including urinary retention, meningism, or severe systemic illness. The guideline covers a range of common clinical scenarios, such as recurrent genital herpes, infection during pregnancy, and co-infection with human immunodeficiency virus.

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

PubMed

Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

2017-03-06

Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

CLEANER-Hydrologic Observatory Joint Science Plan

NASA Astrophysics Data System (ADS)

Welty, C.; Dressler, K.; Hooper, R.

2005-12-01

The CLEANER-Hydrologic Observatory* initiative is a distributed network for research on complex environmental systems that focuses on the intersecting water-related issues of both the CUAHSI and CLEANER communities. It emphasizes research on the nation's water resources related to human-dominated natural and built environments. The network will be comprised of: interacting field sites with an integrated cyberinfrastructure; a centralized technical resource staff and management infrastructure to support interdisciplinary research through data collection from advanced sensor systems, data mining and aggregation from multiple sources and databases; cyber-tools for analysis, visualization, and predictive multi-scale modeling that is dynamically driven. As such, the network will transform 21st century workforce development in the water-related intersection of environmental science and engineering, as well as enable substantial educational and engagement opportunities for all age levels. The scientific goal and strategic intent of the CLEANER-Hydrologic Observatory Network is to transform our understanding of the earth's water cycle and associated biogeochemical cycles across spatial and temporal scales-enabling quantitative forecasts of critical water-related processes, especially those that affect and are affected by human activities. This strategy will develop scientific and engineering tools that will enable more effective adaptive approaches for resource management. The need for the network is based on three critical deficiencies in current abilities to understand large-scale environmental processes and thereby develop more effective management strategies. First we lack basic data and the infrastructure to collect them at the needed resolution. Second, we lack the means to integrate data across scales from different media (paper records, electronic worksheets, web-based) and sources (observations, experiments, simulations). Third, we lack sufficiently accurate modeling and decision-support tools to predict the underlying processes or subsequently forecast the effects of different management strategies. Water is a critical driver for the functioning of all ecosystems and development of human society, and it is a key ingredient for the success of industry, agriculture and, national economy. CLEANER-Hydrologic Observatories will foster cutting-edge science and engineering research that addresses major national needs (public and governmental) related to water and include, for example: (i) water resource problems, such as impaired surface waters, contaminated ground water, water availability for human use and ecosystem needs, floods and floodplain management, urban storm water, agricultural runoff, and coastal hypoxia; (ii) understanding environmental impacts on public health; (iii) achieving a balance of economic and environmental sustainability; (iv) reversing environmental degradation; and (v) protecting against chemical and biological threats. CLEANER (Collaborative Large-scale Engineering Analysis Network for Environmental Research) is an ENG initiative; the Hydrologic Observatory Network is GEO initiative through CUAHSI (Consortium of Universities for the Advancement of Hydrologic Science, Inc.). The two initiatives were merged into a joint, bi-directorate program in December 2004.

Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective.

PubMed

Greenwell, T J; Castle, C; Andrich, D E; MacDonald, J T; Nicol, D L; Mundy, A R

2004-07-01

We developed an algorithm for the management of urethral stricture based on cost-effectiveness. United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132). The costs were urethrotomy/urethral dilation 2,250.00 pounds sterling (3,375.00 dollars, ratio 1.00), simple 1-stage urethroplasty 5,015.00 pounds sterling (7,522.50 dollars, ratio 2.23), complex 1-stage urethroplasty 5,335.00 pounds sterling (8,002.50 dollars, ratio 2.37) and 2-stage urethroplasty 10,370 pounds sterling (15,555.00 dollars, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was 6,113 pounds sterling (9,170 dollars). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of 5,866 pounds sterling (8,799 dollars). A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.

Decision analysis framing study; in-valley drainage management strategies for the western San Joaquin Valley, California

USGS Publications Warehouse

Presser, Theresa S.; Jenni, Karen E.; Nieman, Timothy; Coleman, James

2010-01-01

Constraints on drainage management in the western San Joaquin Valley and implications of proposed approaches to management were recently evaluated by the U.S. Geological Survey (USGS). The USGS found that a significant amount of data for relevant technical issues was available and that a structured, analytical decision support tool could help optimize combinations of specific in-valley drainage management strategies, address uncertainties, and document underlying data analysis for future use. To follow-up on USGS's technical analysis and to help define a scientific basis for decisionmaking in implementing in-valley drainage management strategies, this report describes the first step (that is, a framing study) in a Decision Analysis process. In general, a Decision Analysis process includes four steps: (1) problem framing to establish the scope of the decision problem(s) and a set of fundamental objectives to evaluate potential solutions, (2) generation of strategies to address identified decision problem(s), (3) identification of uncertainties and their relationships, and (4) construction of a decision support model. Participation in such a systematic approach can help to promote consensus and to build a record of qualified supporting data for planning and implementation. In December 2008, a Decision Analysis framing study was initiated with a series of meetings designed to obtain preliminary input from key stakeholder groups on the scope of decisions relevant to drainage management that were of interest to them, and on the fundamental objectives each group considered relevant to those decisions. Two key findings of this framing study are: (1) participating stakeholders have many drainage management objectives in common; and (2) understanding the links between drainage management and water management is necessary both for sound science-based decisionmaking and for resolving stakeholder differences about the value of proposed drainage management solutions. Citing ongoing legal processes associated with drainage management in the western San Joaquin Valley, the U.S. Bureau of Reclamation (USBR) withdrew from the Decision Analysis process early in the proceedings. Without the involvement of the USBR, the USGS discontinued further development of this study.

Chlamydia screening strategies and outcomes in educational settings: a systematic review.

PubMed

Jamil, Muhammad Shahid; Bauer, Heidi M; Hocking, Jane S; Ali, Hammad; Wand, Handan; Walker, Jennifer; Douglas, Laura; Donovan, Basil; Kaldor, John M; Guy, Rebecca J

2014-03-01

Chlamydia trachomatis (CT) screening programs have been established in educational settings in many countries during the past 2 decades. However, recent evidence suggests that high uptake of screening and management (treatment, partner notification, and retesting for reinfection) improves program effectiveness. We conducted a systematic review to understand the screening strategies, the extent of screening conducted, and uptake of management strategies in educational settings. Screening studies in educational settings were identified through a systematic search of published literature from 2005 to 2011. We identified 27 studies describing 30 screening programs in the United States/Canada (n = 10), Europe (n = 8), Australia/New Zealand (n = 5), and Asia (n = 4). Most studies targeted both male and female students (74%). Classroom-based strategies resulted in 21,117 testes overall (4 programs), followed by opportunistic screening during routine health examination (n = 13,470; 5 programs) and opportunistic screening at school-based health centers (n = 13,006; 5 programs). The overall median CT positivity was 4.7% (range, 1.3%-18.1%). Only 5 programs reported treatment rates (median, 100%; range, 86%-100%), 1 partner notification rate (71%), 1 retesting rate within a year of an initial CT diagnosis (47%), and 2 reported repeat positivity rates (21.1% and 26.3%). In conclusion, this systematic review shows that a variety of strategies have been used to screen large numbers of students in educational settings; however, only a few studies have reported CT management outcomes.

Initiating the 2002 Mars Science Laboratory (MSL) Technology Program

NASA Technical Reports Server (NTRS)

Caffrey, Robert T.; Udomkesmalee, Gabriel; Hayati, Samad A.; Henderson, Rebecca

2004-01-01

The Mars Science Laboratory (MSL) Project is an aggressive mission launching in 2009 to investigate the Martian environment and requires new capabilities that are currently are not available. The MSL Technology Program is developing a wide-range of technologies needed for this Mission and potentially other space missions. The MSL Technology Program reports to both the MSL Project and the Mars Technology Program (MTP). The dual reporting process creates a challenging management situation, but ensures the new technology meets both the specific MSL requirements and the broader Mars Program requirements. MTP is a NASA-wide technology development program managed by JPL and is divided into a Focused Program and a Base Program. The MSL Technology Program is under the focused program and is tightly coupled to MSL's mission milestones and deliverables. The technology budget is separate from the flight Project budget, but the technology's requirements and the development process are tightly coordinated with the Project. The MSL Technology Program combines the proven management techniques of flight projects with the commercial technology management strategies of industry and academia, to create a technology management program that meets the short-term requirements of MSL and the long-term requirements of MTP. This paper examines the initiation of 2002 MSL Technology program. Some of the areas discussed in this paper include technology definition, task selection, technology management, and technology assessment. This paper also provides an update of the 2003 MSL technology program and examines some of the drivers that changed the program from its initiation.

Conflict in Protected Areas: Who Says Co-Management Does Not Work?

PubMed Central

Arts, Bas; Vranckx, An; Léon-Sicard, Tomas; Van Damme, Patrick

2015-01-01

Natural resource-related conflicts can be extremely destructive and undermine environmental protection. Since the 1990s co-management schemes, whereby the management of resources is shared by public and/or private sector stakeholders, have been a main strategy for reducing these conflicts worldwide. Despite initial high hopes, in recent years co-management has been perceived as falling short of expectations. However, systematic assessments of its role in conflict prevention or mitigation are non-existent. Interviews with 584 residents from ten protected areas in Colombia revealed that co-management can be successful in reducing conflict at grassroots level, as long as some critical enabling conditions, such as effective participation in the co-management process, are fulfilled not only on paper but also by praxis. We hope these findings will re-incentivize global efforts to make co-management work in protected areas and other common pool resource contexts, such as fisheries, agriculture, forestry and water management. PMID:26714036

Damage control strategy for the treatment of perforated diverticulitis with generalized peritonitis.

PubMed

Sohn, M; Agha, A; Heitland, W; Gundling, F; Steiner, P; Iesalnieks, I

2016-08-01

The best surgical strategy for the management of perforated diverticulitis with generalized peritonitis of the sigmoid colon is not clearly defined. The aim of this retrospective cohort study was to evaluate the value of a damage control strategy. All patients who underwent emergency laparotomy for perforated diverticular disease of the sigmoid colon with generalized peritonitis between 2010 and 2015 were included. The damage control strategy (study group), included a two- stage procedure: limited resection of the diseased colonic segment, closure of proximal colon and distal stump, and application of an abdominal vacuum at the initial surgery followed by second-look laparotomy 24-48 h later At this point a choice was made between anastomosis and Hartmann's procedure. The control group consisted of patients receiving definitive reconstruction (anastomosis or Hartmann's procedure) at the initial operation. Thirty-seven patients were included in the study. Damage control strategy was applied in 19 patients and the control group consisted of 18 patients. Both groups were comparable in terms of demographics, severity of peritonitis, and comorbidities. The overall postoperative mortality was 11 % (n = 4). There were no statistically significant differences between both groups regarding postoperative morbidity and mortality; however, a significantly higher proportion of patients in the control group had a stoma after the initial hospital stay (83 vs. 47 %, p = 0.038). This difference was still significant after adjustment for sex, age, Mannheim Peritonitis Index, American Society of Anesthesiologists class and presence of septic shock at presentation. At the end of the follow-up period, 15 of 17 survivors in the study group and 13 of 16 survivors in the control group had their intestinal continuity restored (p = 0.66). Damage control strategy in patients with generalized peritonitis due to perforated diverticulitis leads to a significantly reduced stoma rate after the initial hospital stay without an increased risk of postoperative morbidity.

Human resources for health strategies adopted by providers in resource-limited settings to sustain long-term delivery of ART: a mixed-methods study from Uganda.

PubMed

Zakumumpa, Henry; Taiwo, Modupe Oladunni; Muganzi, Alex; Ssengooba, Freddie

2016-10-19

Human resources for health (HRH) constraints are a major barrier to the sustainability of antiretroviral therapy (ART) scale-up programs in Sub-Saharan Africa. Many prior approaches to HRH constraints have taken a top-down trend of generalized global strategies and policy guidelines. The objective of the study was to examine the human resources for health strategies adopted by front-line providers in Uganda to sustain ART delivery beyond the initial ART scale-up phase between 2004 and 2009. A two-phase mixed-methods approach was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) across Uganda was conducted. The second phase involved in-depth interviews (n = 36) with ART clinic managers and staff of 6 of the 195 health facilities purposively selected from the first study phase. Quantitative data was analysed based on descriptive statistics, and qualitative data was analysed by coding and thematic analysis. The identified strategies were categorized into five themes: (1) providing monetary and non-monetary incentives to health workers on busy ART clinic days; (2) workload reduction through spacing ART clinic appointments; (3) adopting training workshops in ART management as a motivation strategy for health workers; (4) adopting non-physician-centred staffing models; and (5) devising ART program leadership styles that enhanced health worker commitment. Facility-level strategies for responding to HRH constraints are feasible and can contribute to efforts to increase country ownership of HIV programs in resource-limited settings. Consideration of the human resources for health strategies identified in the study by ART program planners and managers could enhance the long-term sustainment of ART programs by providers in resource-limited settings.

An aggression policy that works.

PubMed

Kitchener, Denby A; Sykes, Sharon R; McEwan, Allan G

2004-12-13

In 1999, a survey of the clinical staff in Royal Darwin Hospital showed that most instances of aggressive and abusive behaviour by patients or visitors occurring in the hospital went unreported because staff believed there would not be any follow-up investigation or action taken by management, Australia. In response, a hospital working party was formed to develop and implement an aggression management policy with practical effective strategies. The principal tool used was an Action Plan that delineated an immediate response to the aggression, as well as long-term strategies such as negotiated care and behaviour modification programs. An advocate is provided for the patient and debriefing for staff members. If the aggressive behaviour continues, early discharge of the patient could be initiated. The fundamental principle of the policy is to prevent fostering a culture of acceptance of aggressive behaviour through appropriate early intervention. In 2002, a follow-up survey showed that 82% of aggressive incidents were being reported and dealt with by management in a timely manner -- a significant improvement.

Impeding movement of the poultry red mite, Dermanyssus gallinae.

PubMed

Pritchard, James; Küster, Tatiana; George, David; Sparagano, Olivier; Tomley, Fiona

2016-07-30

The poultry red mite, Dermanyssus gallinae, is an economically important hematophagous parasite of commercial egg laying hens, also affecting domesticated birds and companion animals. Conventional control of D. gallinae through acaricidal spraying is often ineffective, creating an urgent need to identify alternative management strategies for commercial and domestic infestations. Whilst integrated pest management is being considered for D. gallinae, the potential of impeding mite 'migration' routes, to either prevent initial infestation or manage established populations, has not been researched. Here we demonstrate that barriers of insecticidal glue, double sided sticky tape and thyme oil can contain D. gallinae within a specified area of a petri dish (78-88% of total mite population) and this level of containment was significantly greater than for negative controls (p values <0.05). Further studies in poultry houses are recommended to investigate the efficacy of these barriers in real world application and identity potential for barriers as a strategy for mite control. Copyright © 2016 Elsevier B.V. All rights reserved.

A test-based strategy is more cost effective than empiric dose escalation for patients with Crohn's disease who lose responsiveness to infliximab.

PubMed

Velayos, Fernando S; Kahn, James G; Sandborn, William J; Feagan, Brian G

2013-06-01

Patients with Crohn's disease who become unresponsive to therapy with tumor necrosis factor antagonists are managed initially with either empiric dose escalation or testing-based strategies. The comparative cost effectiveness of these 2 strategies is unknown. We investigated whether a testing-based strategy is more cost effective than an empiric dose-escalation strategy. A decision analytic model that simulated 2 cohorts of patients with Crohn's disease compared outcomes for the 2 strategies over a 1-year time period. The incremental cost-effectiveness ratio of the empiric strategy was expressed as cost per quality-adjusted life-year (QALY) gained, compared with the testing-based strategy. We performed 1-way, probabilistic, and prespecified secondary analyses. The testing strategy yielded similar QALYs compared with the empiric strategy (0.801 vs 0.800, respectively) but was less expensive ($31,870 vs $37,266, respectively). In sensitivity analyses, the incremental cost-effectiveness ratio of the empiric strategy ranged from $500,000 to more than $5 million per QALY gained. Similar rates of remission (63% vs 66%) and response (28% vs 26%) were achieved through differential use of available interventions. The testing-based strategy resulted in a higher percentage of surgeries (48% vs 34%) and lower percentage use of high-dose biological therapy (41% vs 54%). A testing-based strategy is a cost-effective alternative to the current strategy of empiric dose escalation for managing patients with Crohn's disease who have lost responsiveness to infliximab. The basis for this difference is lower cost at similar outcomes. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

The role of communities in sustainable land and forest management: The case of Nyanga, Zvimba and Guruve districts of Zimbabwe

PubMed Central

Sagonda, Ruvimbo; Kaundikiza, Munyaradzi

2016-01-01

Forest benefit analysis is vital in ensuring sustainable community-based natural resources management. Forest depletion and degradation are key issues in rural Zimbabwe and strategies to enhance sustainable forest management are continually sought. This study was carried out to assess the impact of forests on communities from Nyanga, Guruve and Zvimba districts of Zimbabwe. It is based on a Big Lottery Fund project implemented by Progressio-UK and Environment Africa. It focuses on identifying replicable community forest and land management strategies and the level of benefits accruing to the community. Analysis of change was based on the Income and Food Security and Forest benefits, which also constitutes the tools used during the research. The study confirms the high rate of deforestation and the increased realisation by communities to initiate practical measures aimed at protecting and sustaining forest and land resources from which they derive economic and social benefits. The results highlight the value of community structures (Farmer Field Schools and Environmental Action Groups) as conduits for natural resource management. The interconnectivity among forests, agricultural systems and the integral role of people are recognised as key to climate change adaptation.

Data management strategies for multinational large-scale systems biology projects.

PubMed

Wruck, Wasco; Peuker, Martin; Regenbrecht, Christian R A

2014-01-01

Good accessibility of publicly funded research data is essential to secure an open scientific system and eventually becomes mandatory [Wellcome Trust will Penalise Scientists Who Don't Embrace Open Access. The Guardian 2012]. By the use of high-throughput methods in many research areas from physics to systems biology, large data collections are increasingly important as raw material for research. Here, we present strategies worked out by international and national institutions targeting open access to publicly funded research data via incentives or obligations to share data. Funding organizations such as the British Wellcome Trust therefore have developed data sharing policies and request commitment to data management and sharing in grant applications. Increased citation rates are a profound argument for sharing publication data. Pre-publication sharing might be rewarded by a data citation credit system via digital object identifiers (DOIs) which have initially been in use for data objects. Besides policies and incentives, good practice in data management is indispensable. However, appropriate systems for data management of large-scale projects for example in systems biology are hard to find. Here, we give an overview of a selection of open-source data management systems proved to be employed successfully in large-scale projects.

How The Australian National University's emergency management and continuity plans responded to a large-scale fire.

PubMed

Meehan, Bart

2008-01-01

On 18th January, 2003, one of the worst bushfires in the history of Australia hit the capital city, Canberra. By the time it was under control, four people were dead and more than 500 homes were destroyed. The fire also destroyed the Mount Stromlo campus of the Australian National University, the location of the Research School of Astronomy and Astrophysics. In response to the fires, the University initiated its emergency management strategy and business continuity plans. These allowed the School to recommence limited operations within two weeks of the disaster. This paper details a case study of the impact of the fire (in part using personal recollections of staff and students), and the emergency response implemented by the University. It describes the development of the University's emergency management strategy, with its emphasis on the key elements of clear chain of command and flexibility in developing an incident-specific response. The paper also provides an assessment of how the plan worked during an actual incident and some of the lessons learned, including the importance of the early response, managing the impact on people, media management, insurance and communications.

Data management strategies for multinational large-scale systems biology projects

PubMed Central

Peuker, Martin; Regenbrecht, Christian R.A.

2014-01-01

Good accessibility of publicly funded research data is essential to secure an open scientific system and eventually becomes mandatory [Wellcome Trust will Penalise Scientists Who Don’t Embrace Open Access. The Guardian 2012]. By the use of high-throughput methods in many research areas from physics to systems biology, large data collections are increasingly important as raw material for research. Here, we present strategies worked out by international and national institutions targeting open access to publicly funded research data via incentives or obligations to share data. Funding organizations such as the British Wellcome Trust therefore have developed data sharing policies and request commitment to data management and sharing in grant applications. Increased citation rates are a profound argument for sharing publication data. Pre-publication sharing might be rewarded by a data citation credit system via digital object identifiers (DOIs) which have initially been in use for data objects. Besides policies and incentives, good practice in data management is indispensable. However, appropriate systems for data management of large-scale projects for example in systems biology are hard to find. Here, we give an overview of a selection of open-source data management systems proved to be employed successfully in large-scale projects. PMID:23047157

Talking to Score: Impression Management in L2 Oral Assessment and the Co-Construction of a Test Discourse Genre

ERIC Educational Resources Information Center

Luk, Jasmine

2010-01-01

In recent years, the emphasis in second language (L2) oral proficiency assessment has shifted from linguistic accuracy to discourse strategies such as the ability to initiate, respond, and negotiate meaning. This has resulted in a growing interest in the discourse analysis of students' performance in different oral proficiency assessment formats.…

How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money. Energy-Smart Building Choices.

ERIC Educational Resources Information Center

Department of Energy, Washington, DC.

This guide addresses contributions that school facility administrators and business officials can make in an effort to reduce operating costs and free up money for capital improvements. The guide explores opportunities available to utilize energy-saving strategies at any stage in a building's life, from its initial design phase through renovation.…

Cost-utility analysis of a multidisciplinary strategy to manage osteoarthritis of the knee: economic evaluation of a cluster randomized controlled trial study.

PubMed

Marra, Carlo A; Grubisic, Maja; Cibere, Jolanda; Grindrod, Kelly A; Woolcott, John C; Gastonguay, Louise; Esdaile, John M

2014-06-01

To determine if a pharmacist-initiated multidisciplinary strategy provides value for money compared to usual care in participants with previously undiagnosed knee osteoarthritis. Pharmacies were randomly allocated to provide either 1) usual care and a pamphlet or 2) intervention care, which consisted of education, pain medication management by a pharmacist, physiotherapy-guided exercise, and communication with the primary care physician. Costs and quality-adjusted life-years (QALYs) were determined for patients assigned to each treatment and incremental cost-effectiveness ratios (ICERs) were determined. From the Ministry of Health perspective, the average patient in the intervention group generated slightly higher costs compared with usual care. Similar findings were obtained when using the societal perspective. The intervention resulted in ICERs of $232 (95% confidence interval [95% CI] -1,530, 2,154) per QALY gained from the Ministry of Health perspective and $14,395 (95% CI 7,826, 23,132) per QALY gained from the societal perspective, compared with usual care. A pharmacist-initiated, multidisciplinary program was good value for money from both the societal and Ministry of Health perspectives. Copyright © 2014 by the American College of Rheumatology.

The impact and management of symptoms experienced at midlife: a community-based study of women in northeast Scotland.

PubMed

Duffy, O K; Iversen, L; Hannaford, P C

2012-04-01

To determine the frequency and management of menopausal symptoms among community-dwelling women. Cross-sectional study. Northeast Scotland. Women aged 45-54 years registered with 16 general practices. In 2009, a self-completed questionnaire enquiring about the frequency, associated level of bothersomeness and management of 23 symptoms experienced during the previous month was sent to 8206 women. The proportion (95% CI) of women reporting each symptom and management strategy. Hot flushes, night sweats and vaginal dryness were reported by 46.7% (95% CI 45.2-48.2), 46.4% (95% CI 44.9-47.9) and 28.2% (95% CI 26.9-29.6) of women, respectively. Two-fifths of women rated these symptoms as quite bothersome or extremely bothersome. More than 60% managed menopausal symptoms using social support by talking to friends and family. Avoidance or alleviating options were common. Herbal remedies were more commonly used than prescription drugs. Current hormone replacement therapy use was highest among surgically menopausal women (21%); 8% of postmenopausal and <2% of perimenopausal women with symptoms were using hormone replacement therapy. Many women had sought information about symptom management. More than one-third of women wanted more support about menopausal symptoms from their general practitioner or practice nurse. Following the publication of the Women's Health Initiative trial results, menopausal symptoms remain common and are often bothersome. Many women seek information about menopausal symptoms from healthcare professionals. Future studies should look beyond frequently researched management strategies, to consider other commonly used options, such as social support, strategies to reduce core body temperature and information about managing menopausal symptoms. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Logistics modelling: improving resource management and public information strategies in Florida.

PubMed

Walsh, Daniel M; Van Groningen, Chuck; Craig, Brian

2011-10-01

One of the most time-sensitive and logistically-challenging emergency response operations today is to provide mass prophylaxis to every man, woman and child in a community within 48 hours of a bioterrorism attack. To meet this challenge, federal, state and local public health departments in the USA have joined forces to develop, test and execute large-scale bioterrorism response plans. This preparedness and response effort is funded through the US Centers for Disease Control and Prevention's Cities Readiness Initiative, a programme dedicated to providing oral antibiotics to an entire population within 48 hours of a weaponised inhalation anthrax attack. This paper will demonstrate how the State of Florida used a logistics modelling tool to improve its CRI mass prophylaxis plans. Special focus will be on how logistics modelling strengthened Florida's resource management policies and validated its public information strategies.

[Integrated management of patients with schizophrenia: beyond psychotropic drugs].

PubMed

Taborda Zapata, Eliana; Montoya Gonzalez, Laura Elisa; Gómez Sierra, Natalia María; Arteaga Morales, Laura María; Correa Rico, Oscar Andrés

2016-01-01

Schizophrenia is a complex disease with severe functional repercussions; therefore it merits treatment which goes beyond drugs. It requires an approach that considers a diathesis-stress process that includes rehabilitation, psychotherapeutic strategies for persistent cognitive, negative and psychotic symptoms, psychoeducation of patient and communities, community adaptation strategies, such as the introduction to the work force, and the community model, such as a change in the asylum paradigm. It is necessary to establish private and public initiatives for the integrated care of schizophrenia in the country, advocating the well-being of those with the disease. The integrated management of schizophrenic patients requires a global view of the patient and his/her disease, and its development is essential. Copyright © 2015 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Putting conflict management into practice: a nursing case study.

PubMed

Vivar, Cristina García

2006-04-01

This paper is intended to put knowledge in conflict management into practice through reflecting on a nursing case study. Nursing organizations are particularly vulnerable to conflict as the context of nurses' work may be difficult and stressful. Power conflict is argued to be an important source of tension within nursing units. Learning to manage conflict at an early stage is therefore crucial to the effective functioning of nursing organizations. A nursing case study that illustrates power conflict in an oncology nursing unit is displayed and reflection on conflict management from the case is provided. There is no appropriate or inappropriate strategy to deal with conflict. However, detecting initial symptoms of conflict and adopting the most effective behaviour to conflict resolution is essential in nursing units. Further nursing education in conflict management for staff nurses and nurse managers is greatly needed.

Predictors of initial weight loss among women with abdominal obesity: a path model using self-efficacy and health-promoting behaviour.

PubMed

Choo, Jina; Kang, Hyuncheol

2015-05-01

To identify predictors of initial weight loss among women with abdominal obesity by using a path model. Successful weight loss in the initial stages of long-term weight management may promote weight loss maintenance. A longitudinal study design. Study participants were 75 women with abdominal obesity, who were enrolled in a 12-month Community-based Heart and Weight Management Trial and followed until a 6-month assessment. The Weight Efficacy Lifestyle, Exercise Self-Efficacy and Health Promoting Lifestyle Profile-II measured diet self-efficacy, exercise self-efficacy and health-promoting behaviour respectively. All endogenous and exogenous variables used in our path model were change variables from baseline to 6 months. Data were collected between May 2011-May 2012. Based on the path model, increases in both diet and exercise self-efficacy had significant effects on increases in health-promoting behaviour. Increases in diet self-efficacy had a significant indirect effect on initial weight loss via increases in health-promoting behaviour. Increases in health-promoting behaviour had a significant effect on initial weight loss. Among women with abdominal obesity, increased diet self-efficacy and health-promoting behaviour were predictors of initial weight loss. A mechanism by which increased diet self-efficacy predicts initial weight loss may be partially attributable to health-promoting behavioural change. However, more work is still needed to verify causality. Based on the current findings, intensive nursing strategies for increasing self-efficacy for weight control and health-promoting behaviour may be essential components for better weight loss in the initial stage of a weight management intervention. © 2015 John Wiley & Sons Ltd.

Treatment of very early rheumatoid arthritis with symptomatic therapy, disease-modifying antirheumatic drugs, or biologic agents: a cost-effectiveness analysis.

PubMed

Finckh, Axel; Bansback, Nick; Marra, Carlo A; Anis, Aslam H; Michaud, Kaleb; Lubin, Stanley; White, Marc; Sizto, Sonia; Liang, Matthew H

2009-11-03

Long-term control or remission of rheumatoid arthritis (RA) may be possible with very early treatment. However, no optimal first therapeutic strategy has been determined. To assess the potential cost-effectiveness of major therapeutic strategies for very early RA. Decision analytic model with probabilistic sensitivity analyses. Published data, the National Data Bank for Rheumatic Diseases, and actual 2007 hospital costs. U.S. adults with very early RA (symptom duration

Current approaches to the management of new-onset ulcerative colitis

PubMed Central

Marchioni Beery, Renée; Kane, Sunanda

2014-01-01

Ulcerative colitis (UC) is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity) but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to- moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids) or thiopurines (as bridging therapy). Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon) should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide a comprehensive evidence-based approach to current treatment options for new-onset UC with discussion of long-term therapeutic efficacy and safety, patient-centered perspectives including quality of life and medication compliance, and future directions in related inflammatory bowel disease care. PMID:24872716

Management of malignant left colonic obstruction: is an initial temporary colostomy followed by surgical resection a better option?

PubMed

Chéreau, N; Lefevre, J H; Lefrancois, M; Chafai, N; Parc, Y; Tiret, E

2013-11-01

The surgical management of obstructed left colorectal cancer (OLCC) is still a matter of debate, and current guidelines recommend Hartmann's procedure (HP). The study evaluated the results of the surgical management with a focus on a strategy of initial colostomy (IC) followed by elective resection. All patients operated on for OLCC were reviewed. Clinical, surgical, histological, morbidity and long-term results were noted. From 2000-11, 83 patients (48 men) with a mean age of 70.3 ± 15.1 years underwent surgery for OLCC. Eleven (13.3%) had a subtotal colectomy owing to a laceration of the caecal wall. Eleven had a HP for tumour perforation (n = 6) or as palliation in a severely ill patient (n = 5). The remaining 61 (73.5%) patients had an IC, with the intention of performing an elective resection shortly after recovery. Postoperative complications occurred in six (9.8%) and there were two (3.3%) deaths. Fifty-nine operation survivors had a colonoscopy shortly afterwards which showed a synchronous cancer in two (3.4%). Twelve of the 59 patients had synchronous metastases. The subsequent elective resection including the colostomy site could be performed in 45 (74%) patients during the same admission at a median interval of 11 (7-17) days. The overall median length of hospital stay was 20 days and the 30-day mortality was 3/61 (5%). IC followed by surgical resection is a technically simple strategy, allowing initial abdominal exploration with a short period of having a colostomy, and permitting elective surgery with a low morbidity and full oncological lymphadenectomy. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

Initial diagnosis and management of chronic obstructive pulmonary disease in Australia: views from the coal face.

PubMed

Bereznicki, Bonnie; Walters, Haydn; Walters, Julia; Peterson, Gregory; Bereznicki, Luke

2017-07-01

Early diagnosis and management can mitigate the long-term morbidity and mortality of chronic obstructive pulmonary disease (COPD). To gain insights into the initial diagnostic process and early management of COPD by Australian general practitioners (GP). A random sample of Australian GP was invited to complete a postal survey, which assessed familiarity with and use of contemporary practice guidelines, diagnostic criteria and management preferences for COPD. A total of 233 GP completed the survey. While most GP based a COPD diagnosis on smoking history (94.4%), symptoms (91.0%) and spirometry (88.8%), only 39.9% of respondents recorded a formal diagnosis of COPD after the patient's first symptomatic presentation. Tiotropium was the preferred treatment in 77.3% of GP for the initial management of COPD, while only 27.5% routinely recommended pulmonary rehabilitation. GP routinely recorded patients' smoking status and offered smoking cessation advice, but the timing of this advice varied. Less than half of the respondents routinely used COPD management guidelines or tools and resources provided by the Australian Lung Foundation. There is scope for major improvement in GP familiarity with and use of COPD management guidelines and readily available tools and resources. Some systematic issues were highlighted in the Australian primary care setting, such as a reactive and relatively passive and delayed approach to diagnosis, potentially delayed smoking cessation advice and underutilisation of pulmonary rehabilitation. There is an urgent need to devise strategies for improving patient outcomes in COPD using resources that are readily available. © 2017 Royal Australasian College of Physicians.

Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

PubMed Central

Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

2016-01-01

Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment.The referral rate for dizziness was high compared with previous research. PMID:27049170

Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice.

PubMed

Stam, Hanneke; Harting, Thomas; Sluijs, Marjolijn van der; Marum, Rob van; Horst, Henriëtte van der; Wouden, Johannes C van der; Maarsingh, Otto R

2016-06-01

For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP's management of dizziness in older patients, including FRID evaluation and adjustment. Data were derived from electronic medical records, obtained over a 12-month period in 2013. Forty-six Dutch general practices. The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key Points It is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement. This study revealed a wide variety in management strategies for dizziness in older patients. There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment. The referral rate for dizziness was high compared with previous research.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Comparative field trial of alternative vector control strategies for non-domiciliated Triatoma dimidiata.

PubMed

Ferral, Jhibran; Chavez-Nuñez, Leysi; Euan-Garcia, Maria; Ramirez-Sierra, Maria Jesus; Najera-Vazquez, M Rosario; Dumonteil, Eric

2010-01-01

Chagas disease is a major vector-borne disease, and regional initiatives based on insecticide spraying have successfully controlled domiciliated vectors in many regions. Non-domiciliated vectors remain responsible for a significant transmission risk, and their control is a challenge. We performed a proof-of-concept field trial to test alternative strategies in rural Yucatan, Mexico. Follow-up of house infestation for two seasons following the interventions confirmed that insecticide spraying should be performed annually for the effective control of Triatoma dimidiata; however, it also confirmed that insect screens or long-lasting impregnated curtains may represent good alternative strategies for the sustained control of these vectors. Ecosystemic peridomicile management would be an excellent complementary strategy to improve the cost-effectiveness of interventions. Because these strategies would also be effective against other vector-borne diseases, such as malaria or dengue, they could be integrated within a multi-disease control program.

A Stitch in Time: Strategic Self-Control in High School and College Students.

PubMed

Duckworth, Angela L; White, Rachel E; Matteucci, Alyssa J; Shearer, Annie; Gross, James J

2016-04-01

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent.

A Stitch in Time: Strategic Self-Control in High School and College Students

PubMed Central

Duckworth, Angela L.; White, Rachel E.; Matteucci, Alyssa J.; Shearer, Annie; Gross, James J.

2015-01-01

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent. PMID:27158155

Aging management program of the reactor building concrete at Point Lepreau Generating Station

NASA Astrophysics Data System (ADS)

Aldea, C.-M.; Shenton, B.; Demerchant, M. M.; Gendron, T.

2011-04-01

In order for New Brunswick Power Nuclear (NBPN) to control the risks of degradation of the concrete reactor building at the Point Lepreau Generating Station (PLGS) the development of an aging management plan (AMP) was initiated. The intention of this plan was to determine the requirements for specific structural components of concrete of the reactor building that require regular inspection and maintenance to ensure the safe and reliable operation of the plant. The document is currently in draft form and presents an integrated methodology for the application of an AMP for the concrete of the reactor building. The current AMP addresses the reactor building structure and various components, such as joint sealant and liners that are integral to the structure. It does not include internal components housed within the structure. This paper provides background information regarding the document developed and the strategy developed to manage potential degradation of the concrete of the reactor building, as well as specific programs and preventive and corrective maintenance activities initiated.

[Data supporting quality circle management of inpatient depression treatment].

PubMed

Brand, S; Härter, M; Sitta, P; van Calker, D; Menke, R; Heindl, A; Herold, K; Kudling, R; Luckhaus, C; Rupprecht, U; Sanner, Dirk; Schmitz, D; Schramm, E; Berger, M; Gaebel, W; Schneider, F

2005-07-01

Several quality assurance initiatives in health care have been undertaken during the past years. The next step consists of systematically combining single initiatives in order to built up a strategic quality management. In a German multicenter study, the quality of inpatient depression treatment was measured in ten psychiatric hospitals. Half of the hospitals received comparative feedback on their individual results in comparison to the other hospitals (bench marking). Those bench markings were used by each hospital as a statistic basis for in-house quality work, to improve the quality of depression treatment. According to hospital differences concerning procedure and outcome, different goals were chosen. There were also differences with respect to structural characteristics, strategies, and outcome. The feedback from participants about data-based quality circles in general and the availability of bench-marking data was positive. The necessity of carefully choosing quality circle members and professional moderation became obvious. Data-based quality circles including bench-marking have proven to be useful for quality management in inpatient depression care.

International Patterns of Practice in the Management of Radiation Therapy-induced Nausea and Vomiting

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

Dennis, Kristopher; Zhang Liying; Lutz, Stephen

Purpose: To investigate international patterns of practice in the management of radiation therapy-induced nausea and vomiting (RINV). Methods and Materials: Oncologists prescribing radiation therapy in the United States, Canada, The Netherlands, Australia, New Zealand, Spain, Italy, France, Hong Kong, Singapore, Cyprus, and Israel completed a Web-based survey that was based on 6 radiation therapy-only clinical cases modeled after the minimal-, low-, moderate-, and high-emetic risk levels defined in the antiemetic guidelines of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer. For each case, respondents estimated the risks of nausea and vomiting separately andmore » committed to an initial management approach. Results: In total, 1022 responses were received. Risk estimates and management decisions for the minimal- and high-risk cases varied little and were in line with guideline standards, whereas those for the low- and moderate-risk cases varied greatly. The most common initial management strategies were as follows: rescue therapy for a minimal-risk case (63% of respondents), 2 low-risk cases (56% and 80%), and 1 moderate-risk case (66%); and prophylactic therapy for a second moderate-risk case (75%) and a high-risk case (95%). The serotonin (5-HT){sub 3} receptor antagonists were the most commonly recommended prophylactic agents. On multivariate analysis, factors predictive of a decision for prophylactic or rescue therapy were risk estimates of nausea and vomiting, awareness of the American Society of Clinical Oncology antiemetic guideline, and European Society for Therapeutic Radiology and Oncology membership. Conclusions: Risk estimates and management strategies for RINV varied, especially for low- and moderate-risk radiation therapy cases. Radiation therapy-induced nausea and vomiting are under-studied treatment sequelae. New observational and translational studies are needed to allow for individual patient risk assessment and to refine antiemetic guideline management recommendations.« less

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.

New optimization strategies of pavement maintenance: A case study for national road network in Indonesia using integrated road management system

NASA Astrophysics Data System (ADS)

Hamdi, Hadiwardoyo, Sigit P.; Correia, A. Gomes; Pereira, Paulo

2017-06-01

A road network requires timely maintenance to keep the road surface in good condition onward better services to improve accessibility and mobility. Strategies and maintenance techniques must be chosen in order to maximize road service level through cost-effective interventions. This approach requires an updated database, which the road network in Indonesia is supported by a manual and visual survey, also using NAASRA profiler. Furthermore, in this paper, the deterministic model of deterioration was used. This optimization model uses life cycle cost analysis (LCCA), applied in an integrated manner, using IRI indicator, and allows determining the priority of treatment, type of treatment and its relation to the cost. The purpose of this paper was focussed on the aspects of road maintenance management, i.e., maintenance optimization models for different levels of traffic and various initial of road distress conditions on the national road network in Indonesia. The implementation of Integrated Road Management System (IRMS) can provide a solution to the problem of cost constraints in the maintenance of the national road network. The results from this study found that as the lowest as agency cost, it will affect the increasing of user cost. With the achievement of the target plan scenario Pl000 with initial value IRI 2, it was found that the routine management throughout the year and in early reconstruction and periodic maintenance with a 30 mm thick overlay, will simultaneously provide a higher net benefit value and has the lowest total cost of transportation.

A randomized controlled trial testing the efficacy of an HIV/AIDS symptom management manual.

PubMed

Wantland, Dean J; Holzemer, William L; Moezzi, Shahnaz; Willard, Suzanne S; Arudo, John; Kirksey, Kenn M; Portillo, Carmen J; Corless, Inge B; Rosa, María E; Robinson, Linda L; Nicholas, Patrice K; Hamilton, Mary Jane; Sefcik, Elizabeth F; Human, Sarie; Rivero, Marta M; Maryland, Mary; Huang, Emily

2008-09-01

This study investigates whether using an HIV/AIDS symptom management manual with self-care strategies for 21 common symptoms, compared to a basic nutrition manual, had an effect on reducing symptom frequency and intensity. A 775-person, repeated measures, randomized controlled trial was conducted over three months in 12 sites from the United States, Puerto Rico, and Africa to assess the relationship between symptom intensity with predictors for differences in initial symptom status and change over time. A mixed model growth analysis showed a significantly greater decline in symptom frequency and intensity for the group using the symptom management manual (intervention) compared to those using the nutrition manual (control) (t=2.36, P=0.018). The models identified three significant predictors for increased initial symptom intensities and in intensity change over time: (1) protease inhibitor-based therapy (increased mean intensity by 28%); (2) having comorbid illness (nearly twice the mean intensity); and (3) being Hispanic receiving care in the United States (increased the mean intensity by 2.5 times). In addition, the symptom manual showed a significantly higher helpfulness rating and was used more often compared to the nutrition manual. The reduction in symptom intensity scores provides evidence of the need for palliation of symptoms in individuals with HIV/AIDS, as well as symptoms and treatment side effects associated with other illnesses. The information from this study may help health care providers become more aware of self-management strategies that are useful to persons with HIV/AIDS and help them to assist patients in making informed choices.

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

Piette, Mary Ann; Sezgen, Osman; Watson, David S.

This report describes the results of a research project to develop and evaluate the performance of new Automated Demand Response (Auto-DR) hardware and software technology in large facilities. Demand Response (DR) is a set of activities to reduce or shift electricity use to improve electric grid reliability, manage electricity costs, and ensure that customers receive signals that encourage load reduction during times when the electric grid is near its capacity. The two main drivers for widespread demand responsiveness are the prevention of future electricity crises and the reduction of electricity prices. Additional goals for price responsiveness include equity through costmore » of service pricing, and customer control of electricity usage and bills. The technology developed and evaluated in this report could be used to support numerous forms of DR programs and tariffs. For the purpose of this report, we have defined three levels of Demand Response automation. Manual Demand Response involves manually turning off lights or equipment; this can be a labor-intensive approach. Semi-Automated Response involves the use of building energy management control systems for load shedding, where a preprogrammed load shedding strategy is initiated by facilities staff. Fully-Automated Demand Response is initiated at a building or facility through receipt of an external communications signal--facility staff set up a pre-programmed load shedding strategy which is automatically initiated by the system without the need for human intervention. We have defined this approach to be Auto-DR. An important concept in Auto-DR is that a facility manager is able to ''opt out'' or ''override'' an individual DR event if it occurs at a time when the reduction in end-use services is not desirable. This project sought to improve the feasibility and nature of Auto-DR strategies in large facilities. The research focused on technology development, testing, characterization, and evaluation relating to Auto-DR. This evaluation also included the related decisionmaking perspectives of the facility owners and managers. Another goal of this project was to develop and test a real-time signal for automated demand response that provided a common communication infrastructure for diverse facilities. The six facilities recruited for this project were selected from the facilities that received CEC funds for new DR technology during California's 2000-2001 electricity crises (AB970 and SB-5X).« less

Patient credentialing as a population health management strategy: a diabetes case study.

PubMed

Watson, Lindsay L; Bluml, Benjamin M; Skoufalos, Alexandria

2015-06-01

When given the opportunity to become actively involved in the decision-making process, patients can positively impact their health outcomes. Understanding how to empower patients to become informed consumers of health care services is an important strategy for addressing disparities and variability in care. Patient credentialing identifies people who have a certain diagnosis and have achieved certain levels of competency in understanding and managing their disease. Patient credentialing was developed to meet 3 core purposes: (1) enhance patient engagement by increasing personal accountability for health outcomes, (2) create a mass customization strategy for providers to deliver high-quality, patient-centered collaborative care, and (3) provide payers with a foundation for properly aligning health benefit incentives. The Patient Self-Management Credential for Diabetes, a first-of-its-kind, psychometrically validated tool, has been deployed within 3 practice-based research initiatives as a component of innovative diabetes care. Results from these projects show improved clinical outcomes, reduced health care costs, and a relationship between credential achievement levels and clinical markers of diabetes. Implementing patient credentialing as part of collaborative care delivered within various settings across the health care system may be an effective way to reduce disparities, improve access to care and appropriate treatments, incentivize patient engagement in managing their health, and expend time and resources in a customized way to meet individual needs.

USGS science and technology help managers battle invading Asian carp

USGS Publications Warehouse

Kolar, Cynthia S.; Morrison, Sandra S.

2016-09-28

The U.S. Geological Survey (USGS) conducts Asian carp research focused on early detection, risk assessment, and development of control tools and strategies. The goals are to prevent the establishment of invasive Asian carp in the Great Lakes and to reduce their impacts in the Ohio River and Mississippi River Basins and elsewhere. Managers can use the information, tools, and strategies for early detection of Asian carp and to control them when their presence is first evident. New detection and control tools are designed to accommodate expansion to other invasive species and application in geographically diverse areas.This USGS focus complements goals of the Great Lakes Restoration Initiative (GLRI), a multi-agency collaboration started in 2010 to protect and restore the Great Lakes. As a member of the Asian Carp Regional Coordinating Committee, which guides Asian carp efforts, the USGS works closely with Federal and State agencies, Canada, and others to address high-priority Asian carp issues and provide science to inform management decisions.The USGS has gained extensive knowledge of Asian carp biology and life history over the past 30 years. That knowledge guides the design, development, and application of control strategies, and is essential for developing approaches in line with modern principles and practices of integrated pest management (IPM). IPM is a process used to solve pest problems while minimizing risks to people and the environment.

Obstetric simulation as a risk control strategy: course design and evaluation.

PubMed

Gardner, Roxane; Walzer, Toni B; Simon, Robert; Raemer, Daniel B

2008-01-01

Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.

Apoptosis and Self-Destruct: A Contribution to Autonomic Agents?

NASA Technical Reports Server (NTRS)

Sterritt, Roy; Hinchey, Mike

2004-01-01

Autonomic Computing (AC), a self-managing systems initiative based on the biological metaphor of the autonomic nervous system, is increasingly gaining momentum as the way forward in designing reliable systems. Agent technologies have been identified as a key enabler for engineering autonomicity in systems, both in terms of retrofitting autonomicity into legacy systems and designing new systems. The AC initiative provides an opportunity to consider other biological systems and principles in seeking new design strategies. This paper reports on one such investigation; utilizing the apoptosis metaphor of biological systems to provide a dynamic health indicator signal between autonomic agents.

Necrotizing fasciitis: strategies for diagnosis and management.

PubMed

Taviloglu, Korhan; Yanar, Hakan

2007-08-07

Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

NOAA to develop strategy to protect coral and sponge habitat

NASA Astrophysics Data System (ADS)

Showstack, Randy

The U.S. National Marine Fisheries Service (NMFS) will develop a strategy to address research, conservation, and management issues regarding deep-ocean coral and sponge habitat, the agency indicated in an 11 July Federal Register notice. The Service, which is a unit of the National Oceanic and Atmospheric Administration, indicated that this strategy "eventually may result in rulemaking for some fisheries" but that "emergency rulemaking is not warranted."The NMFS announcement is in response to a 24 March 2004 petition to the Commerce Department filed by Oceana, a non-governmental organization. That petition urged the department through NMFS to "initiate immediate rulemaking" to protect coral and sponge habitats in the U.S. exclusive economic zone through mapping, monitoring, research, and enforcement measures.

A modelling methodology to assess the effect of insect pest control on agro-ecosystems.

PubMed

Wan, Nian-Feng; Ji, Xiang-Yun; Jiang, Jie-Xian; Li, Bo

2015-04-23

The extensive use of chemical pesticides for pest management in agricultural systems can entail risks to the complex ecosystems consisting of economic, ecological and social subsystems. To analyze the negative and positive effects of external or internal disturbances on complex ecosystems, we proposed an ecological two-sidedness approach which has been applied to the design of pest-controlling strategies for pesticide pollution management. However, catastrophe theory has not been initially applied to this approach. Thus, we used an approach of integrating ecological two-sidedness with a multi-criterion evaluation method of catastrophe theory to analyze the complexity of agro-ecosystems disturbed by the insecticides and screen out the best insect pest-controlling strategy in cabbage production. The results showed that the order of the values of evaluation index (RCC/CP) for three strategies in cabbage production was "applying frequency vibration lamps and environment-friendly insecticides 8 times" (0.80) < "applying trap devices and environment-friendly insecticides 9 times" (0.83) < "applying common insecticides 14 times" (1.08). The treatment "applying frequency vibration lamps and environment-friendly insecticides 8 times" was considered as the best insect pest-controlling strategy in cabbage production in Shanghai, China.

A modelling methodology to assess the effect of insect pest control on agro-ecosystems

PubMed Central

Wan, Nian-Feng; Ji, Xiang-Yun; Jiang, Jie-Xian; Li, Bo

2015-01-01

The extensive use of chemical pesticides for pest management in agricultural systems can entail risks to the complex ecosystems consisting of economic, ecological and social subsystems. To analyze the negative and positive effects of external or internal disturbances on complex ecosystems, we proposed an ecological two-sidedness approach which has been applied to the design of pest-controlling strategies for pesticide pollution management. However, catastrophe theory has not been initially applied to this approach. Thus, we used an approach of integrating ecological two-sidedness with a multi-criterion evaluation method of catastrophe theory to analyze the complexity of agro-ecosystems disturbed by the insecticides and screen out the best insect pest-controlling strategy in cabbage production. The results showed that the order of the values of evaluation index (RCC/CP) for three strategies in cabbage production was “applying frequency vibration lamps and environment-friendly insecticides 8 times” (0.80) < “applying trap devices and environment-friendly insecticides 9 times” (0.83) < “applying common insecticides 14 times” (1.08). The treatment “applying frequency vibration lamps and environment-friendly insecticides 8 times” was considered as the best insect pest-controlling strategy in cabbage production in Shanghai, China. PMID:25906199

Continuity and change?: Exploring reactions to a guided self-management intervention in a randomised controlled trial for IBS with reference to prior experience of managing a long term condition

PubMed Central

Rogers, Anne; Lee, Victoria; Kennedy, Anne

2007-01-01

Self-care interventions are promoted as effective strategies for improving the quality of life and health outcomes for individuals with long-term health conditions. Outcome measures used in evaluations using Randomised Controlled Trials (RCTs) are not designed to consider patients' prior management strategies and experience of illness. Yet the experience of illness literature suggests that adjusting to living with chronic illness, together with broader contextual influences, are likely to be relevant to understanding responses to self-management initiatives. Using group and individual interview data we attempt to illuminate the transposition of IBS from a condition unsatisfactorily managed by medicine to one successfully managed within the life worlds of individuals. If routine embedding of complex interventions depends on the accomplishment of integration and workability in patients' everyday lives then the design and evaluation of such interventions should view participation as part of a process of continuity as well as change. Responses to formal self-management can be extended beyond psychological and other quantitatively measured outcomes. A useful addendum to trial outcomes for self-management education is an understanding of change as being inextricably linked to people's previous attempts to, and experience of, managing long-term conditions. We suggest that the benefits of understanding the prior experience of managing illness and contact with health services include the acceptability and workability of complex interventions in patients' everyday lives. PMID:17316438

Ecological therapeutic opportunities for oral diseases

PubMed Central

Hoare, Anilei; Marsh, Philip D.; Diaz, Patricia I.

2017-01-01

SUMMARY The three main oral diseases of humans, that is caries, periodontal diseases and oral candidiasis, are associated with microbiome shifts initiated by changes in the oral environment and/or decreased effectiveness of mucosal immune surveillance. In this review we discuss the role that microbial-based therapies may have in the control of these conditions. Most investigations on the use of microorganisms for management of oral disease have been conducted with probiotic strains with some positive but very discrete clinical outcomes. Other strategies such as whole oral microbiome transplantation or modification of community function by enrichment with health-promoting indigenous oral strains may offer more promise but research in this field is still in its infancy. Any microbial-based therapeutics for oral conditions, however, are likely to be only one component within a holistic preventive strategy that should also aim at modification of the environmental influences responsible for the initiation and perpetuation of microbiome shifts associated with oral dysbiosis. PMID:28840820

A delicate web: household changes in health behaviour enabled by microcredit in Burkina Faso.

PubMed

Hennink, Monique; McFarland, Deborah A

2013-01-01

Providing microcredit to women in developing countries has long been highlighted as a simple and effective strategy for poverty reduction and health improvement. However, little is known about how microcredit enables changes in health behaviour. This knowledge is critical to further strengthen microcredit initiatives. This qualitative study, conducted in Burkina Faso, shows how microcredit can not only facilitate savings and investment strategies, but also lead to changes in household decision-making, enabling women to initiate health prevention, seek health treatment and manage health emergencies. Some changes led to increased household burdens for women that impeded health gains, such as administrative loan delays by the microcredit institution and reduced household contributions by the husband. Furthermore, the study highlighted the fragile nature of health gains, which may be eroded due to economic shocks on a household, such as crop failure, drought or illness.

Ecological Therapeutic Opportunities for Oral Diseases.

PubMed

Hoare, Anilei; Marsh, Philip D; Diaz, Patricia I

2017-08-01

The three main oral diseases of humans, that is, caries, periodontal diseases, and oral candidiasis, are associated with microbiome shifts initiated by changes in the oral environment and/or decreased effectiveness of mucosal immune surveillance. In this review, we discuss the role that microbial-based therapies may have in the control of these conditions. Most investigations on the use of microorganisms for management of oral disease have been conducted with probiotic strains with some positive but very discrete clinical outcomes. Other strategies such as whole oral microbiome transplantation or modification of community function by enrichment with health-promoting indigenous oral strains may offer more promise, but research in this field is still in its infancy. Any microbial-based therapeutics for oral conditions, however, are likely to be only one component within a holistic preventive strategy that should also aim at modification of the environmental influences responsible for the initiation and perpetuation of microbiome shifts associated with oral dysbiosis.

Contemporary post surgical management of differentiated thyroid carcinoma.

PubMed

Tala, H; Tuttle, R M

2010-08-01

Risk assessment is the cornerstone of contemporary management of thyroid cancer. Following thyroid surgery, an initial risk assessment of recurrence and disease-specific mortality is made using important intra-operative findings, histologic characteristics of the tumor, molecular profile of the tumor, post-operative serum thyroglobulin and any available cross-sectional imaging studies. This initial risk assessment is used to guide recommendations regarding the need for remnant ablation, external beam irradiation, systemic therapy, degree of TSH suppression, and follow-up disease detection strategy over the first 2 years after initial therapy. While this initial risk stratification provides valuable information, it is a static representation of the patient in the first few weeks post-operatively that does not change over time. Depending on how the patient responds to our initial therapies, the risk of recurrence and death may change significantly during follow-up. In order to account for differences in response to therapy in individual patients and to incorporate the impact of treatment on our initial risk estimates, we recommend a re-stratification of risk at the 2-year point of follow-up. This re-stratification provides an updated risk estimate that can be used to guide ongoing management recommendations including the frequency and intensity of follow-up, degree of ongoing TSH suppression, and need for additional therapies. Ongoing management recommendations must be tailored to realistic, evolving risk estimates that are actively updated during follow-up. By individualizing therapy on the basis of initial and ongoing risk assessments, we can maximize the beneficial effects of aggressive therapy in patients with thyroid cancer who are likely to benefit from it, while minimizing potential complications and side effects in low-risk patients destined to have a full healthy and productive life after minimal therapeutic intervention. Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Identifying Synergies in Multilevel Interventions.

PubMed

Lewis, Megan A; Fitzgerald, Tania M; Zulkiewicz, Brittany; Peinado, Susana; Williams, Pamela A

2017-04-01

Social ecological models of health often describe multiple levels of influence that interact to influence health. However, it is still common for interventions to target only one or two of these levels, perhaps owing in part to a lack of guidance on how to design multilevel interventions to achieve optimal impact. The convergence strategy emphasizes that interventions at different levels mutually reinforce each other by changing patterns of interaction among two or more intervention audiences; this strategy is one approach for combining interventions at different levels to produce synergistic effects. We used semistructured interviews with 65 representatives in a cross-site national initiative that enhanced health and outcomes for patients with diabetes to examine whether the convergence strategy was a useful conceptual model for multilevel interventions. Using a framework analysis approach to analyze qualitative interview data, we found three synergistic themes that match the convergence strategy and support how multilevel interventions can be successful. These three themes were (1) enhancing engagement between patient and provider and access to quality care; (2) supporting communication, information sharing, and coordination among providers, community stakeholders, and systems; and (3) building relationships and fostering alignment among providers, community stakeholders, and systems. These results support the convergence strategy as a testable conceptual model and provide examples of successful intervention strategies for combining multilevel interventions to produce synergies across levels and promote diabetes self-management and that may extend to management of other chronic illnesses as well.

Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery?

PubMed

Leppäniemi, Ari K; Mentula, Panu J; Streng, Mari H; Koivikko, Mika P; Handolin, Lauri E

2011-12-01

Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Initial management was nonoperative in 94 blunt trauma patients with 8 failures. Uni- and multivariate analyses were used to calculate predictor odds ratios (OR) with 95% confidence intervals (CI). Factors associated with early laparotomy in blunt trauma included shock on admission, associated grade IV-V splenic injury, grade IV-V head injury, and grade V liver injury. Only shock was an independent predictor (OR, 26.1; 95% CI, 8.9-77.1; P < 0.001). The presence of a grade IV-V splenic injury predicted damage control strategy (OR infinite; P = 0.021). Failed nonoperative management was associated with grade IV-V splenic injury (OR, 14.00; 95% CI, 1.67-117.55), and shock (OR, 6.82; 95% CI, 1.49-31.29). The hospital mortality rate was 15%; 8 of 21 deaths were liver-related. Shock (OR, 9.3; 95% CI, 2.4-35.8; P = 0.001) and severe head injury (OR, 9.25; 95% CI, 3.0-28.9; P = 0.000) were independent predictors for mortality. In patients with severe liver injury, associated severe splenic injury favors early laparotomy and damage control strategy. Patients who arrive in shock or have an associated severe splenic injury should not be managed nonoperatively. In addition to severe head injury, uncontrollable bleeding from the liver injury is still a major cause of early death.

'I believe high blood pressure can kill me:' using the PEN-3 Cultural Model to understand patients' perceptions of an intervention to control hypertension in Ghana.

PubMed

Blackstone, Sarah; Iwelunmor, Juliet; Plange-Rhule, Jacob; Gyamfi, Joyce; Quakyi, Nana Kofi; Ntim, Micheal; Addison, Abigail; Ogedegbe, Gbenga

2017-07-04

Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients' perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana. Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data. Emergent themes included patients' perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes. This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.

Characteristics of effective interventions supporting quality pain management in Australian emergency departments: an exploratory study.

PubMed

Shaban, Ramon Z; Holzhauser, Kerri; Gillespie, Kerri; Huckson, Sue; Bennetts, Scott

2012-02-01

It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management. A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken. Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients' pain level and attitudes toward pain assessment and pain management were identified as barriers. This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED. Copyright © 2011 College of Emergency Nursing Australasia Ltd. All rights reserved.

Operating a sustainable disease management program for chronic obstructive pulmonary disease.

PubMed

Endicott, Linda; Corsello, Phillip; Prinzi, Michele; Tinkelman, David G; Schwartz, Abby

2003-01-01

Chronic obstructive pulmonary disease (COPD) is one of our nation's most rapidly growing chronic health conditions. It is estimated that over 16 million individuals are diagnosed with COPD (Friedman & Hilleman, 2001). In addition, another 16 million are misdiagnosed as asthma or not diagnosed at all. COPD is a condition that affects the working-age as well as the elderly. Despite the high mortality rate, COPD is a treatable and modifiable condition. Disease management programs (DMPs) for asthma are a common initiative within many health insurance plans and integrated delivery networks. Similar initiatives are not as common for COPD. This article will highlight the National Jewish Medical and Research Center's COPD DMP interventions and outcomes. To outline interventions and operational strategies critical in developing and operating a sustainable and effective disease management program for COPD. Disease Management is an effective model for managing individuals with COPD. Applying a case management model that includes (1) risk-identification and stratification; (2) education and empowerment regarding self-monitoring and management; (3) lifestyle modification; (4) communication and collaboration amongst patients, healthcare providers, and case managers to enhance the treatment plan; (5) providing after-hours support; and (6) monitoring care outcomes is crucial. Applying these interventions in a credible manner will improve the quality of life and quality of care delivered to individuals with mild, moderate, severe, and very severe COPD. Additionally, these interventions can significantly reduce utilization events.

Technology-Enhanced Teaching and Learning: Leading and Supporting the Transformation on Your Campus. EDUCAUSE Leadership Strategies. The Jossey-Bass Higher and Adult Education Series.

ERIC Educational Resources Information Center

Barone, Carole A., Ed.; Hagner, Paul R., Ed.

This book offers academic leaders advice to help their institutions initiate, implement, and manage the transformation to technology-enhanced teaching and learning in order to become Internet-based communication and learning environments. The book contains the following chapters: (1) "Engaging the Faculty" (Paul R. Hagner and Charles A.…

Acute liver failure.

PubMed

Slack, Andy; Wendon, Julia

2011-06-01

ALF is a multisystem disorder necessitating both predictive and reactive management strategies to support and protect organs from the initial and subsequent insults encountered. Early referral to a specialist liver centre with the option of liver transplantation is recommended. Furthermore, a good understanding of the poor prognostic variables is necessary to determine those most at risk of developing ALF in order to facilitate timely, safe transfer and listing for liver transplantation.

Biochar and wood ash amendments for forestry in the Lake States: field report and initial results

Treesearch

Robert P. Richard; Lynette R. Potvin; Evan S. Kane; Stephen D. Handler; Patrick J. Smith; Don Peterson

2017-01-01

Soil amendments are common in agriculture but are not widely used in Lake States forestry. Our objectives were to test the efficacy of operational-scale application of soil amendments on marginal sites as a management strategy for adaptation to drier conditions. Wood ash and biochar amendments were applied throughout 50 acres of recently harvested scrub oak stands, and...

Parasites, Plants, and People.

PubMed

Johnson, Marion; Moore, Tony

2016-06-01

Anthelminthic resistance is acknowledged worldwide and is a major problem in Aotearoa New Zealand, thus alternative parasite management strategies are imperative. One Health is an initiative linking animal, human, and environmental health. Parasites, plants, and people illustrate the possibilities of providing diverse diets for stock thereby lowering parasite burdens, improving the cultural wellbeing of a local community, and protecting the environment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Establishing Research and Management Priorities for Monoecious Hydrilla

DTIC Science & Technology

2014-01-01

strategies. While use of high stocking rates of non-selective sterile grass carp (Ctenopharyngodon idella) has successfully controlled hydrilla in many...discussions of classical biological control agents (e.g. insects that feed specifically on hydrilla) did not yield any promising near-term candidates...possible. Diver- assisted dredging techniques and hand removal techniques were explored on the infestation in the Lake Cayuga inlet; initial results were

Management Options for Biochemically Recurrent Prostate Cancer.

PubMed

Fakhrejahani, Farhad; Madan, Ravi A; Dahut, William L

2017-05-01

Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent. In selected cases, high-intensity focused ultrasound and cryotherapy may be considered in patients that meet very narrow criteria as defined by non-randomized trials. If salvage options are not practical or unsuccessful, androgen deprivation therapy (ADT) is a standard option for disease control. While some patients prefer ADT to manage the disease immediately, others defer treatment because of the associated toxicity. In the absence of definitive randomized data, patients may be followed using PSA doubling time as a trigger to initiate ADT. Based on retrospective data, a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis and thus could be used signal to initiate ADT. Once treatment is begun, patients and their providers can choose between an intermittent and continuous ADT strategy. The intermittent approach may limit side effects but in patients with metastatic disease studies could not exclude a 20% greater risk of death. In men with biochemical recurrence, large studies have shown that intermittent therapy is non-inferior to continuous therapy, thus making this a reasonable option. Since biochemically recurrent prostate cancer is defined by technological limitations of radiographic detection, as new imaging (i.e., PSMA) strategies are developed, it may alter how the disease is monitored and perhaps managed. Furthermore, patients have no symptoms related to their disease and thus many prefer options that minimize toxicity. For this reason, herbal agents and immunotherapy are under investigation as potential alternatives to ADT and its accompanying side effects. New therapeutic options combined with improved imaging to evaluate the disease may markedly change how biochemically recurrent prostate cancer is managed in the future.

Intravenous iron administration strategies and anemia management in hemodialysis patients.

PubMed

Michels, Wieneke M; Jaar, Bernard G; Ephraim, Patti L; Liu, Yang; Miskulin, Dana C; Tangri, Navdeep; Crews, Deidra C; Scialla, Julia J; Shafi, Tariq; Sozio, Stephen M; Bandeen-Roche, Karen; Cook, Courtney J; Meyer, Klemens B; Boulware, L Ebony

2017-01-01

The effect of maintenance intravenous (IV) iron administration on subsequent achievement of anemia management goals and mortality among patients recently initiating hemodialysis is unclear. We performed an observational cohort study, in adult incident dialysis patients starting on hemodialysis. We defined IV administration strategies over a 12-week period following a patient's initiation of hemodialysis; all those receiving IV iron at regular intervals were considered maintenance, and all others were considered non-maintenance. We used multivariable models adjusting for demographics, clinical and treatment parameters, iron dose, measures of iron stores and pro-infectious and pro-inflammatory parameters to compare these strategies. The outcomes under study were patients' (i) achievement of hemoglobin (Hb) of 10-12 g/dL, (ii) more than 25% reduction in mean weekly erythropoietin stimulating agent (ESA) dose and (iii) mortality, ascertained over a period of 4 weeks following the iron administration period. Maintenance IV iron was administered to 4511 patients and non-maintenance iron to 8458 patients. Maintenance IV iron administration was not associated with a higher likelihood of achieving an Hb between 10 and 12 g/dL {adjusted odds ratio (OR) 1.01 [95% confidence interval (CI) 0.93-1.09]} compared with non-maintenance, but was associated with a higher odds of achieving a reduced ESA dose of 25% or more [OR 1.33 (95% CI 1.18-1.49)] and lower mortality [hazard ratio (HR) 0.73 (95% CI 0.62-0.86)]. Maintenance IV iron strategies were associated with reduced ESA utilization and improved early survival but not with the achievement of Hb targets. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Dissemination of sustainable irrigation strategies for almond and olive orchards via a participatory approach. Project LIFE+IRRIMAN

NASA Astrophysics Data System (ADS)

Garcia-Vila, Margarita; Gamero-Ojeda, Pablo; Ascension Carmona, Maria; Berlanga, Jose; Fereres, Elias

2017-04-01

Dissemination of sustainable irrigation strategies for almond and olive orchards via a participatory approach. Project LIFE+IRRIMAN Spain is the world's first and third largest producer of olive oil and almond, respectively. Despite huge efforts in the last years by the production sector towards intensification, cultural issues relative to the traditional rain-fed crop management know how, prevent farmers from adoption of sustainable irrigation management practices. Consequently, even though there has been progress in irrigation management research for these two crops, adoption of modern irrigation techniques by farmers has been slow. Sustainable irrigation strategies for olive and almond orchards are being designed, implemented, validated and disseminated under the framework of the LIFE+ IRRIMAN project, through a participatory approach. The implementation of the LIFE+ IRRIMAN innovative and demonstrative actions has been carried out in an irrigation district of Southern Spain (Genil-Cabra Irrigation Scheme, Andalusia). The approach designed has four phases: i) design and implementation of sustainable irrigation strategies in demonstration farms; ii) dissemination of best irrigation practices which were tested in the initial year throughout the irrigation scheme by the irrigation advisory service; iii) assessment of degree of adoption and re-design of the dissemination strategies; and, iv) based on the results obtained, elaboration of sustainable irrigation guidelines for knowledge transfer in the district at regional and national levels to promote changes in irrigation practices. Participatory approaches have proven to be effective tools for successful irrigation strategies design and diffusion, especially in traditional rain fed crops such as olive and almond trees in the Mediterranean countries. Acknowledgements This work has been funded by the European Union LIFE+ project IRRIMAN (LIFE13 ENV/ES/000539).

Initial medical management in acute type A aortic dissection patients with a thrombosed false lumen in the ascending aorta combining intramural hematoma and retrograde dissection from the descending to the ascending aorta.

PubMed

Sadamatsu, Kenji; Takase, Susumu; Sagara, Shuichiro; Ohe, Kensuke; Nishi, Jun-Ichiro; Tashiro, Hideki; Kosuga, Tomokazu; Yasunaga, Hiroshi

2018-05-01

The feasibility of medical management for select patients with acute type A aortic dissection has been reported from a few institutions. In this study, we retrospectively investigated the safety and feasibility of our conservative approach for patients with type A aortic dissection in daily practice. From January 2013 to December 2017, 131 consecutive patients were admitted to our institution for acute aortic dissection, including 58 patients of type A. Initial medical management was attempted in select patients who were clinically stable and had a thrombosed false lumen of the ascending aorta without ulcer-like projections in the ascending aorta. Except for nine patients contraindicated for surgery, urgent surgery was performed in 26 patients (SRG group), while 23 patients (MED group) were treated with the initial medical management. The maximum diameter of the ascending aorta was significantly larger in the SRG group than in the MED group. In the MED group, the heart rate and blood pressures were well-controlled at admission to the intensive-care unit, and the systolic blood pressure was further reduced at 24 h after. The in-hospital mortality rates of the MED and SRG groups were 0% and 15%, respectively. During the follow-up period, the survival rate was significantly higher in the MED group than in the SRG group, and the aortic event-free survival at one year was 80%. The initial medical management for select patients with a thrombosed false lumen in the ascending aorta was a safe and feasible strategy in real-world practice.

Pilot In Command: A Feasibility Assessment of Autonomous Flight Management Operations

NASA Technical Reports Server (NTRS)

Wing, David J.; Ballin, Mark G.; Krishnamurthy, Karthik

2004-01-01

Several years of NASA research have produced the air traffic management operational concept of Autonomous Flight Management with high potential for operational feasibility, significant system and user benefits, and safety. Among the chief potential benefits are demand-adaptive or scalable capacity, user flexibility and autonomy that may finally enable truly successful business strategies, and compatibility with current-day operations such that the implementation rate can be driven from within the user community. A concept summary of Autonomous Flight Management is provided, including a description of how these operations would integrate in shared airspace with existing ground-controlled flight operations. The mechanisms enabling the primary benefits are discussed, and key findings of a feasibility assessment of airborne autonomous operations are summarized. Concept characteristics that impact safety are presented, and the potential for initially implementing Autonomous Flight Management is discussed.

A European initiative to define research needs and foster the adoption of Managed Aquifer Recharge into river basin management

NASA Astrophysics Data System (ADS)

Kneppers, Angeline; Grützmacher, Gesche; Kazner, Christian; Zojer, Hans

2010-05-01

The European Technology Platform for Water (WssTP) was initiated by the European Commission to federate a highly fragmented sector with the aim to foster competitive innovations and promote sustainable solutions. To achieve this, pilot programmes endorsing a bottom-up approach were launched in 2007 with a variety of stakeholders having representative water issues to solve. Integrated Water Resources Management (IWRM) was adopted as a balancing process for the safe and sustainable development, allocation and monitoring of water resource use in the context of current and future social, economic and environmental objectives. As a result key drivers were selected and a methodology was followed to identify and validate the needs with stakeholders and experts, and demonstrate solutions as an integrated part of the river basin management plans. Managed Aquifer Recharge (MAR) was identified as a key component of integrated water resources management, especially in water scarce regions and an area relevant for further research. The paper shall summarize the process followed by the WssTP, initiating a Task Force with 36 representatives from European research institutes and industry partners with participation of a few international experts. During a workshop conducted in Graz in June 2009 these experts developed the basis for a report that has now been submitted to the European Commission for consideration in future research calls. Implementing IWRM and MAR is made difficult by the number of different water bodies, but also by the large number of stakeholders, policies, legislations and conflicting interests. The results of the MAR Task Force initiative set the basis for further discussions with the international MAR community on the relevance of the identified research needs but also on the importance and process to associate the institutional and managerial entities for capacity building and the adoption of MAR into the overall management strategies.

Embedding care management in the medical home: a case study.

PubMed

Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

2014-04-01

Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

Brazilian health technology assessment bulletin: editorial process, dissemination strategies, critical appraisal, and initial impact.

PubMed

Silva, Marcus Tolentino; de Almeida, Rosimary Terezinha; Gava, Cintia Maria; Galvão, Taís Freire; da Silva, Edina Mariko Koga; Santos, Vania Cristina Canuto; Ronchini, Misani Akiko Kanamota; de Mesquita, Aline Monte; Elias, Flávia Tavares Silva; d'Oliveira, Alexandre Lemgruber Portugal; Atallah, Alvaro Nagib

2012-01-01

This study reports on the Brazilian experience of developing a specialized bulletin, the Brazilian Health Technology Assessment Bulletin (BRATS), on health technology assessments (HTA). The editorial process, format, and dissemination strategy of the publication are presented. A critical appraisal of the available issues was made using the checklist for HTA reports of the International Network of Agencies for Health Technology Assessment. The initial impact was estimated based on a retrospective observational measurement of the types of publications that cite the bulletin as a source of information. The publications citing BRATS were identified using Google Scholar. Since June 2008, fourteen issues of the bulletin have been produced. BRATS has not presented any significant limitation that would compromise generalizations of its results within the Brazilian context. The initial impact of the bulletin, however, has been small, which may be due to its exclusively electronic dissemination format and technical language. We found nine publications citing BRATS in Google Scholar. It is hoped that the bulletin will promote the continuity of HTA actions among health-sector managers and professionals in Brazil.

Improving water quality through California's Clean Beach Initiative: an assessment of 17 projects.

PubMed

Dorsey, John H

2010-07-01

California's Clean Beach Initiative (CBI) funds projects to reduce loads of fecal indicator bacteria (FIB) impacting beaches, thus providing an opportunity to judge the effectiveness of various CBI water pollution control strategies. Seventeen initial projects were selected for assessment to determine their effectiveness on reducing FIB in the receiving waters along beaches nearest to the projects. Control strategies included low-flow diversions, sterilization facilities, sewer improvements, pier best management practices (BMPs), vegetative swales, and enclosed beach BMPs. Assessments were based on statistical changes in pre- and postproject mean densities of FIB at shoreline monitoring stations targeted by the projects. Most low-flow diversions and the wetland swale project were effective in removing all contaminated runoff from beaches. UV sterilization was effective when coupled with pretreatment filtration and where effluent was released within a few hundred meters of the beach to avoid FIB regrowth. Other BMPs were less effective because they treated only a portion of contaminant sources impacting their target beach. These findings should be useful to other coastal states and agencies faced with similar pollution control problems.

75 FR 75707 - Request for Public Comment on the Draft National Nanotechnology Initiative Strategy for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-06

... Nanotechnology Initiative Strategy for Nanotechnology-Related Environmental, Health, and Safety Research AGENCY... the public regarding the draft National Nanotechnology Initiative (NNI) Strategy for Nanotechnology... confidential. Overview: The National Nanotechnology Initiative Strategy for Nanotechnology-Related...

Cancer-Related Fatigue in Cancer Survivorship.

PubMed

Ebede, Chidinma C; Jang, Yongchang; Escalante, Carmen P

2017-11-01

Cancer-related fatigue (CRF) significantly interferes with usual functioning because of the distressing sense of physical, emotional, and cognitive exhaustion. Assessment of CRF is important and should be performed during the initial cancer diagnosis, throughout cancer treatment, and after treatment using a fatigue scoring scale (mild-severe). The general approach to CRF management applies to cancer survivors at all fatigue levels and includes education, counseling, and other strategies. Nonpharmacologic interventions include psychosocial interventions, exercise, yoga, physically based therapy, dietary management, and sleep therapy. Pharmacologic interventions include psychostimulants. Antidepressants may also benefit when CRF is accompanied by depression. Copyright © 2017 Elsevier Inc. All rights reserved.

Achieving a competitive advantage through referral management.

PubMed

D'Amaro, R; Thomas, C S

1989-01-01

The physician remains the primary referral source in medical service. Referral patterns, in turn, reflect interactions between referring physicians and consultants which relate to quality of care, costs, and personal factors such as age and common training. Referrals initiated by patients relate to the desire to seek a second opinion and are heavily influenced by other family members. Alterations in the referral process are emerging due to cost escalation, the emergence of large payor groupings and aggregation of physicians into larger group settings. Strategies to manage the referral process include enhanced communications using new telecommunication technology and joint ventures with hospitals.

Physician involvement in disease management as part of the CCM.

PubMed

Wallace, Paul J

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I.

Physician Involvement in Disease Management as Part of the CCM

PubMed Central

Wallace, Paul J.

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I. PMID:17288075

Unexplained infertility: overall ongoing pregnancy rate and mode of conception.

PubMed

Brandes, M; Hamilton, C J C M; van der Steen, J O M; de Bruin, J P; Bots, R S G M; Nelen, W L D M; Kremer, J A M

2011-02-01

Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility. In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management-IUI-IVF (main treatment route), (ii) IUI-IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception. Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor's advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history. Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials.

Are you a strategist or just a manager?

PubMed

Hinterhuber, H H; Popp, W

1992-01-01

Perhaps the greatest strategist of all time was not a business executive but a general. Helmuth von Moltke, chief of the Prussian and German general staffs from 1858 to 1888, issued "directives" to his officers rather than specific commands. These guidelines for autonomous decision making encouraged Moltke's subordinates to show individual initiative. In this article, Hans Hinterhuber and Wolfgang Popp translate Moltke's example into business terms. According to Moltke, strategy is applied common sense and cannot be taught. The authors suggest that good entrepreneurs and managers--along with generals--are born with the qualities that make them successful. But even if managers have the potential to be good strategists, they must develop and hone their natural talents. And CEOs and top management can help by identifying and promoting such talents in their employees. Hinterhuber and Popp have created a questionnaire that helps measure strategic management competence. Managers and entrepreneurs take this test themselves, answering ten questions such as, "Do I have an entrepreneurial vision?", "Do I have a corporate philosophy?", and "Do I have competitive advantages?" Using the questionnaire, company management can evaluate managers being considered for a promotion. At the same time, those who take the test can use it to determine their own performance as strategists. Strategic managers provide subordinates with general guidelines, just as Helmuth von Moltke issued directives to his officers. And outstanding entrepreneurs create a corporate culture in which their vision, philosophy, and business strategies are implemented by employees who think independently.

A total system approach to sustainable pest management

PubMed Central

Lewis, W. J.; van Lenteren, J. C.; Phatak, Sharad C.; Tumlinson, J. H.

1997-01-01

A fundamental shift to a total system approach for crop protection is urgently needed to resolve escalating economic and environmental consequences of combating agricultural pests. Pest management strategies have long been dominated by quests for “silver bullet” products to control pest outbreaks. However, managing undesired variables in ecosystems is similar to that for other systems, including the human body and social orders. Experience in these fields substantiates the fact that therapeutic interventions into any system are effective only for short term relief because these externalities are soon “neutralized” by countermoves within the system. Long term resolutions can be achieved only by restructuring and managing these systems in ways that maximize the array of “built-in” preventive strengths, with therapeutic tactics serving strictly as backups to these natural regulators. To date, we have failed to incorporate this basic principle into the mainstream of pest management science and continue to regress into a foot race with nature. In this report, we establish why a total system approach is essential as the guiding premise of pest management and provide arguments as to how earlier attempts for change and current mainstream initiatives generally fail to follow this principle. We then draw on emerging knowledge about multitrophic level interactions and other specific findings about management of ecosystems to propose a pivotal redirection of pest management strategies that would honor this principle and, thus, be sustainable. Finally, we discuss the potential immense benefits of such a central shift in pest management philosophy. PMID:9356432

Dawn of a New Space Age: Developing a Global Exploration Strategy.

NASA Technical Reports Server (NTRS)

Volosin, Jeff

2006-01-01

Jeff Volosin is an aerospace engineer with over 20 years of experience in the design, development, and operations of both robotic and crewed spacecraft. Mr. Volosin is currently leading the NASA effort to develop and integrate a global exploration strategy which reflects the lunar exploration interests of international space agencies, academia and commercial stakeholders. Prior to joining NASA as a member of the Exploration Systems Mission Directorate in 2004, Jeff was an aerospace contractor, serving in a number of leadership positions including: Operations Manager for the NASA Communications Network and Flight Operations Manager for the Advanced Composition Explorer, Tropical Rainfall Measuring Mission, and the NOAA Polar and Geostationary satellite constellations. Earlier in his career, Jeff spent 4 years as a system engineer supporting the Space Exploration Initiative studies on human voyages to the Moon and Mars and also supported the Space Station program as an advanced life support engineer.

Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy - a review.

PubMed

Freitag, Julien; Bates, Dan; Boyd, Richard; Shah, Kiran; Barnard, Adele; Huguenin, Leesa; Tenen, Abi

2016-05-26

Osteoarthritis is a leading cause of pain and disability across the world. With an aging population its prevalence is likely to further increase. Current accepted medical treatment strategies are aimed at symptom control rather than disease modification. Surgical options including joint replacement are not without possible significant complications. A growing interest in the area of regenerative medicine, led by an improved understanding of the role of mesenchymal stem cells in tissue homeostasis and repair, has seen recent focused efforts to explore the potential of stem cell therapies in the active management of symptomatic osteoarthritis. Encouragingly, results of pre-clinical and clinical trials have provided initial evidence of efficacy and indicated safety in the therapeutic use of mesenchymal stem cell therapies for the treatment of knee osteoarthritis. This paper explores the pathogenesis of osteoarthritis and how mesenchymal stem cells may play a role in future management strategies of this disabling condition.

Integrating a Patient-Controlled Admission Program Into Mental Health Hospital Service: A Multicenter Grounded Theory Study.

PubMed

Ellegaard, Trine; Bliksted, Vibeke; Mehlsen, Mimi; Lomborg, Kirsten

2018-05-01

Patient-controlled admissions (PCAs) enable mental health patients by means of a contract to initiate an admission at a mental health hospital unit without using traditional admission procedures. This study was part of a 3-year Danish multicenter project, and we explored how mental health professionals experienced and managed the implementation of a PCA program. The methodology was grounded theory and the sample included 26 participants. We performed a constant comparative analysis to explore the concerns, attitudes, and strategies of mental health professionals. We developed a model of how the mental health professionals strived to integrate PCA into clinical practice. The process was motivated by the idea of establishing a partnership with patients and involved two interrelated strategies to manage (a) the patient-related duties and (b) the admission contracts. The professionals moved from a phase of professional discomfort to a phase of professional awareness, and ended up with professional comprehension.

Child Sexual Abuse in Zimbabwe.

PubMed

Mantula, Fennie; Saloojee, Haroon

2016-01-01

Although child sexual abuse is a significant public health problem globally, its incidence, prevention, and management is less well described in resource-poor settings. In poorer settings prevention initiatives assume even more importance since resources for managing abused children are severely limited. This article examines the current status of policy and practice related to the prevention of child sexual abuse in Zimbabwe. It identifies implementation challenges and highlights opportunities that could be embraced to reduce CSA in Zimbabwe, based on evidence synthesized from recent work. Although Zimbabwe has a well-established legal and regulatory framework to protect children from child sexual abuse, implementation of existing policies is weak. Financial, human, and material resource constraints are frequently cited to explain limited prevention activity. Effective strategies for the prevention of child sexual abuse should focus on implementing existing legislation, targeting schoolchildren, and getting community involvement. A dedicated budget would help entrench these strategies, but gains can be achieved even in the absence of this.

National launch strategy vehicle data management system

NASA Technical Reports Server (NTRS)

Cordes, David

1990-01-01

The national launch strategy vehicle data management system (NLS/VDMS) was developed as part of the 1990 NASA Summer Faculty Fellowship Program. The system was developed under the guidance of the Engineering Systems Branch of the Information Systems Office, and is intended for use within the Program Development Branch PD34. The NLS/VDMS is an on-line database system that permits the tracking of various launch vehicle configurations within the program development office. The system is designed to permit the definition of new launch vehicles, as well as the ability to display and edit existing launch vehicles. Vehicles can be grouped in logical architectures within the system. Reports generated from this package include vehicle data sheets, architecture data sheets, and vehicle flight rate reports. The topics covered include: (1) system overview; (2) initial system development; (3) supercard hypermedia authoring system; (4) the ORACLE database; and (5) system evaluation.

Characterization of Model-Based Reasoning Strategies for Use in IVHM Architectures

NASA Technical Reports Server (NTRS)

Poll, Scott; Iverson, David; Patterson-Hine, Ann

2003-01-01

Open architectures are gaining popularity for Integrated Vehicle Health Management (IVHM) applications due to the diversity of subsystem health monitoring strategies in use and the need to integrate a variety of techniques at the system health management level. The basic concept of an open architecture suggests that whatever monitoring or reasoning strategy a subsystem wishes to deploy, the system architecture will support the needs of that subsystem and will be capable of transmitting subsystem health status across subsystem boundaries and up to the system level for system-wide fault identification and diagnosis. There is a need to understand the capabilities of various reasoning engines and how they, coupled with intelligent monitoring techniques, can support fault detection and system level fault management. Researchers in IVHM at NASA Ames Research Center are supporting the development of an IVHM system for liquefying-fuel hybrid rockets. In the initial stage of this project, a few readily available reasoning engines were studied to assess candidate technologies for application in next generation launch systems. Three tools representing the spectrum of model-based reasoning approaches, from a quantitative simulation based approach to a graph-based fault propagation technique, were applied to model the behavior of the Hybrid Combustion Facility testbed at Ames. This paper summarizes the characterization of the modeling process for each of the techniques.

Risk-based management of invading plant disease.

PubMed

Hyatt-Twynam, Samuel R; Parnell, Stephen; Stutt, Richard O J H; Gottwald, Tim R; Gilligan, Christopher A; Cunniffe, Nik J

2017-05-01

Effective control of plant disease remains a key challenge. Eradication attempts often involve removal of host plants within a certain radius of detection, targeting asymptomatic infection. Here we develop and test potentially more effective, epidemiologically motivated, control strategies, using a mathematical model previously fitted to the spread of citrus canker in Florida. We test risk-based control, which preferentially removes hosts expected to cause a high number of infections in the remaining host population. Removals then depend on past patterns of pathogen spread and host removal, which might be nontransparent to affected stakeholders. This motivates a variable radius strategy, which approximates risk-based control via removal radii that vary by location, but which are fixed in advance of any epidemic. Risk-based control outperforms variable radius control, which in turn outperforms constant radius removal. This result is robust to changes in disease spread parameters and initial patterns of susceptible host plants. However, efficiency degrades if epidemiological parameters are incorrectly characterised. Risk-based control including additional epidemiology can be used to improve disease management, but it requires good prior knowledge for optimal performance. This focuses attention on gaining maximal information from past epidemics, on understanding model transferability between locations and on adaptive management strategies that change over time. © 2017 The Authors. New Phytologist © 2017 New Phytologist Trust.

[Health system in Afghanistan: problems and institutional perspectives].

PubMed

Lejars, M

2008-10-01

Afghanistan has been ravaged by years of conflict. To provide emergency services and restore access health services, the Public Health Ministry with the assistance of partners developed first a package of basic health services delivered by NGO contractors and second a package of essential hospital services. The Ministry's role consists of providing guidance. To reduce the many issues and problems affecting this role, reforms are now being undertaken and a new national health care strategy is being developed within the framework of the National Development Strategy. An institution-building project has been initiated with European Union funding to allow the Health Ministry to carry out its stewardship and management functions with greater effectiveness and transparency. This project is essential for the successful outcome of all future strategies and programs planned by the Health Ministry to enhance its institutional effectiveness. The objectives of this project are to strengthen planning and auditing activities, promote quality assurance, implement funding mechanisms for health-related activities, organize management of human resources, maintain ongoing efforts to reform the administration and fight against corruption, and lay the foundations for managing finances and procurement. The scope of this project underlines the importance of its outcome. However the institution-building process will be long and constantly threatened by political instability and insecurity.

Acute coronary syndromes: is there a place for a real pre-hospital treatment for patients "en route" to the coronary intensive care unit?

PubMed

Assez, Nathalie; Smith, Grégoire; Adriansen, Christophe; Aboukais, Wissam; Wiel, Eric; Goldstein, Patrick

2012-08-01

Acute initial management of patients with acute coronary syndrome (ACS) is based on a precise clinical and electrocardiographic diagnosis. Initial risk stratification in the pre-hospital phase is the key step. The last step, adequate patient routing, is decided based on emergency level and reperfusion strategies, considered right from the pre-hospital phase. The management of a patient with an ACS requires close collaboration between emergency physicians and cardiologists, according to simplified protocols for easier access to catheterisation. The next challenges for the pre-hospital management of ACS are based on: - precise knowledge of new antiplatelet and anticoagulant drugs by the emergency physicians, in order to adjust their prescriptions to the patient profile; - developing co-operation between hospitals, according to regional specificities (geographic considerations and distribution of PCI centres) in order to reduce access time to catheterisation rooms; - organising the healthcare network, where the SAMU has an essential role in coordinating the different medical actors; - regular analysis of the evolution of our professional practices, considering, e.g., the guidelines of the "HAS" (French official healthcare guidelines institute);- integrating pre-hospital medicine in health prevention programmes; - improving our understanding of the population's presentations of coronary artery disease, in order to encourage the patients and their families to call the EMS as soon as possible. The challenge of the emergency physician is to adapt the strategies to the patient's needs.

Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)--a realist synthesis.

PubMed

Maidment, Ian; Booth, Andrew; Mullan, Judy; McKeown, Jane; Bailey, Sylvia; Wong, Geoffrey

2017-07-03

Medication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mechanisms. The MEdication Management in Older people: REalist Approaches BAsed on Literature and Evaluation (MEMORABLE) project uses realist synthesis to understand how, why, for whom and in what context interventions, to improve medication management in older people on complex medication regimes residing in the community, work. This realist synthesis uses secondary data and primary data from interviews to develop the programme theory. A realist logic of analysis will synthesise data both within and across the two data sources to inform the design of a complex intervention(s) to help improve medication management in older people. 1. Literature review The review (using realist synthesis) contains five stages to develop an initial programme theory to understand why processes are more or less successful and under which situations: focussing of the research question; developing the initial programme theory; developing the search strategy; selection and appraisal based on relevance and rigour; and data analysis/synthesis to develop and refine the programme theory and context, intervention and mechanism configurations. 2. Realist interviews Realist interviews will explore and refine our understanding of the programme theory developed from the realist synthesis. Up to 30 older people and their informal carers (15 older people with multi-morbidity, 10 informal carers and 5 older people with dementia), and 20 care staff will be interviewed. 3. Developing framework for the intervention(s) Data from the realist synthesis and interviews will be used to refine the programme theory for the intervention(s) to identify: the mechanisms that need to be 'triggered', and the contexts related to these mechanisms. Intervention strategies that change the contexts so the mechanisms are triggered to produce desired outcomes will be developed. Feedback on these strategies will be obtained. This realist synthesis aims to develop a framework (underpinned by our programme theory) for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens. PROSPERO CRD42016043506.

New perspectives on sea use management: initial findings from European experience with marine spatial planning.

PubMed

Douvere, Fanny; Ehler, Charles N

2009-01-01

Increased development pressures on the marine environment and the potential for multiple use conflicts, arising as a result of the current expansion of offshore wind energy, fishing and aquaculture, dredging, mineral extraction, shipping, and the need to meet international and national commitments to biodiversity conservation, have led to increased interest in sea use planning with particular emphasis on marine spatial planning. Several European countries, on their own initiative or driven by the European Union's Marine Strategy and Maritime Policy, the Bergen Declaration of the North Sea Conference, and the EU Recommendation on Integrated Coastal Zone Management, have taken global leadership in implementing marine spatial planning. Belgium, The Netherlands, and Germany in the North Sea, and the United Kingdom in the Irish Sea, have already completed preliminary sea use plans and zoning proposals for marine areas within their national jurisdictions. This paper discusses the nature and context of marine spatial planning, the international legal and policy framework, and the increasing need for marine spatial planning in Europe. In addition, the authors review briefly three marine spatial planning initiatives in the North Sea and conclude with some initial lessons learned from these experiences.

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

Eto, Joe; Eto, Joe; Lesieutre, Bernard

The increased need to manage California?s electricity grid in real time is a result of the ongoing transition from a system operated by vertically-integrated utilities serving native loads to one operated by an independent system operator supporting competitive energy markets. During this transition period, the traditional approach to reliability management -- construction of new transmission lines -- has not been pursued due to unresolved issues related to the financing and recovery of transmission project costs. In the absence of investments in new transmission infrastructure, the best strategy for managing reliability is to equip system operators with better real-time information aboutmore » actual operating margins so that they can better understand and manage the risk of operating closer to the edge. A companion strategy is to address known deficiencies in offline modeling tools that are needed to ground the use of improved real-time tools. This project: (1) developed and conducted first-ever demonstrations of two prototype real-time software tools for voltage security assessment and phasor monitoring; and (2) prepared a scoping study on improving load and generator response models. Additional funding through two separate subsequent work authorizations has already been provided to build upon the work initiated in this project.« less

The next 10 years in the management of peripheral artery disease: perspectives from the 'PAD 2009' Conference.

PubMed

Norgren, L; Hiatt, W R; Dormandy, J A; Hirsch, A T; Jaff, M R; Diehm, C; Baumgartner, I; Belch, J J F

2010-09-01

To briefly inform on the conclusions from a conference on the next 10 years in the management of peripheral artery disease (PAD). International participation, invited presentations and open discussion were based on the following issues: Why is PAD under-recognised? Health economic impact of PAD; funding of PAD research; changes of treatment options? Aspects on clinical trials and regulatory views; and the role of guidelines. A relative lack of knowledge about cardiovascular risk and optimal management of PAD patients exists not only among the public, but also in parts of the health-care system. Specialists are required to act for improved information. More specific PAD research is needed for risk management and to apply the best possible evaluation of evidence for treatment strategies. Better strategies for funding are required based on, for example, public/private initiatives. The proportion of endovascular treatments is steadily increasing, more frequently based on observational studies than on randomised controlled trials. The role of guidelines is therefore important to guide the profession in the assessment of most relevant treatment. Copyright 2010 European Society for Vascular Surgery. All rights reserved.

Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania

PubMed Central

Kayombo, Edmund J; Uiso, Febronia C; Mbwambo, Zakaria H; Mahunnah, Rogasian L; Moshi, Mainen J; Mgonda, Yasin H

2007-01-01

Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods. The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas. After consultative meetings these leaders showed to be willing to collaborate; and opened doors to other traditional healers, who too were willing to collaborate with the Institute of Traditional Medicine in managing HIV/AIDS patients. Seventy five percent of traditional healers who claimed to be treating HIV/AIDS knew some HIV/AIDS symptoms; and some traditional healers attempted to manage these symptoms. Even though, they were willing to collaborate with the Institute of Traditional Medicine there were nevertheless some reservations based on questions surrounding sharing from collaboration. The reality of past experiences of mistreatment of traditional healers in the colonial period informed these reservations. General findings suggest that initiating collaboration is not as easy as it appears to be from the literature, if it is to be meaningful; and thus we are calling for appropriate strategies to access potential healers targeted for any study designed with sustainability in mind. PMID:17257409

Optimal strength and timing of steroids in the management of erlotinib-related skin toxicities in a post-marketing surveillance study (POLARSTAR) of 9909 non-small-cell lung cancer patients.

PubMed

Yamazaki, Naoya; Kiyohara, Yoshio; Kudoh, Shoji; Seki, Akihiro; Fukuoka, Masahiro

2016-04-01

Skin toxicities, such as rash, are the most common adverse reactions associated with erlotinib. Steroids are a key treatment option for rash management; however, optimal timing of administration and selection of steroid strength have not been fully established. In this surveillance study of Japanese non-small-cell lung cancer (NSCLC) patients treated with erlotinib, rash management using topical steroids was analyzed in routine clinical practice. From December 2007 to October 2009, all recurrent/advanced NSCLC patients in Japan treated with erlotinib were enrolled into this study (POst-Launch All-patient Registration Surveillance in TARceva). The observation period was 12 months, and data for all adverse events were collected. Erlotinib-related rash, interventions for the symptoms, and outcomes of the interventions were analyzed. A total of 9909 patients were evaluated. Rash occurred in 67.4 % of patients; grade 1, 2, and 3 rash were observed in 26.8 %, 32.4 %, and 7.2 % of patients, respectively. The most common management strategy was topical steroids in 75.0 % of patients with rash. Regardless of rash grade, earlier initiation of steroids resulted in quicker recovery. In those for whom topical steroids were initiated more than 21 days after rash onset, median recovery time was more than 100 days regardless of rash grade, compared with those treated before rash onset, whose median time to recovery was 35-51 days, depending on rash grade. Median time to recovery of rash in the group initiated on medium-rank steroids then changed to strong-rank steroids was 47, 98, and 103 days for those with grade 1, 2, and 3 rash, respectively, compared with 39, 53, and 73 days median recovery for grade 1, 2, and 3 rash, respectively, in patients initiated on strong-rank steroids. Earlier initiation of topical steroids for the management of rash with strong or higher-rank steroids could achieve faster improvement.

Responses of HMO Medical Directors to Trust Building in Managed Care

PubMed Central

Mechanic, David; Rosenthal, Marsha

1999-01-01

Managed care organizations (MCOs) are facing intense criticism at national, state, and local levels and battling initiatives that would impose stricter regulation. Medical directors of HMOs were surveyed regarding their organizations’ strategies of communication, the programs they have instituted to build trust, and their commitment to sponsoring family and patient support groups. The responses obtained from 252 directors indicate that nonprofit and free-standing organizations are more likely than either for-profitHMOs or organizations that are part of a chain to sponsor community activities and programs and to offer family and patient support groups. Staff- and group-model HMOs are more likely than other organizational configurations to initiate many types of “trust programs.” The results indicate that more dispersed and “virtual-type” organizations must explore ways to respond meaningfully to community concerns–and to public health, prevention, and health promotion needs as well–while continuing to improve their practice patterns. PMID:10526546

Risk-adapted management of pulmonary embolism.

PubMed

Barco, Stefano; Konstantinides, Stavros V

2017-03-01

The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE. Catheter-directed pharmacomechanical reperfusion treatment represents a promising option for minimizing bleeding risk; for reduced-dose intravenous thrombolysis, the data are still preliminary. Non-vitamin K-dependent oral anticoagulants, directly inhibiting factor Xa (rivaroxaban, apixaban, edoxaban) or thrombin (dabigatran), have simplified initial and long-term anticoagulation for PE while reducing major bleeding risk. Use of vena cava filters should be restricted to selected patients with absolute contraindications to anticoagulation, or PE recurrence despite adequately dosed anticoagulants. © 2017 Elsevier Ltd. All rights reserved.

Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling.

PubMed

Robinson, M; Palmer, S; Sculpher, M; Philips, Z; Ginnelly, L; Bowens, A; Golder, S; Alfakih, K; Bakhai, A; Packham, C; Cooper, N; Abrams, K; Eastwood, A; Pearman, A; Flather, M; Gray, D; Hall, A

2005-07-01

To identify and prioritise key areas of clinical uncertainty regarding the medical management of non-ST elevation acute coronary syndrome (ACS) in current UK practice. Electronic databases. Consultations with clinical advisors. Postal survey of cardiologists. Potential areas of important uncertainty were identified and 'decision problems' prioritised. A systematic literature review was carried out using standard methods. The constructed decision model consisted of a short-term phase that applied the results of the systematic review and a long-term phase that included relevant information from a UK observational study to extrapolate estimated costs and effects. Sensitivity analyses were undertaken to examine the dependence of the results on baseline parameters, using alternative data sources. Expected value of information analysis was undertaken to estimate the expected value of perfect information associated with the decision problem. This provided an upper bound on the monetary value associated with additional research in the area. Seven current areas of clinical uncertainty (decision problems) in the drug treatment of unstable angina patients were identified. The agents concerned were clopidogrel, low molecular weight heparin, hirudin and intravenous glycoprotein antagonists (GPAs). Twelve published clinical guidelines for unstable angina or non-ST elevation ACS were identified, but few contained recommendations about the specified decision problems. The postal survey of clinicians showed that the greatest disagreement existed for the use of small molecule GPAs, and the greatest uncertainty existed for decisions relating to the use of abciximab (a large molecule GPA). Overall, decision problems concerning the GPA class of drugs were considered to be the highest priority for further study. Selected papers describing the clinical efficacy of treatment were divided into three groups, each representing an alternative strategy. The strategy involving the use of GPAs as part of the initial medical management of all non-ST elevation ACS was the optimal choice, with an incremental cost-effectiveness ratio (ICER) of 5738 pounds per quality-adjusted life-year (QALY) compared with no use of GPAs. Stochastic analysis showed that if the health service is willing to pay 10,000 pounds per additional QALY, the probability of this strategy being cost-effective was around 82%, increasing to 95% at a threshold of 50,000 pounds per QALY. A sensitivity analysis including an additional strategy of using GPAs as part of initial medical management only in patients at particular high risk (as defined by age, ST depression or diabetes) showed that this additional strategy was yet more cost-effective, with an ICER of 3996 pounds per QALY compared with no treatment with GPA. Value of information analysis suggested that there was considerable merit in additional research to reduce the level of uncertainty in the optimal decision. At a threshold of 10,000 pounds per QALY, the maximum potential value of such research in the base case was calculated as 12.7 million pounds per annum for the UK as a whole. Taking account of the greater uncertainty in the sensitivity analyses including clopidogrel, this figure was increased to approximately 50 million pounds. This study suggests the use of GPAs in all non-ST elevation ACS patients as part of their initial medical management. Sensitivity analysis showed that virtually all of the benefit could be realised by treating only high-risk patients. Further clarification of the optimum role of GPAs in the UK NHS depends on the availability of further high-quality observational and trial data. Value of information analysis derived from the model suggests that a relatively large investment in such research may be worthwhile. Further research should focus on the identification of the characteristics of patients who benefit most from GPAs as part of medical management, the comparison of GPAs with clopidogrel as an adjunct to standard care, follow-up cohort studies of the costs and outcomes of high-risk non-ST elevation ACS over several years, and exploring how clinicians' decisions combine a normative evidence-based decision model with their own personal behavioural perspective.

Managing uncertainty in collaborative robotics engineering projects: The influence of task structure and peer interaction

NASA Astrophysics Data System (ADS)

Jordan, Michelle

Uncertainty is ubiquitous in life, and learning is an activity particularly likely to be fraught with uncertainty. Previous research suggests that students and teachers struggle in their attempts to manage the psychological experience of uncertainty and that students often fail to experience uncertainty when uncertainty may be warranted. Yet, few educational researchers have explicitly and systematically observed what students do, their behaviors and strategies, as they attempt to manage the uncertainty they experience during academic tasks. In this study I investigated how students in one fifth grade class managed uncertainty they experienced while engaged in collaborative robotics engineering projects, focusing particularly on how uncertainty management was influenced by task structure and students' interactions with their peer collaborators. The study was initiated at the beginning of instruction related to robotics engineering and preceded through the completion of several long-term collaborative robotics projects, one of which was a design project. I relied primarily on naturalistic observation of group sessions, semi-structured interviews, and collection of artifacts. My data analysis was inductive and interpretive, using qualitative discourse analysis techniques and methods of grounded theory. Three theoretical frameworks influenced the conception and design of this study: community of practice, distributed cognition, and complex adaptive systems theory. Uncertainty was a pervasive experience for the students collaborating in this instructional context. Students experienced uncertainty related to the project activity and uncertainty related to the social system as they collaborated to fulfill the requirements of their robotics engineering projects. They managed their uncertainty through a diverse set of tactics for reducing, ignoring, maintaining, and increasing uncertainty. Students experienced uncertainty from more different sources and used more and different types of uncertainty management strategies in the less structured task setting than in the more structured task setting. Peer interaction was influential because students relied on supportive social response to enact most of their uncertainty management strategies. When students could not garner socially supportive response from their peers, their options for managing uncertainty were greatly reduced.

Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: an interview study

PubMed Central

Tong, Allison; Campbell, Katrina L; Craig, Jonathan C; Lee, Vincent W

2018-01-01

Objective To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care. Design Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory. Setting 21 haemodialysis centres across Australia. Participants 42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences. Results Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies). Conclusions Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient–clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis. PMID:29523567

Common Data Servers as a Foundation for Specialized Services

NASA Astrophysics Data System (ADS)

Burger, E. F.; Schweitzer, R.; O'Brien, K.; Manke, A. B.; Smith, K. M.

2017-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a broad range of research efforts that span many scientific and environmental research disciplines. Many of these research projects have their own data streams that are as diverse as the research. Data are collected using various platforms, including innovative new platforms such as Saildrones and autonomous profilers. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data landscape for Federal agencies. In 2015, with support from the PMEL Director, the PMEL Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. The PMEL integrated data management strategy will provide data access, visualization and some archive services to PMEL data and use existing and proven frameworks for this capability. In addition to these foundational data services, these data access and visualization frameworks are also leveraged to provide enhanced services to scientists. One enhanced service developed is a data management "dashboard". This application provides scientists with a snapshot of their data assets, access to these data, a map view of data locations, and information on the archival status. Ideally, information on the dashboard continually updates to accurately reflect the project's data asset status. This poster explains how frameworks such as ERDDAP and LAS were used as a foundation for the development of custom services, as well as an explanation of the PMEL data management dashboard functionality. We will also highlight accomplishments of the PMEL Integrated data management strategy implementation.

Initial Capabilities Documents: A 10-Year Retrospective of Tools, Methodologies, and Best Practices

DTIC Science & Technology

2014-07-01

Nixon, J. (2010). Exploring SWOT analysis -where are we now? A review of academic research from the last decade. Journal of Strategy and Management, 3(3...analyze threats, etc.). Strengths, Weaknesses, Opportunities and Threats ( SWOT ) Analysis (Helms & Nixon, 2010) Analyzes internal (strengths...market share/total market pies to enhance analysis . Augments SWOT . Mostly pre-CBA; used to build portfolios; however, can be used in a CBA

Land Management Panel: Army’s Net Zero Installation Initiative

DTIC Science & Technology

2012-05-24

same watershed so not to deplete the groundwater and surface water resources of that region in quantity or quality.  A Net Zero WASTE Installation...0.15 0.2 0.25 Assistant Secretary of the Army (Installations, Energy & Environment) Net Zero Waste A Net Zero WASTE Installation reduces, reuses...Net Zero Waste Strategy 17 Assistant Secretary of the Army (Installations, Energy & Environment) Waste Roadmaps Material flow analysis

Developing strategies to initialize landscape-scale vegetation maps from FIA data to enhance resolution of individual species-size cohort representation in the landscape disturbance model SIMPPLLE

Treesearch

Jacob John Muller

2014-01-01

The ability of forest resource managers to understand and anticipate landscape-scale change in composition and structure relies upon an adequate characterization of the current forest composition and structure of various patches (or stands), along with the capacity of forest landscape models (FLMs) to predict patterns of growth, succession, and disturbance at multiple...

Risk Scan: A Review of Risk Assessment Capability and Maturity within the Canadian Safety and Security Program

DTIC Science & Technology

2014-06-01

SCADA / ICS Cyber Test Lab initiated in 2013 Psychosocial – academic research exists,; opportunity for sharing and developing impact assessment...ecosystems and species at risk), accidents / system failure (rail; pipelines ; ferries CSSP strategy for the North Focus on regional l(and local) problem...Guidance; business planning; environmental scan; proposal evaluation; and performance measurement Program Risk Management – Guidelines for project

Succession planning and leadership development: critical business strategies for healthcare organizations.

PubMed

Collins, Sandra K; Collins, Kevin S

2007-01-01

As labor shortages intensify, succession planning and leadership development have become strategic initiatives requiring rigorous consideration. Traditional methods of replacing personnel will not accommodate the vacancies expected to plague healthcare organizations. Managers should focus on identifying potential gaps of key personnel and adapting programs to accommodate organizational need. Attention should be placed on capturing the intellectual capital existent in the organization and developing diverse groups of leadership candidates.

HIV-related symptoms and management in HIV and antiretroviral therapy patients in KwaZulu-Natal, South Africa: A longitudinal study

PubMed Central

Peltzer, Karl

2014-01-01

Aim The study aimed to determine the prevalence, predictors, and self-reported management of HIV- or ARV-related symptoms among HIV patients prior to antiretroviral therapy (ART) and over three time points while receiving ART in KwaZulu-Natal, South Africa. Method A total of 735 consecutive patients (29.8% male and 70.2% female) who attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 months, and 499 after 20 months on ART. Results The HIV patients reported an average of 7.5 symptoms (prior to ART), 1.2 symptoms after 6 months on ART, 0.3 symptoms after 12 months on ART, and 0.2 symptoms after 20 months on ART on the day of the interview, with a higher symptom frequency amongst patients who were not employed, had lower CD4 cell counts, experienced internalised stigma, and used alcohol. The most common symptoms or conditions identified by the self-report included tuberculosis, diarrhoea, headaches, rash, nausea and vomiting, pain, neuropathy, lack of appetite, cough, and chills. Overall, the participants reported medications as the most frequently occurring management strategy, with the second being spiritual, and the third being complementary or traditional treatments. The use of all other management strategies decreased over the four different assessment periods from prior to ART to 20 months on ART. Conclusion This study found a high symptom burden among HIV patients, which significantly decreased with progression on antiretroviral treatment. Several symptoms that persisted over time and several sociodemographic factors were identified that can guide symptom management. The utilisation of different symptom management strategies (medical, spiritual, complementary, and traditional) should be taken into consideration in HIV treatment. PMID:24405285

Managed Realignment in Europe: Achievements and Challenges

NASA Astrophysics Data System (ADS)

Esteves, L. S.

2017-12-01

Environmental and financial sustainability associated with climate change adaptation needs are the key drivers leading to the development of national and regional strategies which promote managed realignment. Managed realignment aims to maximise environmental and socioeconomic benefits by creating space for coastal habitats to evolve more naturally. Therefore, the natural adaptive capacity of coastal habitats and the range of ecosystem services they provide are paramount to the success of these strategies. In Europe, most projects involve the creation of intertidal areas by artificially restoring tidal flow into embanked land. Projects generally involve at least one of the following: removal, breach, or realignment of existing coastal protection, controlled tidal restoration and managed retreat (i.e. relocation from risk areas). Since early 1980s, over 140 managed realignment projects have been implemented (or are under construction) in Europe, mainly in the UK, France, Germany, Netherlands, Belgium and Spain, resulting in approximately 15,800 ha of habitat creation. This paper will present an overview of managed realignment initiatives in Europe, summarise achievements so far and discuss ways to overcome commonly faced challenges, focusing on high-level strategy; delivery of objectives at the project level; and public perception. Projects vary greatly as planning must take into account local social and environmental characteristics and constraints. Evidence of benefits gained in each project and their contribution to high level targets need to be quantified and widely disseminated to help attract public support. However, the lack of information and/or undisputable evidence about the realisation of tangible socioeconomic benefits is still hindering public acceptance. The knowledge about how the many social, economic, and technical aspects interact is evolving fast as new policies are formulated, more projects are implemented, and monitoring data are made available.

Investigation of the Impact of User Gaming in the Next Generation National Airspace System

NASA Technical Reports Server (NTRS)

Hunter, George C.; Gao, Huina

2011-01-01

Over the past three decades, growth in the demand for air transportation has exceeded the growth in the national airspace system (NAS) capacity. Systems operating near capacity inevitably have delays and NAS d elays have increased in recent years. The desire to minimize delay costs has placed attention on the NAS air traffic management (ATM) syste m.One initiative that has helped to provide user representation in the ATM solution is the collaborative decision making (CDM) process. CDM addresses this issue by bringing users (referred to here as airline operation centers [AOCs]) and ATM providers together for information e xchange and cooperative planning. Such cooperative planning has been instituted, for instance, for the purpose of planning airport slot control strategies and rerouting strategies. While the CDM initiatives ha ve met with much success, they have also introduced the potential for AOCs to manipulate the system in unforeseen, unintended, and perhaps undesirable ways, from a system-wide, synoptic perspective. This type of manipulation is sometimes referred to as "gaming" the system. This study uses a high-fidelity simulation tool to investigate several models of user decision making behavior which could be considered to be gaming behavior and the emergent system dynamics and interactions between AOCs and traffic management.

[Quality management and strategic consequences of assessing documentation and coding under the German Diagnostic Related Groups system].

PubMed

Schnabel, M; Mann, D; Efe, T; Schrappe, M; V Garrel, T; Gotzen, L; Schaeg, M

2004-10-01

The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

Flexibility First, Then Standardize: A Strategy for Growing Inter-Departmental Systems.

PubMed

á Torkilsheyggi, Arnvør

2015-01-01

Any attempt to use IT to standardize work practices faces the challenge of finding a balance between standardization and flexibility. In implementing electronic whiteboards with the goal of standardizing inter-departmental practices, a hospital in Denmark chose to follow the strategy of "flexibility first, then standardization." To improve the local grounding of the system, they first focused on flexibility by configuring the whiteboards to support intra-departmental practices. Subsequently, they focused on standardization by using the white-boards to negotiate standardization of inter-departmental practices. This paper investigates the chosen strategy and finds: that super users on many wards managed to configure the whiteboard to support intra-departmental practices; that initiatives to standardize inter-departmental practices improved coordination of certain processes; and that the chosen strategy posed a challenge for finding the right time and manner to shift the balance from flexibility to standardization.

The introduction of new vaccines into developing countries. IV: Global Access Strategies.

PubMed

Mahoney, Richard T; Krattiger, Anatole; Clemens, John D; Curtiss, Roy

2007-05-16

This paper offers a framework for managing a comprehensive Global Access Strategy for new vaccines in developing countries. It is aimed at strengthening the ability of public-sector entities to reach their goals. The Bill and Melinda Gates Foundation and The Rockefeller Foundation have been leaders in stimulating the creation of new organizations - public/private product development partnerships (PDPs) - that seek to accelerate vaccine development and distribution to meet the health needs of the world's poor. Case studies of two of these PDPs - the Salmonella Anti-pneumococcal Vaccine Program and the Pediatric Dengue Vaccine Initiative - examine development of such strategies. Relying on the application of innovation theory, the strategy leads to the identification of six Components of Innovation which cover all aspects of the vaccine innovation process. Appropriately modified, the proposed framework can be applied to the development and introduction of other products in developing countries including drugs, and nutritional and agricultural products.

A summary of the new GINA strategy: a roadmap to asthma control

PubMed Central

Bateman, Eric D.; Becker, Allan; Boulet, Louis-Philippe; Cruz, Alvaro A.; Drazen, Jeffrey M.; Haahtela, Tari; Hurd, Suzanne S.; Inoue, Hiromasa; de Jongste, Johan C.; Lemanske, Robert F.; Levy, Mark L.; O'Byrne, Paul M.; Paggiaro, Pierluigi; Pedersen, Soren E.; Pizzichini, Emilio; Soto-Quiroz, Manuel; Szefler, Stanley J.; Wong, Gary W.K.; FitzGerald, J. Mark

2015-01-01

Over the past 20 years, the Global Initiative for Asthma (GINA) has regularly published and annually updated a global strategy for asthma management and prevention that has formed the basis for many national guidelines. However, uptake of existing guidelines is poor. A major revision of the GINA report was published in 2014, and updated in 2015, reflecting an evolving understanding of heterogeneous airways disease, a broader evidence base, increasing interest in targeted treatment, and evidence about effective implementation approaches. During development of the report, the clinical utility of recommendations and strategies for their practical implementation were considered in parallel with the scientific evidence. This article provides a summary of key changes in the GINA report, and their rationale. The changes include a revised asthma definition; tools for assessing symptom control and risk factors for adverse outcomes; expanded indications for inhaled corticosteroid therapy; a framework for targeted treatment based on phenotype, modifiable risk factors, patient preference, and practical issues; optimisation of medication effectiveness by addressing inhaler technique and adherence; revised recommendations about written asthma action plans; diagnosis and initial treatment of the asthma−chronic obstructive pulmonary disease overlap syndrome; diagnosis in wheezing pre-school children; and updated strategies for adaptation and implementation of GINA recommendations. PMID:26206872

NOAA to develop strategy to protect coral and sponge habitat

NASA Astrophysics Data System (ADS)

Showstack, Randy

The U.S. National Marine Fisheries Service (NMFS) will develop a strategy to address research, conservation, and management issues regarding deep-ocean coral and sponge habitat, the agency indicated in an 11 July Federal Register notice. The Service, which is a unit of the National Oceanic and Atmospheric Administration, indicated that this strategy “eventually may result in rulemaking for some fisheries” but that “emergency rulemaking is not warranted.”The NMFS announcement is in response to a 24 March 2004 petition to the Commerce Department filed by Oceana, a non-governmental organization. That petition urged the department through NMFS to “initiate immediate rulemaking” to protect coral and sponge habitats in the U.S. exclusive economic zone through mapping, monitoring, research, and enforcement measures.

Local strategies to prevent and treat osteoporosis.

PubMed

Torstrick, F Brennan; Guldberg, Robert E

2014-03-01

Despite advances in systemic osteoporosis therapeutic outcomes, management of fragility fractures and implant fixation in osteoporotic bone remain difficult clinical challenges. Low initial bone density and a prolonged healing response can lead to fracture nonunion and aseptic implant loosening. Local treatment strategies could be used to prevent fracture, accelerate healing, and increase implant fixation by locally stimulating anabolic pathways or inhibiting catabolic pathways. Local strategies under investigation include direct drug release from injectable materials or implant surface coatings. Common locally delivered drugs include bisphosphonates, parathyroid hormone, and bone morphogenetic proteins, yet additional compounds targeting novel pathways in bone biology are also being actively explored. Mechanical stimulation via low intensity pulsed ultrasound, alone or in combination with drug therapy, may also prove effective to promote local bone healing and implant fixation within osteoporotic bone.

Coleman Advocates for Children And Youth: a pioneering child advocacy organization (1974-2008).

PubMed

Carnochan, Sarah; Austin, Michael J

2011-01-01

Coleman Advocates for Youth and Children is a pioneering 30-year-old child advocacy organization founded by several affluent community members and children's service professionals to stop housing abused and neglected children in juvenile hall. Today, low-income youth and parents in families of color are now assuming leadership in developing a unique hybrid approach that integrates community organizing with more traditional child advocacy strategies and focuses on increasing affordable housing and improving the city's educational system. The strategies employed by Coleman have also evolved, shifting from insider advocacy with administrative officials to public campaigns targeting the city budget process, to local initiative campaigns, and most recently to electoral politics. This organizational history features the issues mission and structure, leadership, managing issues, advocacy strategies and community relations, and funding.

Avoid the four perils of CRM.

PubMed

Rigby, Darrell K; Reichheld, Frederick F; Schefter, Phil

2002-02-01

Customer relationship management is one of the hottest management tools today. But more than half of all CRM initiatives fail to produce the anticipated results. Why? And what can companies do to reverse that negative trend? The authors--three senior Bain consultants--have spent the past ten years analyzing customer-loyalty initiatives, both successful and unsuccessful, at more than 200 companies in a wide range of industries. They've found that CRM backfires in part because executives don't understand what they are implementing, let alone how much it will cost or how long it will take. The authors' research unveiled four common pitfalls that managers stumble into when trying to implement CRM. Each pitfall is a consequence of a single flawed assumption--that CRM is software that will automatically manage customer relationships. It isn't. Rather, CRM is the creation of customer strategies and processes to build customer loyalty, which are then supported by the technology. This article looks at best practices in CRM at several companies, including the New York Times Company, Square D, GE Capital, Grand Expeditions, and BMC Software. It provides an intellectual framework for any company that wants to start a CRM program or turn around a failing one.

Deep space telecommunications, navigation, and information management. Support of the space exploration initiative

NASA Astrophysics Data System (ADS)

Hall, Justin R.; Hastrup, Rolf C.

The United States Space Exploration Initiative (SEI) calls for the charting of a new and evolving manned course to the Moon, Mars, and beyond. This paper discusses key challenges in providing effective deep space telecommunications, navigation, and information management (TNIM) architectures and designs for Mars exploration support. The fundamental objectives are to provide the mission with means to monitor and control mission elements, acquire engineering, science, and navigation data, compute state vectors and navigate, and move these data efficiently and automatically between mission nodes for timely analysis and decision-making. Although these objectives do not depart, fundamentally, from those evolved over the past 30 years in supporting deep space robotic exploration, there are several new issues. This paper focuses on summarizing new requirements, identifying related issues and challenges, responding with concepts and strategies which are enabling, and, finally, describing candidate architectures, and driving technologies. The design challenges include the attainment of: 1) manageable interfaces in a large distributed system, 2) highly unattended operations for in-situ Mars telecommunications and navigation functions, 3) robust connectivity for manned and robotic links, 4) information management for efficient and reliable interchange of data between mission nodes, and 5) an adequate Mars-Earth data rate.

Marshall Space Flight Center Propulsion Systems Department (PSD) Knowledge Management (KM) Initiative

NASA Technical Reports Server (NTRS)

Caraccioli, Paul; Varnedoe, Tom; Smith, Randy; McCarter, Mike; Wilson, Barry; Porter, Richard

2006-01-01

NASA Marshall Space Flight Center's Propulsion Systems Department (PSD) is four months into a fifteen month Knowledge Management (KM) initiative to support enhanced engineering decision making and analyses, faster resolution of anomalies (near-term) and effective, efficient knowledge infused engineering processes, reduced knowledge attrition, and reduced anomaly occurrences (long-term). The near-term objective of this initiative is developing a KM Pilot project, within the context of a 3-5 year KM strategy, to introduce and evaluate the use of KM within PSD. An internal NASA/MSFC PSD KM team was established early in project formulation to maintain a practitioner, user-centric focus throughout the conceptual development, planning and deployment of KM technologies and capabilities within the PSD. The PSD internal team is supported by the University of Alabama's Aging Infrastructure Systems Center of Excellence (AISCE), lntergraph Corporation, and The Knowledge Institute. The principle product of the initial four month effort has been strategic planning of PSD KNI implementation by first determining the "as is" state of KM capabilities and developing, planning and documenting the roadmap to achieve the desired "to be" state. Activities undertaken to suppoth e planning phase have included data gathering; cultural surveys, group work-sessions, interviews, documentation review, and independent research. Assessments and analyses have beon pedormed including industry benchmarking, related local and Agency initiatives, specific tools and techniques used and strategies for leveraging existing resources, people and technology to achieve common KM goals. Key findings captured in the PSD KM Strategic Plan include the system vision, purpose, stakeholders, prioritized strategic objectives mapped to the top ten practitioner needs and analysis of current resource usage. Opportunities identified from research, analyses, cultural1KM surveys and practitioner interviews include: executive and senior management sponsorship, KM awareness, promotion and training, cultural change management, process improvement, leveraging existing resources and new innovative technologies to align with other NASA KM initiatives (convergence: the big picture). To enable results based incremental implementation and future growth of the KM initiative, key performance measures have been identified including stakeholder value, system utility, learning and growth (knowledge capture, sharing, reduced anomaly recurrence), cultural change, process improvement and return-on-investment. The next steps for the initial implementation spiral (focused on SSME Turbomachinery) have been identified, largely based on the organization and compilation of summary level engineering process models, data capture matrices, functional models and conceptual-level svstems architecture. Key elements include detailed KM requirements definition, KM technology architecture assessment, - evaluation and selection, deployable KM Pilot design, development, implementation and evaluation, and justifying full implementation (estimated Return-on-Investment). Features identified for the notional system architecture include the knowledge presentation layer (and its components), knowledge network layer (and its components), knowledge storage layer (and its components), User Interface and capabilities. This paper provides a snapshot of the progress to date, the near term planning for deploying the KM pilot project and a forward look at results based growth of KM capabilities with-in the MSFC PSD.

Tracking implementation strategies: a description of a practical approach and early findings.

PubMed

Bunger, Alicia C; Powell, Byron J; Robertson, Hillary A; MacDowell, Hannah; Birken, Sarah A; Shea, Christopher

2017-02-23

Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children's access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.'s (Med Care Res Rev 69:123-57, 2012) taxonomy of implementation strategies. Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.

Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France

PubMed Central

Galperine, Tatiana; Denies, Fanette; Lannoy, Damien; Lenne, Xavier; Odou, Pascal; Guery, Benoit; Dervaux, Benoit

2017-01-01

Background Clostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France. Methods We developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses. Results Three strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY. Conclusions FMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY. PMID:28103289

Cost-Effectiveness Analysis of Five Competing Strategies for the Management of Multiple Recurrent Community-Onset Clostridium difficile Infection in France.

PubMed

Baro, Emilie; Galperine, Tatiana; Denies, Fanette; Lannoy, Damien; Lenne, Xavier; Odou, Pascal; Guery, Benoit; Dervaux, Benoit

2017-01-01

Clostridium difficile infection (CDI) is characterized by high rates of recurrence, resulting in substantial health care costs. The aim of this study was to analyze the cost-effectiveness of treatments for the management of second recurrence of community-onset CDI in France. We developed a decision-analytic simulation model to compare 5 treatments for the management of second recurrence of community-onset CDI: pulsed-tapered vancomycin, fidaxomicin, fecal microbiota transplantation (FMT) via colonoscopy, FMT via duodenal infusion, and FMT via enema. The model outcome was the incremental cost-effectiveness ratio (ICER), expressed as cost per quality-adjusted life year (QALY) among the 5 treatments. ICERs were interpreted using a willingness-to-pay threshold of €32,000/QALY. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses. Three strategies were on the efficiency frontier: pulsed-tapered vancomycin, FMT via enema, and FMT via colonoscopy, in order of increasing effectiveness. FMT via duodenal infusion and fidaxomicin were dominated (i.e. less effective and costlier) by FMT via colonoscopy and FMT via enema. FMT via enema compared with pulsed-tapered vancomycin had an ICER of €18,092/QALY. The ICER for FMT via colonoscopy versus FMT via enema was €73,653/QALY. Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations showed that FMT via enema was the most cost-effective strategy in 58% of simulations and FMT via colonoscopy was favored in 19% at a willingness-to-pay threshold of €32,000/QALY. FMT via enema is the most cost-effective initial strategy for the management of second recurrence of community-onset CDI at a willingness-to-pay threshold of €32,000/QALY.

Reliability and concurrent and construct validity of the Strategies for Weight Management measure for adults.

PubMed

Kolodziejczyk, Julia K; Norman, Gregory J; Rock, Cheryl L; Arredondo, Elva M; Roesch, Scott C; Madanat, Hala; Patrick, Kevin

2016-01-01

This study evaluates the reliability and validity of the strategies for weight management (SWM) measure, a questionnaire that assesses weight management strategies for adults. The SWM includes 20 items that are categorized within the following subscales: (1) energy intake, (2) energy expenditure, (3) self-monitoring, and (4) self-regulation. Baseline and 6-month data were collected from 404 overweight/obese adults (mean age=22±3.8 years, 68% ethnic minority) enrolled in a randomized controlled trial aiming to reduce weight by improving diet and physical activity behaviours. Reliability and validity were assessed for each subscale separately. Cronbach alpha was conducted to assess reliability. Concurrent, construct I (sensitivity to the study treatment condition), and construct II (relationship to the outcomes) validity were assessed using linear regressions with the following outcome measures: weight, self-reported diet, and weekly energy expenditure. All subscales showed strong internal consistency. The strength of the validity evidence depended on subscale and validity type. The strongest validity evidence was concurrent validity of the energy intake and energy expenditure subscales; construct I validity of the energy intake and self-monitoring subscales; and construct II validity of the energy intake, energy expenditure, and self-regulation subscales. Results indicate that the SWM can be used to assess weight management strategies among an ethnically diverse sample of adults as each subscale showed evidence of reliability and select types of validity. As validity is an accumulation of evidence over multiple studies, this study provides initial reliability and validity evidence in one population segment. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.

PubMed

Rodriguez, Hector P; Ivey, Susan L; Raffetto, Brian J; Vaughn, Jennifer; Knox, Margae; Hanley, Hattie Rees; Mangione, Carol M; Shortell, Stephen M

2014-04-01

The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.

Early wound infection identification using the WIRE tool in community health care settings: An audit report.

PubMed

Siaw-Sakyi, Vincent

2017-12-01

Wound infection is proving to be a challenge for health care professionals. The associated complications and cost of wound infection is immense and can lead to death in extreme cases. Current management of wound infection is largely subjective and relies on the knowledge of the health care professional to identify and initiate treatment. In response, we have developed an infection prediction and assessment tool. The Wound Infection Risk-Assessment and Evaluation tool (WIRE) and its management strategy is a tool with the aim to bring objectivity to infection prediction, assessment and management. A local audit carried out indicated a high infection prediction rate. More work is being done to improve its effectiveness.

Promoting family planning through women's development.

PubMed

Gulhati, K

1986-12-01

Private initiatives in developing countries have been successful in increasing women's desire for family planning by enabling them to earn more income. These approaches have incorporated a woman-to-woman strategy in which women train others not only in how to earn an income from producing and marketing products, but also in the skills needed to establish and manage their own organizations. Private voluntary organizations play an especially crucial role in training project managers. The Center for Development and Population Activities, for example, has held 19 Women in Management workshops and channels funds and technical assistance for projects in health, family planning, nutrition, and income generation. Women who move from managerial to policymaking positions are most able to help other women raise their political, social, and economic status.

From shared care to disease management: key-influencing factors.

PubMed

Eijkelberg, I M; Spreeuwenberg, C; Mur-Veeman, I M; Wolffenbuttel, B H

2001-01-01

In order to improve the quality of care of chronically ill patients the traditional boundaries between primary and secondary care are questioned. To demolish these boundaries so-called 'shared care' projects have been initiated in which different ways of substitution of care are applied. When these projects end, disease management may offer a solution to expand the achieved co-operation between primary and secondary care. Answering the question: What key factors influence the development and implementation of shared care projects from a management perspective and how are they linked? The theoretical framework is based on the concept of the learning organisation. Reference point is a multiple case study that finally becomes a single case study. Data are collected by means of triangulation. The studied cases concern two interrelated Dutch shared care projects for type 2 diabetic patients, that in the end proceed as one disease management project. In these cases the predominant key-influencing factors appear to be the project management, commitment and local context, respectively. The factor project management directly links the latter two, albeit managing both appear prerequisites to its success. In practice this implies managing the factors' interdependency by the application of change strategies and tactics in a committed and skillful way. Project management, as the most important and active key factor, is advised to cope with the interrelationships of the influencing factors in a gradually more fundamental way by using strategies and tactics that enable learning processes. Then small-scale shared care projects may change into a disease management network at a large scale, which may yield the future blueprint to proceed.

Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit.

PubMed

McGovern, M; Kernan, R; O'Neill, M B

2017-02-10

Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child's illness but on educating and empowering the parent.

Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change.

PubMed

Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

2014-03-01

Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.

Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

PubMed

Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

2017-05-01

Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships

PubMed Central

Allen, Caitlin; Nell Brownstein, J.; Jayapaul-Philip, Bina; Matos, Sergio; Mirambeau, Alberta

2017-01-01

The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. PMID:26049655

Enhanced Adaptive Management: Integrating Decision Analysis, Scenario Analysis and Environmental Modeling for the Everglades

PubMed Central

Convertino, Matteo; Foran, Christy M.; Keisler, Jeffrey M.; Scarlett, Lynn; LoSchiavo, Andy; Kiker, Gregory A.; Linkov, Igor

2013-01-01

We propose to enhance existing adaptive management efforts with a decision-analytical approach that can guide the initial selection of robust restoration alternative plans and inform the need to adjust these alternatives in the course of action based on continuously acquired monitoring information and changing stakeholder values. We demonstrate an application of enhanced adaptive management for a wetland restoration case study inspired by the Florida Everglades restoration effort. We find that alternatives designed to reconstruct the pre-drainage flow may have a positive ecological impact, but may also have high operational costs and only marginally contribute to meeting other objectives such as reduction of flooding. Enhanced adaptive management allows managers to guide investment in ecosystem modeling and monitoring efforts through scenario and value of information analyses to support optimal restoration strategies in the face of uncertain and changing information. PMID:24113217

Investigating strategies used by hospital pharmacists to effectively communicate with patients during medication counselling.

PubMed

Chevalier, Bernadette A M; Watson, Bernadette M; Barras, Michael A; Cottrell, William Neil

2017-10-01

Medication counselling opportunities are key times for pharmacists and patients to discuss medications and patients' concerns about their therapy. Communication Accommodation Theory (CAT) describes behavioural, motivational and emotional processes underlying communication exchanges. Five CAT strategies (approximation, interpretability, discourse management, emotional expression and interpersonal control) permit identification of effective communication. To invoke CAT to investigate communication strategies used by hospital pharmacists during patient medication counselling. This was a theory-based, qualitative study using transcribed audiorecordings of patients and hospital pharmacists engaged in medication counselling. Recruited pharmacists practised in inpatient or outpatient settings. Eligible patients within participating pharmacists' practice sites were prescribed at least three medications to manage chronic disease(s). The extent to which pharmacists accommodate, or not, to patients' conversational needs based on accommodative behaviour described within CAT strategies. Twelve pharmacists engaged four patients (48 total interactions). Exemplars provided robust examples of pharmacists effectively accommodating or meeting patients' conversational needs. Non-accommodation mainly occurred when pharmacists spoke too quickly, used terms not understood by patients and did not include patients in the agenda-setting phase. Multiple strategy use resulted in communication patterns such as "information-reassurance-rationale" sandwiches. Most pharmacists effectively employed all five CAT strategies to engage patients in discussions. Pharmacists' communication could be improved at the initial agenda-setting phase by asking open-ended questions to invite patients' input and allow patients to identify any medication-related concerns or issues. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.