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Sample records for initial work-up management

  1. Classical Hodgkin’s lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

    PubMed Central

    Brusamolino, Ercole; Bacigalupo, Andrea; Barosi, Giovanni; Biti, Giampaolo; Gobbi, Paolo G.; Levis, Alessandro; Marchetti, Monia; Santoro, Armando; Zinzani, Pier Luigi; Tura, Sante

    2009-01-01

    The Italian Society of Hematology (SIE), the Italian Society of Experimental Haematology (SIES) and the Italian Group for Bone Marrow Transplantation (GITMO) commissioned a project to develop practice guidelines for the initial work-up, therapy and follow-up of classical Hodgkin’s lymphoma. Key questions to the clinical evaluation and treatment of this disease were formulated by an Advisory Committee, discussed and approved by an Expert Panel (EP) composed of senior hematologists and one radiotherapist. After a comprehensive and systematic literature review, the EP recommendations were graded according to their supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of a strong evidence. The EP decided that the target domain of the guidelines should include only classical Hodgkin’s lymphoma, as defined by the WHO classification, and exclude lymphocyte predominant histology. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease, monitoring procedures and salvage therapy, including hemopoietic stem cell transplant. Separate recommendations were formulated for elderly patients. Pre-treatment volumetric CT scan of the neck, thorax, abdomen, and pelvis is mandatory, while FDG-PET is recommended. As to the therapy of early stage disease, a combined modality approach is still recommended with ABVD followed by involved-field radiotherapy; the number of courses of ABVD will depend on the patient risk category (favorable or unfavorable). Full-term chemotherapy with ABVD is recommended in advanced stage disease; adjuvant radiotherapy in patients without initial bulk who achieved a complete remission is not recommended. In the elderly, chemotherapy regimens more intensive than ABVD are not recommended. Early evaluation of response with FDG-PET scan is suggested. Relapsed or refractory patients should receive high

  2. [Work-up and management of constrictive pericarditis: a critical review].

    PubMed

    Pinamonti, Bruno; Habjan, Sara; De Luca, Antonio; Proclemer, Alberto; Morea, Gaetano; Abate, Elena; Vitrella, Giancarlo; Sinagra, Gianfranco

    2016-03-01

    Constrictive pericarditis is a rare pericardial disorder that causes an impairment of cardiac filling and frequently heart failure. The clinical presentation is non-specific and the differential diagnosis includes myocardial diseases, particularly restrictive cardiomyopathy. Echocardiography has a central role in the initial diagnosis. Some peculiar signs, such as abnormal inspiratory shift of the interventricular septum, increased respiratory variations of transmitral, transtricuspid and hepatic vein flow velocities and the normality of early diastolic relaxation velocity (e') at tissue Doppler, increase the likelihood of the disease. These signs are an expression of increased ventricular interdependence and dissociation between intrathoracic and intracardiac pressures typical of pericardial constriction. For further diagnosis, computed tomography and magnetic resonance are used to identify the presence of pericardial thickening. Invasive cardiac catheterization is indicated in dubious cases and in the assessment of the severity of hemodynamic abnormalities, especially in cases with surgical indication. Pericardiectomy is indicated in symptomatic patients meeting the diagnostic criteria of constrictive pericarditis and is able to improve the prognosis.

  3. Current understanding of coronary in-stent restenosis. Pathophysiology, clinical presentation, diagnostic work-up, and management.

    PubMed

    Schiele, T M

    2005-11-01

    In-stent restenosis is the limiting entity following coronary stent implantation. It is associated with significant morbidity and cost and thus represents a major clinical and economical problem. Worldwide, approximately 250 000 in-stent restenotic lesions per year have to be dealt with. The pathophysiology of instent restenosis is multifactorial and comprises inflammation, smooth muscle cell migration and proliferation and extracellular matrix formation, all mediated by distinct molecular pathways. Instent restenosis has been recognised as very difficult to manage, with a repeat restenosis rate of 50% regardless of the mechanical angioplasty device used. Much more favourable results were reported for the adjunctive irradiation of the in-stent restenotic lesion, with a consistent reduction of the incidence of repeat in-stent restenosis by 50%. Data from the first clinical trials on drug-eluting stents for the treatment of in-stent restenosis have shown very much promise yielding this strategy likely to become the treatment of choice. This review outlines the histological and molecular findings of the pathophysiology, the epidemiology, the predictors and the diagnostic work-up of in-stent restenosis and puts emphasis on the various treatment options for its prevention and therapy.

  4. Work-up and management of a high-risk patient with primary central nervous system lymphoma

    PubMed Central

    Zeynalova, Pervin A.; Tumyan, Gayane S.; Dolgushin, Mikhail B.; Akhmedov, Mobil I.

    2016-01-01

    Primary central nervous system lymphoma (PCNSL) is a rare disorder that, in 95% of cases, represents diffuse large B-cell lymphoma. As such, making an accurate diagnosis is important. At present, stereotactic-guided biopsy is a recognized method of choice for tissue analysis. However, the diagnostic work-up for high-risk patients is determined by their performance status. Here, we report a case of PCNSL in a high-risk patient, for whom diagnosis was established by cerebrospinal fluid cytology and flow cytometry, which significantly shortened a diagnostic work-up period and allowed for the immediate treatment of the patient. PMID:28154784

  5. Work up of the child with hypertension.

    PubMed

    Sanders, John T; Jones, Deborah P

    2010-01-01

    This paper outlines the work up of children with hypertension. In those with confirmed hypertension, the initial work up should be focused on the evaluation for renal parenchymal and renovascular disease. Secondary evaluation should be focused on history and clinical findings. Consideration of angiography should be made in children with severe hypertension and no evidence of renal parenchymal disease, with hypertension requiring more than a single antihypertensive agent to achieve adequate BP control, or with confirmed BP > 99th percentile for sex/age/height percentile. Screening for endocrinopathies should be directed by compatible history and findings on physical examination and should not be a part of a routine initial work up. In any child diagnosed with hypertension, attempts should be made to evaluate for end-organ disease and co-morbid conditions, particularly left ventricular hypertrophy. Pediatricians should establish a degree of comfort in the evaluation and management of hypertension; however, children with severe and complicated hypertension should be referred to a specialist well versed and practiced in the evaluation and management of this disease.

  6. Adrenal incidentalomas: are they being worked up appropriately?

    PubMed Central

    Sahni, Pooja; Trivedi, Apoorva; Omer, Abdulkadir; Trivedi, Nitin

    2016-01-01

    Introduction Adrenal incidentalomas are defined as masses picked up on imaging studies that were done for apparently different reasons. With frequent use of imaging modalities, incidental adrenal masses are commonly encountered in clinical practice. Guidelines are currently available for the diagnosis and management of adrenal incidentalomas, but the appropriateness of initial work-up and subsequent follow-up of incidental adrenal masses in the community hospital setting is unknown. Objective We studied the appropriateness of initial work-up and follow-up of incidental adrenal masses discovered on abdominal computerized tomography (CT). Methods In our retrospective study, we reviewed sequential CT scans of the abdomen performed in the month of January 2010 at a community hospital. Once patients with one or more adrenal masses were identified, outpatient charts for initial biochemical testing and follow-up imaging were obtained either through directly accessing the electronic medical records or through contacting primary care physician's offices. Patient charts were reviewed to assess the data for the next 2 years following the discovery of an adrenal abnormality. Results Twenty adrenal masses were incidentally discovered on 723 abdominal CTs performed within the month of January 2010 resulting in an overall incidence of 2.76%. Of the patients with incidentally discovered adrenal masses, appropriate biochemical and follow-up imaging were only performed in patients referred to an endocrinologist (2 of 20 patients). Thirty percent of patients with incidental masses received a repeat CT scan for non-adrenal reasons, and no change in the mass size was noted. Conclusion Despite published guidelines, the initial work-up and follow-up of patients with an incidentally discovered adrenal mass is unsatisfactory. There is a desperate need for education of providers regarding appropriate work-up of incidental adrenal masses. PMID:27802863

  7. [Dyspepsia: work-up or provisional treatment?].

    PubMed

    Koelz, H R

    1995-05-09

    Dyspepsia is defined as symptoms that are considered by a physician to originate from the upper gastrointestinal tract. The term 'functional dyspepsia' designates dyspepsia after exclusion of organic causes. Dyspepsia is a frequent problem in general practice. Mainly for economical reasons, it is impossible to perform every available diagnostic test in every patient to exclude all possible organic causes. The initial work-up is directed at identifying alarm symptoms and alarm signs from history, physical examination, and simple laboratory tests. The presence of any alarm symptoms or alarm sign requires prompt investigation. If none can be found, empirical drug treatment may be performed according to the leading symptom. Treatment failure or rapid recurrence require additional investigations, in particular by gastroscopy.

  8. Initial management of temporomandibular disorders.

    PubMed

    Syrop, Steven B

    2002-08-01

    The existing dental literature does not support the superiority of any one type of treatment to manage TMD. Few studies meet rigorous scientific standards of the randomized clinical trial. This has led to enormous controversy. The initial management of TMD does not have to be controversial. Noninvasive, reversible modalities can be employed that carry very little risk and a high degree of success (Table 4). The success rate of this approach has been studied and determined to be 75% to 90%. Of course, not every patient will get better with this approach. For those who do not improve more advanced techniques must be used, and referral to specialists in TMD, neurology, and rehabilitation medicine may be required. A few patients will need surgery. Initial treatment of TMD requires relatively simple modalities, such as patient education, adherence to a soft diet, reducing oral habits, self-directed home physical therapy, muscle relaxation, the use of medication, and the proper use of bite plates. The majority of TMD patients will respond successfully to these basic treatments.

  9. Managing Dualities in Planned Change Initiatives

    ERIC Educational Resources Information Center

    Barge, J. Kevin; Lee, Michael; Maddux, Kristy; Nabring, Richard; Townsend, Bryan

    2008-01-01

    Dualities play an important role in creating the conditions for change and managing planned change initiatives. Building on Seo, Putnam, and Bartunek's (2003) work, this study focuses on the dualities associated with managing change processes. A case study of a planned change process called the Circle of Prosperity Initiative, a multi-stakeholder…

  10. Work up of Pediatric Urinary Tract Infection

    PubMed Central

    Copp, Hillary L.; Schmidt, Bogdana

    2016-01-01

    Pediatric UTI costs the healthcare system upwards of 180 million dollars annually, and accounts for over 1.5 million clinician visits per year. Accurate and timely diagnosis of these infections is important for determining appropriate treatment and preventing long-term complications such as renal scarring, hypertension, and end-stage renal disease. Outside of the first 12 months, girls are more likely to be diagnosed with a UTI. About half of boys with UTI will be diagnosed within the first 12 months of life. The prevalence and incidence of pediatric UTI varies by age, race/ethnicity, sex and circumcision status. Diagnosis of UTI is made based on history and exam findings and confirmed with appropriately collected urine. If a bag specimen is negative, this can be used to rule out UTI without the need for confirmatory culture; however positive urinalysis tests from bag specimen warrant further investigation with a catheterized specimen or suprapubic aspiration. Urine culture is the gold standard for diagnosing UTI: Greater than 50,000 CFU on a catheterized specimen or suprapubic aspiration indicate presence of a UTI. Greater than 100,000 CFU on a voided specimen is considered a positive culture. There is no consensus on the need and optimal strategy for imaging in the setting of urinary tract infection in the pediatric population. Prompt recognition of UTI and antibiogram-based, empiric treatment or culture-based, targeted treatment should be initiated within 72 of presentation. PMID:26475948

  11. Hanford Tanks Initiative risk management guide

    SciTech Connect

    Schaus, P.S.

    1997-10-29

    This project-specific Risk Management Guide describes the general approach and process being used by the HTI Project to manage risk associated with execution of the HTI mission. It includes the initial identification of risk and the quantification of its likelihood and severity of its consequences. It further addresses the formulation of risk mitigation plans, periodic statusing of the Risk Management List, and risk closure.

  12. Recent Initiatives in Labor-Management Cooperation.

    ERIC Educational Resources Information Center

    National Center for Productivity and Quality of Working Life, Washington, DC.

    This report draws on a series of conferences held to develop guides for labor-management cooperation at the plant level. These included six recent initiatives conferences held in cooperation with State University Institutes of Industrial Relations and the Federal Mediation and Conciliation Service (FMCS) and a seventh sponsored by the Commission…

  13. Update on Washington initiatives on ecosystem management

    SciTech Connect

    Kostka, D.

    1995-12-01

    A biological {open_quotes}revolution{close_quotes} is in progress. Due to initiatives of the Clinton-Gore administration, biologists across the nation are trying to define and use a new concept called ecosystem management. {open_quotes}Ecosystem management{close_quotes} was born in the frustration of trying to deal with the spotted owl controversy in the Northwest. Biologists could not agree on what should be done. And the biologists and economists rarely got together to try to solve problems. Some astute individuals realized that to achieve a sustainable development, ecosystems would have to be managed on a much larger scale than merely small plots of lands. And people from many different backgrounds and disciplines would need to come together to find solutions. This paper will present the views of a Washington insider who has been a player (although too frequently a minor league player!) in administration initiatives to infuse ecosystem management principles and practices in our national conscience. Today, federal agency staff talk to those in other offices within their own agency. Federal agency staff also work on joint projects across federal agencies. In addition, state government, nonprofits, universities, interested individuals, and tribal governments are becoming involved. This is the biological {open_quotes}revolution{close_quotes} that is in progress. The emphasis is shifting from looking at the life history and problems of single species to a much broader approach of examining many species, including humans. The author will present a report on results of the ecosystem management initiative in the last year and point out some of the hurdles still ahead.

  14. 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.

  15. Risk management for the Space Exploration Initiative

    NASA Astrophysics Data System (ADS)

    Buchbinder, Ben

    1993-01-01

    Probabilistic Risk Assessment (PRA) is a quantitative engineering process that provides the analytic structure and decision-making framework for total programmatic risk management. Ideally, it is initiated in the conceptual design phase and used throughout the program life cycle. Although PRA was developed for assessment of safety, reliability, and availability risk, it has far greater application. Throughout the design phase, PRA can guide trade-off studies among system performance, safety, reliability, cost, and schedule. These studies are based on the assessment of the risk of meeting each parameter goal, with full consideration of the uncertainties. Quantitative trade-off studies are essential, but without full identification, propagation, and display of uncertainties, poor decisions may result. PRA also can focus attention on risk drivers in situations where risk is too high. For example, if safety risk is unacceptable, the PRA prioritizes the risk contributors to guide the use of resources for risk mitigation. PRA is used in the Space Exploration Initiative (SEI) Program. To meet the stringent requirements of the SEI mission, within strict budgetary constraints, the PRA structure supports informed and traceable decision-making. This paper briefly describes the SEI PRA process.

  16. The economic approach to the stroke work-up.

    PubMed

    Shriver, M E; Prockop, L D

    1993-02-01

    Stroke is the leading cause of morbidity in the United States and the expenditure for stroke aftercare, including lost wages, is astronomical. Reduction of risk factors and use of the most accurate diagnostic technology allows for intervention prior to catastrophic neurologic deficit. The most advantageous combination of diagnostic testing with regard to risk-benefit has been debated, but it is generally agreed that the cost of even the most sophisticated stroke work-up is far less than that of stroke aftercare.

  17. Cracking haematuria in adolescent with negative work up.

    PubMed

    Guo, Perry; Belostotsky, Vladimir

    2013-05-24

    A 16-year-old girl was referred to our nephrology clinic with persistent visible haematuria (2 months), no urinary tract infection, proteinuria ranging from negligible to 1.5 g/l, normal kidney function and otherwise negative work up including immunology screen. After negative ultrasound scans of the kidneys and bladder, normal renal biopsy and normal cystoscopy, a CT angiogram was obtained. It showed no evidence of arteriovenous malformation but revealed compression of left renal vein (nutcracker syndrome).

  18. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  19. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  20. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  1. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  2. 10 CFR 473.22 - Initial review by manager.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Initial review by manager. 473.22 Section 473.22 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION AUTOMOTIVE PROPULSION RESEARCH AND DEVELOPMENT Review and Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager....

  3. Knowledge Management Initiatives at a Small University

    ERIC Educational Resources Information Center

    Gill, Avninder

    2009-01-01

    Purpose: The purpose of this paper is to address the knowledge management (KM) challenges faced by the administration of a small university which does not have a mature research culture. Design/methodology/approach: The paper follows both technocratic as well as ecological approaches to develop a sustainable KM. Strengths, weaknesses,…

  4. Paradise nearly Gained. Volume 1: Developing the Frontline Management Initiative.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    The Frontline Management Initiative (FMI) provides a framework for competency-based development of frontline managers in Australian enterprises. The FMI's impact on businesses was examined in a national study that included the following activities: focus groups; a national survey of management development and targeted national survey of FMI users;…

  5. Hanford Tanks Initiative requirements and document management process guide

    SciTech Connect

    Schaus, P.S.

    1998-05-22

    This revision of the guide provides updated references to project management level Program Management and Assessment Configuration Management activities, and provides working level directions for submitting requirements and project documentation related to the Hanford Tanks Initiative (HTI) project. This includes documents and information created by HTI, as well as non-HTI generated materials submitted to the project.

  6. Pediatric trauma resuscitation: initial fluid management.

    PubMed

    Schweer, Lynn

    2008-01-01

    Fluid management is a vital component in the resuscitative care of the injured child. The goal of fluid resuscitation is to restore tissue perfusion without compromising the body's natural compensatory mechanism. Recent literature has questioned the timing, type, and amount of fluid administration during the resuscitative phase. When managing a pediatric resuscitation, it is imperative to use a variety of age-appropriate physiologic parameters because reliance on blood pressure alone will lead to delayed recognition of shock. Establishing vascular access, via peripheral intravenous, central venous, or intraosseous catheter, should be a high nursing priority. Hemorrhage control and fluid resuscitation of an injured child remains a top priority of trauma care. Early intravenous access with appropriate fluid administration continues to be a universal treatment for the hypotensive trauma patient. Fluid resuscitation in the early phase of care, whether in the field, emergency department, or operating room, should be targeted toward perfusing critical organs, such as the brain and heart. Once obvious bleeding is controlled, the overall goal for fluid management centers on maintaining oxygen delivery to perfuse vital structures with enough oxygen and energy substrates to maintain cellular function, thus avoiding tissue ischemia. However, specific issues around timing and type of fluid administration, once thought to be straightforward, have triggered increasing investigation of current beliefs.

  7. [Constrictive pericarditis: etiology, diagnostic work-up, and therapy].

    PubMed

    Föll, Daniela; Geibel-Zehender, Annette; Bode, Christoph

    2010-03-01

    Constrictive pericarditis is characterized by a fibrous thickened pericardial layer which prevents the cardiac chambers from regular filling. Today, this disease is often caused by previous cardiac surgery or mediastinal radiotherapy, whereas tuberculosis as a cause is less important nowadays. Due to the reduced diastolic filling the cardiac output is diminished and the veins are engorged. The patients present with ascites, liver congestion, and dilated jugular veins. A pericardial effusion, the ECG or an echocardiography may give first hints for the diagnosis. The chest X-ray examination might detect pericardial calcifications (see Figure 2). Doppler echocardiography and cardiac catheterization, especially during breathing maneuvers, are diagnostic, as they demonstrate the diastolic filling disturbance ("dip-plateau sign", see Figure 1), the equal increase of left and right ventricular end-diastolic and mean atrial pressures, and the strong dependency of ventricular filling from respiration. Computed tomography or magnetic resonance imaging might reveal the thickened pericardial layer (see Figures 3 and 4). The most important differential diagnosis is restrictive cardiomyopathy, which has similar clinical and hemodynamic findings. A comprehensive diagnostic work-up is necessary, as the constrictive pericarditis may be cured by a timely performed pericardial resection.

  8. Diagnosis and initial management of dysmenorrhea.

    PubMed

    Osayande, Amimi S; Mehulic, Suarna

    2014-03-01

    Dysmenorrhea is one of the most common causes of pelvic pain. It negatively affects patients' quality of life and sometimes results in activity restriction. A history and physical examination, including a pelvic examination in patients who have had vaginal intercourse, may reveal the cause. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. Abnormal uterine bleeding, dyspareunia, noncyclic pain, changes in intensity and duration of pain, and abnormal pelvic examination findings suggest underlying pathology (secondary dysmenorrhea) and require further investigation. Transvaginal ultrasonography should be performed if secondary dysmenorrhea is suspected. Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. Management options for primary dysmenorrhea include nonsteroidal anti-inflammatory drugs and hormonal contraceptives. Hormonal contraceptives are the first-line treatment for dysmenorrhea caused by endometriosis. Topical heat, exercise, and nutritional supplementation may be beneficial in patients who have dysmenorrhea; however, there is not enough evidence to support the use of yoga, acupuncture, or massage.

  9. [Initiative management of medical instruments and equipments' operation and maintenance].

    PubMed

    Jia, Guo-Lliang; Ge, Yi; Deng, Hou-Bin

    2005-03-01

    We expatiate on an initiative management mode of medical instruments and equipments' operation and maintenace, which is different from the usual passive management. The application of this mode is helpful for keeping them in good condition and increasing the activity ratio, and thus to increase their economic and social benefits.

  10. Management Control System Support of Initiatives for Disruptive Students

    ERIC Educational Resources Information Center

    Scott, Colin

    2011-01-01

    Purpose: The purpose of the paper is to investigate the management control system (MCS) support of school initiatives to develop the school climate and to re-engage disruptive students. Design/methodology/approach: The paper adopts an approach of critical action research interviews with management and document reviews informed by Habermasian…

  11. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....

  12. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.63 Initial medical evaluation and management. (a... hunger strike: (1) Measure and record height and weight; (2) Take and record vital signs; (3) Urinalysis... weight and vital signs at least once every 24 hours while the inmate is on a hunger strike....

  13. Attitudes toward Anger Management Scale: Development and Initial Validation

    ERIC Educational Resources Information Center

    Boudreaux, David J.; Dahlen, Eric R.; Madson, Michael B.; Bullock-Yowell, Emily

    2014-01-01

    This article describes the development and preliminary validation of the Attitudes Toward Anger Management Scale (ATAMS), a self-report measure of attitudes toward anger management services. Undergraduate volunteers ("N" = 415) completed an initial version of the instrument. Principal components analysis yielded a two-factor solution.…

  14. Work up of incidental adrenal mass: state of the art.

    PubMed

    Bada, Maida; Castellan, Pietro; Tamburro, Fabiola R; Berardinelli, Francesco; Neri, Fabio; Cindolo, Luca; Schips, Luigi

    2016-11-18

    Due to the increasing use of radiological investigations, the detection of incidental adrenal masses has become even more frequent. Therefore, it is crucial to identify the nature of the adrenal mass in order to decide the type of treatment that should be undertaken. Toward this goal, biochemical tests are useful in order to assess catecholamines levels for the presence of a pheochromocytoma or cortisol excess in case of Cushing's syndrome. Furthermore, the dexamethasone suppression test and late-night salivary cortisol may be useful in measuring plasma cortisol, respectively, in the blood and urine. Hyperaldosteronism could be suspected in the presence of arterial hypertension. With regard to imaging modalities, the contrast washout and Hounsfield units estimation might play a role as indicators on computed tomography. In terms of treatment, a surgical approach is most suitable for a hyperfunctioning adrenal mass irrespective of size, and for nonfunctioning masses >4 cm. For indeterminate smaller lesions, with washout >50%, <10 Hounsfield Unit, nonfunctioning, benign-appearing, undergoing a follow-up in regular intervals is more appropriate in order to estimate mass growth. This paper summarizes recent findings on the management of incidental adrenal masses, with a special focus on the use of imaging, surgical management and follow-up modalities in improving patient outcomes.

  15. Land Management Panel: Army’s Net Zero Installation Initiative

    DTIC Science & Technology

    2012-05-24

    Assistant Secretary of the Army (Installations, Energy & Environment) DRAFT DECK 1 Land Management Panel Army’s Net Zero Installation...00-00-2012 4. TITLE AND SUBTITLE Land Management Panel Army’s Net Zero Installation Initiative 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...water in new / renovated federal buildings from solar power • 30% by FY2015 if life cycle cost-effective Fossil fuel use in new / renovated

  16. Initial resuscitation and management of pediatric septic shock

    PubMed Central

    Martin, Kelly; Weiss, Scott L.

    2015-01-01

    The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function, 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications, and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock. PMID:25604591

  17. The significance and work-up of minor gastrointestinal bleeding in hospitalized nursing home patients.

    PubMed Central

    Suatengco, R.; Posner, G. L.; Marsh, F.

    1995-01-01

    Twenty-seven consecutive admissions from nursing homes who underwent a gastrointestinal (GI) consult for coffee ground vomitus or occult GI bleeding to evaluate the outcome were reviewed retrospectively to determine whether a GI work-up was or would have been useful. There were 15 deaths, all associated with severe infection or respiratory failure. Endoscopy, barium studies, and a history of nonsteroidal anti-inflammatory drug use or peptic ulcer disease did not affect the management or outcome. No patient developed major GI bleeding. When nursing home patients present with coffee ground vomitus or newly found occult blood in the stool, efforts should be made to identify and vigorously treat any acute underlying infection or respiratory failure. Endoscopy is not helpful in this clinical situation. Both the primary care physician and the GI consultant should be aware of these associations and should focus on the underlying etiology. PMID:7473849

  18. Advances in the Genetic Screening, Work-up, and Treatment of Pancreatic Cancer.

    PubMed

    Frucht, Harold; Stevens, Peter D.; Fogelman, David R.; Verna, Elizabeth C.; Chen, Johnson; Chabot, John A.; Fine, Robert L.

    2004-10-01

    Familiarity with the updated results in genetic screening and work-up presented here is essential to early diagnosis and possible cure. In the metastatic setting, we most frequently begin with the GTX regimen, consisting of Gemcitabine, Taxotere, and Xeloda. The regimen is based on our laboratory data demonstrating a synergistic increase in cell killing of pancreatic cancer cell lines. The combination takes advantage of the selective cell cycle effects of each of the three drugs. In our initial experience, we have seen a response rate of 40% at metastatic sites and 31% at the primary site after nine cycles of GTX. We are now conducting a formal phase II protocol to confirm these results. The median survival of this group of patients (at least 10.4 months) is as long as, or longer than other currently used regimens. In those patients who do not tolerate GTX or progress despite the regimen, we have found that a regimen of the same three drugs, administered on a different schedule, can produce responses. In the neoadjuvant (unresectable) setting, we treat with GTX initially and then follow with radiation; gemcitabine is used as a radiosensitizer during this treatment. An aggressive surgical approach with a team of surgeons were able to resect for cure 12 of the 16 patients who were initially unresectable; one year survival of these 12 was 100%; 2 year survival was 50%. Future work in this disease should focus on targeted agents such as bevacizumab.

  19. Wyoming Landscape Conservation Initiative data management and integration

    USGS Publications Warehouse

    Latysh, Natalie; Bristol, R. Sky

    2011-01-01

    Six Federal agencies, two State agencies, and two local entities formally support the Wyoming Landscape Conservation Initiative (WLCI) and work together on a landscape scale to manage fragile habitats and wildlife resources amidst growing energy development in southwest Wyoming. The U.S. Geological Survey (USGS) was tasked with implementing targeted research and providing scientific information about southwest Wyoming to inform the development of WLCI habitat enhancement and restoration projects conducted by land management agencies. Many WLCI researchers and decisionmakers representing the Bureau of Land Management, U.S. Fish and Wildlife Service, the State of Wyoming, and others have overwhelmingly expressed the need for a stable, robust infrastructure to promote sharing of data resources produced by multiple entities, including metadata adequately describing the datasets. Descriptive metadata facilitates use of the datasets by users unfamiliar with the data. Agency representatives advocate development of common data handling and distribution practices among WLCI partners to enhance availability of comprehensive and diverse data resources for use in scientific analyses and resource management. The USGS Core Science Informatics (CSI) team is developing and promoting data integration tools and techniques across USGS and partner entity endeavors, including a data management infrastructure to aid WLCI researchers and decisionmakers.

  20. Overview of the federal interagency ecosystem management initiative

    SciTech Connect

    Huke, S.

    1995-12-01

    In early 1994, the White House established a Federal Interagency Ecosystem Management Task Force and Working Group to implement the ecosystem management recommendation in the Vice President`s National Performance Review. The Task Force identified seven ecosystems where mature interagency ecosystem-based activities are mature and ongoing and may provide valuable lessons for broader application. Case studies of each of the seven ecosystems were prepared by interagency teams conducting interviews with representatives of federal, state, and local governments and private interests. The seven ecosystems are: the Southern Appalachian Highlands, Anacostia River Watershed, Prince William Sound, Pacific Northwest Forests, Coastal Louisiana, South Florida, and Great Lakes ecosystems. A final synthesis report, scheduled for completion in the Spring of 1995, will provide an overview of constraints, opportunities, and recommendations in five issue areas: legal, budgetary, science, institutional, policy, and public involvement. A second phase of this initiative will entail the development of ecosystem management strategies for three {open_quotes}new initiatives{close_quotes} laboratories.

  1. Portfolio management for off-line revenue initiatives.

    PubMed

    Edgett, S J

    1996-01-01

    During the past decade, the health services sector has experienced a period of rapid change that has resulted in the creation of a large number of new services. This article advocates the use of a service development matrix as a planning aid for senior managers seeking to attract additional revenue through the development of new services. By strategically selecting and developing new services, rather than simple imitating other health care providers, marketers will be better able to focus limited corporate resources on new service initiatives that generate positive returns.

  2. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    PubMed

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted.

  3. 77 FR 11798 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives... title (Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions)....

  4. Initial robotics research for environmental restoration and waste management

    SciTech Connect

    Hamel, W.R.; Mann, R.C. )

    1990-06-01

    This paper describes the initial research and development activities at the Oak Ridge National Laboratory (ORNL) that will support the technology development component of the overall National Robotics Technology Development Program (NRTDP). The NRTDP is a subelement of the US Department of Energy's (DOE's) Environmental Restoration and Waste Management (ER and WM) 5-Year Applied Research, Development, Demonstration, Testing, and Evaluation Plan and of overall efforts at DOE operational sites around the country. ORNL research will focus on fundamental improvement of remote manipulation through enhancements of the human man/machine interface, integration of automated functions, and the incorporation of machine intelligence to increase productivity. Background and goals for these activities are presented in this paper.

  5. 94-A13 Native American Initiative Short Course Management Plan

    SciTech Connect

    Carroll, Herbert B.; Johnson, William I.; Kokesh, Judith H.

    1999-04-27

    A training program conducted in Bartlesville by BDM-Oklahoma technical staff, which included geologists, geophysicists, exploration and drilling specialists, and environmental policy experts. The proposed training schedule offered four courses per year and included those coursed identified by the tribes in the survey. The training program was outlined for members of Native American Tribes whose lands have oil and gas resources. The proposed program contributed to meeting the goals of the U.S. Department of Energy's (DOE) Domestic Oil and Gas Initiative to help Native American tribes become more self-sufficient in developing and managing their resources through training in cost-effective, improved technologies for hydrocarbon production that will meet environmental regulations. The training program outlined was for adult tribal representatives who are responsible for managing tribal mineral holdings or setting policy, or who work in the oil and gas industry. The course content is in response to a survey that was developed by BDM-Oklahoma and sent in the Spring of 1995 to 26 tribal agencies identified through previous contact with DOE. Tribes were asked to indicate course content needs, levels, preferred time of year, and location. Six tribes responded with specific recommendations and needs. These tribes, were the Creek, Pueblo, Cherokee, St. Regis Mohawk, Northern Arapho, and Ute Mountain Ute.

  6. The NOAH Initiative: Disaster Management Using WebGIS

    NASA Astrophysics Data System (ADS)

    Alconis, J. A.; Eco, R. C.; Lagmay, A.; Aracan, K.; Seveses, L.

    2013-12-01

    The Philippines is beset by many natural hazards that result in disasters costing huge amount of lives and millions worth of economic damages. In response to these perennial problems, the Philippine government, through the Department of Science and Technology, launched the Nationwide Operational Assessment of Hazards (NOAH) in July 2012 to integrate government resources and various initiatives, and develop technologies aimed at mitigating disasters. Among the current activities are high-resolution mapping of critical watersheds using LiDAR to serve as base maps for geohazard models, deployment of automated rain gauges and water level sensors across the country, and use of Doppler radar data and satellite imagery to quantify and downscale weather forecasts among others. A critical component of this initiative is the development of a near real-time web-based spatial data infrastructure which integrates all disaster-related datasets from different agencies from both government and non-government institutions. The program is designed to utilize the latest communication technologies to process, analyze, and disseminate both spatial and non-spatial information with temporal components and their associated metadata to come up with a centralized hazards decision support system for disaster management. It is now being utilized by end-users such as government agencies, local government units, academic institutions, and non-government organizations. More importantly, since its launch, thousands of lives have been saved from severe floods brought by the August 2012 Southwest Monsoon rains and the onslaught of Supertyphoon Bopha in December 2012. Though much work still remains, this is a needed step in the right direction.

  7. Quality improvement initiatives in a case management service: case study.

    PubMed

    Davies, Deborah J

    2015-01-01

    This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

  8. Management initiatives to waste management decisions and environmental compliance in Oak Ridge, Tennessee

    SciTech Connect

    Jones, C.G.

    1988-01-01

    Martin Marietta Energy Systems, Inc. (MMES) has been the operating contractor for the nuclear production and research facilities at Oak Ridge, Tennessee and Paducah, Kentucky for about four and one-half years. Environmental compliance, regulatory interaction, and public confidence have been very significant issues during this time. This presentation will review the environmental situation in Oak Ridge in 1984 and will discuss management initiatives and experience in the development and implementation of effective environmental and waste management and health and safety programs committed to the protection of the environment, our workers and the public with an overall goal of full compliance with all current and anticipated regulations.

  9. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... initial Management Expenses. If you plan to obtain Leverage, you must have your Management Expenses approved by SBA at the time of licensing. (See § 107.520 for the definition of Management Expenses.) ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial...

  10. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses approved by SBA at the time of designation as a NMVC Company. (See § 108.520 for the definition of Management... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial...

  11. Results of comprehensive diagnostic work-up in ‘idiopathic’ dilated cardiomyopathy

    PubMed Central

    Broch, Kaspar; Andreassen, Arne K; Hopp, Einar; Leren, Trond P; Scott, Helge; Müller, Fredrik; Aakhus, Svend; Gullestad, Lars

    2015-01-01

    Objective Dilated cardiomyopathy (DCM) is characterised by left ventricular dilation and dysfunction not caused by coronary disease, valvular disease or hypertension. Owing to the considerable aetiological and prognostic heterogeneity in DCM, an extensive diagnostic work-up is recommended. We aimed to assess the value of diagnostic testing beyond careful physical examination, blood tests, echocardiography and coronary angiography. Methods From October 2008 to November 2012, we prospectively recruited 102 patients referred to our tertiary care hospital with a diagnosis of ‘idiopathic’ DCM based on patient history, physical examination, routine blood tests, echocardiography and coronary angiography. Extended work-up included cardiac MRI, exercise testing, right-sided catheterisation with biopsies, 24 h ECG and genetic testing. Results In 15 patients (15%), a diagnosis other than ‘idiopathic’ DCM was made based on additional tests. In 10 patients (10%), a possibly disease-causing mutation was detected. 2 patients were found to have non-compaction cardiomyopathy based on MRI findings; 2 patients had systemic inflammatory disease with cardiac involvement; and in 1 patient, cardiac amyloidosis was diagnosed by endomyocardial biopsy. Only in 5 cases did the results of the extended work-up have direct therapeutic consequences. Conclusions In patients with DCM, in whom patient history and routine work-up carry no clues to the aetiology, the diagnostic and therapeutic yield of extensive additional testing is modest. PMID:26468400

  12. It's Not Really Over: Thurston County, Washington's Vegetation Management Initiative.

    ERIC Educational Resources Information Center

    MacGregor, Jean

    1992-01-01

    Describes the establishment and results of a study committee asked to review existing pesticide policy, vegetation management programs and provide improvement recommendations in Thurston County, Washington. (MCO)

  13. The Experience of Initial Management Training in ELT

    ERIC Educational Resources Information Center

    Rimmer, Wayne

    2016-01-01

    Management training in ELT organizations is often inadequate. New managers are in severe need of training, especially for tasks which are non-pedagogical, yet they operate in a milieu where there are few opportunities for support compared with colleagues in mainstream education. The purpose of this case study, a rare evidence-based contribution to…

  14. Disease management. A global cost-containing initiative?

    PubMed

    Bloor, K; Maynard, A

    2000-06-01

    Disease management has been marketed by healthcare industry providers as a way of improving resource allocation in healthcare and containing costs. However, to achieve improved efficiency in healthcare requires the guidelines and protocols in the disease management process to be based on sound evidence of effectiveness and cost effectiveness. This has not always been the case. The approach itself has an inadequate evidence base in terms of randomised controlled trials, other rigorous methods of evaluation and the results of economic evaluation. Disease management can be viewed as an attempt by pharmaceutical companies to undertake forward vertical integration into other parts of the healthcare process. This could reduce uncertainty for purchasers and reduce transaction costs, thereby potentially facilitating both healthcare expenditure control and efficiency. However, such cost savings may be outweighed by a concentration of power in disease management (pharmaceutical) companies, and the exploitation of such power to inflate expenditure and misallocate resources. Disease management must be appraised with care.

  15. Live or computerized simulation of clinical encounters: do clinicians work up patient cases differently?

    PubMed

    Nendaz, Mathieu R; Ponte, Belen; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Junod, Alain F; Vu, Nu V

    2006-03-01

    Computer simulation of clinical encounters is increasingly used in clinical settings to train patient work-up. The aim of this prospective, controlled study was to compare the characteristics of data collection and diagnostic exploration of physicians working up cases with a standardized patient and in a computerized simulation. Six clinicians of different clinical experience in internal medicine worked up three cases with a standardized patient and through a computer simulation allowing free inquiry. After each encounter, we asked the subjects to justify the information collected and to comment on their working diagnoses. The characteristics of data collected and working diagnoses generated were assessed and compared, according to the simulation method used. In the computer simulation, physicians limited their data collection and focused earlier and more specifically on information and working diagnoses with high levels of relevance. They reached a similar diagnostic accuracy and made decisions of a similar relevance. Computer simulation with a free-inquiry approach reproduces the data collection and the diagnostic exploration observed in a standardized-patient simulation and promotes an early collection of relevant data. Its contribution to extend the competence of learners in clinical settings should be further evaluated.

  16. Searching for Extended Identity: The Problematised Role of Managing People Development, as Illuminated by the Frontline Management Initiative.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis

    Australia's Frontline Management Initiative (FMI) marks a political move toward workplace learning and provides evidence concerning development of managing identities and management of such workplace learning. The FMI was examined as a technology of identity within the discourse of enterprise and an instrument of textualization of the workplace.…

  17. Greening of a Campus through Waste Management Initiatives: Experience from a Higher Education Institution in Thailand

    ERIC Educational Resources Information Center

    Tangwanichagapong, Siwaporn; Nitivattananon, Vilas; Mohanty, Brahmanand; Visvanathan, Chettiyappan

    2017-01-01

    Purpose: This paper aims to describe the effects of 3R (reduce, reuse and recycle) waste management initiatives on a campus community. It ascertains the environmental attitudes and opinions of the residents and investigates their behavioral responses to waste management initiatives. Practical implications for enhancing sustainable waste management…

  18. The Healthy Learner Model for Student Chronic Condition Management--Part II: The Asthma Initiative

    ERIC Educational Resources Information Center

    Erickson, Cecelia DuPlessis; Splett, Patricia L.; Mullett, Sara Stoltzfus; Jensen, Charlotte; Belseth, Stephanie Bisson

    2006-01-01

    The Healthy Learner Asthma Initiative (HLAI) was designed as a comprehensive, school-community initiative to improve asthma management and produce healthy learners. National asthma guidelines were translated into components of asthma management in the school setting that defined performance expectations and lead to greater quality and consistency…

  19. Management of the Commercial Operations and Support Savings Initiative Program

    DTIC Science & Technology

    2007-11-02

    7,882 $ 8,399 0 $ 16,281 systems management tools FltCast program N00039-97-C- 8002 6,927 8,499 $ 12,570 27,996 Marine Corps signal intelligence...1998 12 0 Stage 1 complete, Stage 2 not planned or budgeted N00039-97-C- 8002 September 4, 1997 June 4, 1998 9 0 Stage 1 complete, Stage 2 not planned or...Science and Technology) on Finding A and Audit Response 50 F. Report Distribution 56 Management Comments Deputy Under Secretary of Defense (Science

  20. Initial evaluation and management of the critical burn patient.

    PubMed

    Vivó, C; Galeiras, R; del Caz, Ma D P

    2016-01-01

    The major improvement in burn therapy is likely to focus on the early management of hemodynamic and respiratory failures in combination with an aggressive and early surgical excision and skin grafting for full-thickness burns. Immediate burn care by first care providers is important and can vastly alter outcomes, and it can significantly limit burn progression and depth. The goal of prehospital care should be to cease the burning process as well as prevent future complications and secondary injuries for burn shock. Identifying burn patients appropriate for immediate or subacute transfer is an important step in reducing morbidity and mortality. Delays in transport to Burn Unit should be minimized. The emergency management follows the principles of the Advanced Trauma Life Support Guidelines for assessment and stabilization of airway, breathing, circulation, disability, exposure and environment control. All patients with suspected inhalation injury must be removed from the enclosure as soon as possible, and immediately administer high-flow oxygen. Any patient with stridor, shortness of breath, facial burns, singed nasal hairs, cough, soot in the oral cavity, and history of being in a fire in an enclosed space should be strongly considered for early intubation. Fibroscopy may also be useful if airway damage is suspected and to assess known lung damage. Secondary evaluation following admission to the Burn Unit of a burned patient suffering a severe thermal injury includes continuation of respiratory support and management and treatment of inhalation injury, fluid resuscitation and cardiovascular stabilization, pain control and management of burn wound.

  1. Recent Initiatives to Manage Sediment in US Reservoirs

    NASA Astrophysics Data System (ADS)

    Wegner, D. L.

    2014-12-01

    Sediment has long been either ignored or considered unimportant in the planning and management of federal and state water resources across the United States. All reservoirs trap sediment that had previously been transported downriver to either the ocean or larger bodies of water. The trapping of reservoirs has implications for reservoir longevity and downstream channel geomorphology or ecology. Concerns associated with reservoir sedimentation include the loss of reservoir storage capacity, river channel incisement and degradation downstream from dams, loss of channel capacity downstream, impacts to reservoir and river ecology and water chemistry, and impacts to cultureal resources and municipal water supplies. Climate change with resulting impacts to hydrologic and sediment dynamics could have profound management implications for water agencies. To date, little effort has been made by the federal water management agencies to include reservoir sedimentation in their planning or operational considerations. In recent years sediment management in rivers has become more important, especially in the Missouri, Columbia, Snake, Colorado, Mississippi and Susquehanna river systems.

  2. A Cost Management Control Procedure for Initial Training in Surface Ship Acquisition Programs. Final Report.

    ERIC Educational Resources Information Center

    Nutter, Roger V.; And Others

    A study was conducted to develop a cost management control procedure to assist Navy managers in making decisions about initial training development and implementation in surface ship acquisition programs. Objectives were (1) develop and illustrate a cost management control procedure for centralized collection, storage, and control of cost data for…

  3. 7 CFR 4290.360 - Initial review of Applicant's management team's qualifications.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Initial review of Applicant's management team's...'s management team's qualifications. The Secretary will review the information submitted by the Applicant concerning the qualifications of the Applicant's management team to determine in his or her...

  4. Defense Infrastructure: Army Has a Process to Manage Litigation Costs for the Military Housing Privatization Initiative

    DTIC Science & Technology

    2014-04-01

    DEFENSE INFRASTRUCTURE Army Has a Process to Manage Litigation Costs for the Military Housing Privatization...DEFENSE INFRASTRUCTURE Army Has a Process to Manage Litigation Costs for the Military Housing Privatization Initiative Why GAO Did This Study In 1996...financing and management to repair, renovate, construct, and operate military family housing . The Army has invested $1.97 billion and the private

  5. Initial pretreatment module safety management plan. Revision 1

    SciTech Connect

    Smith, D.A.

    1995-01-30

    The IPM Safety Management Plan establishes the approach to be utilized for integrating the responsibilities for safety documentation and review with the design, construction and start-up activities. The plan defines the requirements for the safety analysis documentation and the independent safety review to ensure that the design for the facility operation will not present undue risk to the health and safety of the employees, visitors, or members of the public and provides adequate protection of the environment.

  6. Technology Integration Initiative In Support of Outage Management

    SciTech Connect

    Gregory Weatherby; David Gertman

    2012-07-01

    Plant outage management is a high priority concern for the nuclear industry from cost and safety perspectives. Often, command and control during outages is maintained in the outage control center where many of the underlying technologies supporting outage control are the same as those used in the 1980’s. This research reports on the use of advanced integrating software technologies and hand held mobile devices as a means by which to reduce cycle time, improve accuracy, and enhance transparency among outage team members. This paper reports on the first phase of research supported by the DOE Light Water Reactor Sustainability (LWRS) Program that is performed in close collaboration with industry to examine the introduction of newly available technology allowing for safe and efficient outage performance. It is thought that this research will result in: improved resource management among various plant stakeholder groups, reduced paper work, and enhanced overall situation awareness for the outage control center management team. A description of field data collection methods, including personnel interview data, success factors, end-user evaluation and integration of hand held devices in achieving an integrated design are also evaluated. Finally, the necessity of obtaining operations cooperation support in field studies and technology evaluation is acknowledged.

  7. Initial Conservative Management of Exomphalos Major with Gentian Violet

    PubMed Central

    Ferdous, KMN

    2012-01-01

    Aim: The purpose of the study was to assess the results of topical use of gentian violet (GV), among the babies with exomphalos major in our institute. Methods: The study was carried out retrospectively in a tertiary care hospital during the period from 2005 to 2010 inclusive. Exomphalos patients were classified as major if diameter was >5 cm and/or had liver in the sac as content. These patients were initially preferentially treated conservatively with topical 1% GV over the sac resultig a ventral hernia to be repaired later. Results: A total of 84 exomphalos patients were admitted during the study period. Among them, 37 neonates (26 males and 11 females) had exomphalos major (EM). Ten of them were prenatally diagnosed. The mean gestational age at delivery was 35 weeks, and mean birth weight was 2.1 Kg. Mean age at presentation was 3.7 days. Thirty (81%) had other associated anomalies, mostly cardiac (66.6%) and pulmonary (46.6%). Ten patients with EM needed early operation because of ruptured sac, and other anomalies. There were 2 pre-operative and 8 postoperative deaths in this subgroup. Twenty seven patients were treated conservatively, among these 4 died of overwhelming sepsis. Remaining 23 patients left the hospital with a ventral hernia planned to be repaired at 1 year of age. Overall mortality in our series was 37.83%. Conclusion: Initial conservative treatment of the sac with GV results in satisfactory outcome for infants with EM who cannot undergo immediate closure. PMID:26023410

  8. Informing the Design and Evaluation of Superuser Care Management Initiatives

    PubMed Central

    Cantor, Joel C.

    2016-01-01

    Background: Health care spending is concentrated among a small number of high-cost patients, and the popularity of initiatives to improve care and reduce cost among such “superusers” (SUs) is growing. However, SU costs decline naturally over time, even without intervention, a statistical phenomenon known as regression-to-the-mean (RTM). Objectives: We assess the magnitude of RTM in hospital costs for cohorts of hospital SUs identified on the basis of high inpatient (IP) or emergency department (ED) utilization. We further examine how cost and RTM are associated with patient characteristics including behavioral health (BH) problems, multiple chronic conditions, and indicators of vulnerability. Study Design: Using longitudinally linked all-payer hospital billing data, we selected patient cohorts with ≥2 IP stays (IP SUs) or ≥6 ED visits (ED SUs) during a 6-month baseline period, and additional subgroups defined by combinations of IP and ED superuse. Population Studied: A total of 289,060 NJ hospital IP and treat-and-release ED patients over 2009–2011. Results: Hospital costs among IP and ED SUs declined 70% and 38%, respectively, over 8 quarters following the baseline period. The decrease occurs more quickly for IP SUs compared with ED SUs. Presence of BH problems was positively associated with costs among patients overall, but the relationship varied by SU cohort. Conclusions: Understanding patterns of RTM among SU populations is important for designing intervention strategies, as there is greater potential for savings among patients with more persistent costs (less RTM). Further, as many SU initiatives lack resources for rigorous evaluation, quantifying the extent of RTM is vital for interpreting program outcomes. PMID:27219632

  9. INTEGRATED SAFETY MANAGEMENT SYSTEM SAFETY CULTURE IMPROVEMENT INITIATIVE

    SciTech Connect

    MCDONALD JA JR

    2009-01-16

    In 2007, the Department of Energy (DOE) identified safety culture as one of their top Integrated Safety Management System (ISMS) related priorities. A team was formed to address this issue. The team identified a consensus set of safety culture principles, along with implementation practices that could be used by DOE, NNSA, and their contractors. Documented improvement tools were identified and communicated to contractors participating in a year long pilot project. After a year, lessons learned will be collected and a path forward determined. The goal of this effort was to achieve improved safety and mission performance through ISMS continuous improvement. The focus of ISMS improvement was safety culture improvement building on operating experience from similar industries such as the domestic and international commercial nuclear and chemical industry.

  10. The Appropriate Use of Neuroimaging in the Diagnostic Work-Up of Dementia

    PubMed Central

    2014-01-01

    Background Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype to manage patients and suitably plan for the future. Objectives This analysis sought to determine the appropriate use of neuroimaging during the diagnostic work-up of dementia, including indications for neuroimaging and comparative accuracy of alternative technologies. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2000 and 2013. Review Methods Data on diagnostic accuracy and impact on clinical decision making were abstracted from included studies. Quality of evidence was assessed using GRADE. Results The search yielded 5,374 citations and 15 studies were included. Approximately 10% of dementia cases are potentially treatable, though less than 1% reverse partially or fully. Neither prediction rules nor clinical indications reliably select the subset of patients who will likely benefit from neuroimaging. Clinical utility is highest in ambiguous cases or where dementia may be mixed, and lowest for clinically diagnosed Alzheimer disease or clinically excluded vascular dementia. There is a lack of evidence that MRI is superior to CT in detecting a vascular component to dementia. Accuracy of structural imaging is moderate to high for discriminating different types of dementia. Limitations There was significant heterogeneity in estimates of diagnostic accuracy, which often prohibited a statistical summary of findings. The quality of data reported by studies prohibited calculation of likelihood ratios in the present analysis. No studies from primary care were found; thus, generalizability beyond tertiary care settings may be limited. Conclusions A diagnosis of reversible dementia is rare. Imaging has the most

  11. 77 FR 10695 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions AGENCY: Office of the Assistant Secretary for Housing--Federal...

  12. How to Tackle Tremor – Systematic Review of the Literature and Diagnostic Work-Up

    PubMed Central

    Buijink, A. W. G.; Contarino, M. F.; Koelman, J. H. T. M.; Speelman, J. D.; van Rootselaar, A. F.

    2012-01-01

    Background: Tremor is the most prevalent movement disorder in clinical practice. It is defined as involuntary, rhythmic, oscillatory movements. The diagnostic process of patients with tremor can be laborious and challenging, and a clear, systematic overview of available diagnostic techniques is lacking. Tremor can be a symptom of many diseases, but can also represent a distinct disease entity. Objective: The objective of this review is to give a clear, systematic and step-wise overview of the diagnostic work-up of a patient with tremor. The clinical relevance and value of available laboratory tests in patients with tremor will be explored. Methods: We systematically searched through EMBASE. The retrieved articles were supplemented by articles containing relevant data or provided important background information. Studies that were included investigated the value and/or usability of diagnostic tests for tremor. Results: In most patients, history and clinical examination by an experienced movement disorders neurologist are sufficient to establish a correct diagnosis, and further ancillary examinations will not be needed. Ancillary investigation should always be guided by tremor type(s) present and other associated signs and symptoms. The main ancillary examination techniques currently are electromyography and SPECT imaging. Unfortunately, many techniques have not been studied in large prospective, diagnostic studies to be able to determine important variables like sensitivity and specificity. Conclusion: When encountering a patient with tremor, history, and careful clinical examination should guide the diagnostic process. Adherence to the diagnostic work-up provided in this review will help the diagnostic process of these patients. PMID:23109928

  13. 76 FR 23583 - Application of the Energy Planning and Management Program Power Marketing Initiative to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-27

    ... Area Power Administration Application of the Energy Planning and Management Program Power Marketing... (Western), a Federal power marketing agency of the Department of Energy (DOE), will apply the Energy Planning and Management Program (Program) Power Marketing Initiative (PMI), as modified in this notice,...

  14. Paradise nearly Gained. Volume 2: Case Studies of Impact and Diversity for Frontline Management Initiative Practice.

    ERIC Educational Resources Information Center

    Barratt-Pugh, Llandis; Soutar, Geoffrey N.

    This document presents the case studies from a multi-phase study of the impact of Australia's Frontline Management Initiative (FMI), which provides a framework for competency-based development of frontline managers in Australian enterprises. Nineteen organizational case studies and one individual case study of the FMI's impacts are included. The…

  15. Northern Gulf of Mexico (NGOM) Regional Sediment Management Demonstration Program Initiatives

    DTIC Science & Technology

    2005-09-01

    Gulf of Mexico (NGOM) Regional Sediment Management (RSM) Demonstration Program (DP), which was led by the US Army Corps of Engineers Mobile District. Mobile s demonstration identified and prioritized projects and associated issues that could quickly realize the benefits resulting from a regional management approach. The experience gained from these initiatives has been extended and applied to other Mobile District projects throughout the

  16. [Importance of an initial check-up for diagnostic radiology apparatus management].

    PubMed

    Ishida, Hideki; Take, Toshio; Okabe, Keigo; Saitoh, Hajime; Asanuma, Shinichi; Akiyama, Masayuki; Nakazawa, Yasuo

    2006-11-20

    The management of apparatus for diagnostic imaging is an important job for radiological technologists. In the last 10 years we have encountered 2227 malfunctions in 3652 days. We detected 163 cases at the initial check-up, which accounted for 7.3% of total cases. By performing an initial check-up, we detected one malfunction every 21 days and were able to keep the effects of mishaps to a minimum, prevent accidents, and obtain stable-quality images.

  17. Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management.

    PubMed

    Tanwar, Raman; Rathore, Kirti Vijay; Rohilla, Mahesh Kumar

    2015-01-01

    Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients.

  18. [Potentials of cooperative quality management initiatives: BQS Institute projects, January 2010 - July 2013].

    PubMed

    Veit, Christof; Bungard, Sven; Hertle, Dagmar; Grothaus, Franz-Josef; Kötting, Joachim; Arnold, Nicolai

    2013-01-01

    Alongside the projects of internal quality management and mandatory quality assurance there is a variety of quality driven projects across institutions initiated and run by various partners to continuously improve the quality of care. The multiplicity and characteristics of these projects are discussed on the basis of projects run by the BQS Institute between 2010 and 2013. In addition, useful interactions and linking with mandatory quality benchmarking and with internal quality management are discussed. (As supplied by publisher).

  19. 76 FR 81487 - Application of the Energy Planning and Management Program Power Marketing Initiative to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-28

    ... Area Power Administration Application of the Energy Planning and Management Program Power Marketing Initiative to the Boulder Canyon Project Post-2017 Remarketing AGENCY: Western Area Power Administration... withdrawing its decisions and proposals relating to its Boulder Canyon Project (BCP) Post-2017...

  20. Designing a Feasibility Study: A Starting Point for Considering New Management Initiatives for Working Parents.

    ERIC Educational Resources Information Center

    Friedman, Dana E.

    This brief paper was prepared as a starting point for employers considering the adoption of a new management initiative for working parents. It is not an exhaustive outline of all considerations in the decision-making process, nor does it provide solutions to all the known pitfalls. It does, however, suggest the potential scope and complexity of…

  1. 78 FR 8551 - Federal Housing Administration (FHA) Risk Management Initiatives: Changes to Maximum Loan-to...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-06

    ... URBAN DEVELOPMENT Federal Housing Administration (FHA) Risk Management Initiatives: Changes to Maximum...--Federal Housing Commissioner, HUD. ACTION: Notice. SUMMARY: This proposed notice would make changes to the... long-term outlook. HUD has determined that this proposed change to the LTV requirements is necessary...

  2. New mechanism under International Flood Initiative toward robustness for flood management in the Asia Pacific region

    NASA Astrophysics Data System (ADS)

    Murase, M.; Yoshitani, J.; Takeuchi, K.; Koike, T.

    2015-12-01

    Climate change is likely to result in increases in the frequency or intensity of extreme weather events. It is imperative that a good understanding is developed of how climate change affects the events that are reflected in hydrological extremes such as floods and how practitioners in water resources management deal with them. Since there is still major uncertainty as to how the impact of climate change affect actual water resources management, it is important to build robustness into management schemes and communities. Flood management under such variety of uncertainty favors the flexible and adaptive implementation both in top-down and bottom-up approaches. The former uses projections of global or spatially downscaled models to drive resource models and project resource impacts. The latter utilizes policy or planning tools to identify what changes in climate would be most threatening to their long-range operations. Especially for the bottom-up approaches, it is essential to identify the gap between what should be done and what has not been achieved for disaster risks. Indicators or index are appropriate tools to measure such gaps, but they are still in progress to cover the whole world. The International Flood Initiative (IFI), initiated in January 2005 by UNESCO and WMO in close cooperation with UNU and ISDR, IAHS and IAHR, has promoted an integrated approach to flood management to take advantage of floods and use of flood plains while reducing the social, environmental and economic risks. Its secretariat is located in ICHARM. The initiative objective is to support national platforms to practice evidence-based disaster risk reduction through mobilizing scientific and research networks at national, regional and international levels. The initiative is now preparing for a new mechanism to facilitate the integrated approach for flood management on the ground regionally in the Asia Pacific (IFI-AP) through monitoring, assessment and capacity building.

  3. Waste Management Improvement Initiatives at Atomic Energy of Canada Limited - 13091

    SciTech Connect

    Chan, Nicholas; Adams, Lynne; Wong, Pierre

    2013-07-01

    Atomic Energy of Canada Limited's (AECL) Chalk River Laboratories (CRL) has been in operation for over 60 years. Radioactive, mixed, hazardous and non-hazardous wastes have been and continue to be generated at CRL as a result of research and development, radioisotope production, reactor operation and facility decommissioning activities. AECL has implemented several improvement initiatives at CRL to simplify the interface between waste generators and waste receivers: - Introduction of trained Waste Officers representing their facilities or activities at CRL; - Establishment of a Waste Management Customer Support Service as a Single-Point of Contact to provide guidance to waste generators for all waste management processes; and - Implementation of a streamlined approach for waste identification with emphasis on early identification of waste types and potential disposition paths. As a result of implementing these improvement initiatives, improvements in waste management and waste transfer efficiencies have been realized at CRL. These included: 1) waste generators contacting the Customer Support Service for information or guidance instead of various waste receivers; 2) more clear and consistent guidance provided to waste generators for waste management through the Customer Support Service; 3) more consistent and correct waste information provided to waste receivers through Waste Officers, resulting in reduced time and resources required for waste management (i.e., overall cost); 4) improved waste minimization and segregation approaches, as identified by in-house Waste Officers; and 5) enhanced communication between waste generators and waste management groups. (authors)

  4. Knee Dislocation: A Case Report, Diagnostic Vascular Work-Up, and Literature Review

    PubMed Central

    Burg, Michael D.; Dijkstra, Björn L.

    2017-01-01

    Knee dislocation is an uncommon, potentially limb-threatening, knee injury. Most often caused by high-velocity trauma, it can also result from low- or even ultra-low-velocity trauma. Rapid identification of the injury, reduction, and definitive management are necessary to minimize neurovascular damage. We present a case of rotatory anterolateral knee dislocation sustained during a twisting sports-related event. Special emphasis is placed on diagnosing vascular injuries associated with knee dislocations. PMID:28321343

  5. Pain Management in Long-Term Care Communities: A Quality Improvement Initiative

    PubMed Central

    Reid, M C; O’Neil, Kevin W.; Dancy, JaNeen; Berry, Carolyn A.; Stowell, Stephanie A.

    2015-01-01

    Pain is underrecognized and undertreated in the long-term care (LTC) setting. To improve the management of pain for LTC residents, the authors implemented a quality improvement (QI) initiative at one LTC facility. They conducted a needs assessment to identify areas for improvement and designed a 2-hour educational workshop for facility staff and local clinicians. Participants were asked to complete a survey before and after the workshop, which showed significant improvement in their knowledge of pain management and confidence in their ability to recognize and manage residents’ pain. To measure the effectiveness of the QI initiative, the authors performed a chart review at baseline and at 3 and 8 months after the workshop and evaluated relevant indicators of adequate pain assessment and management. The post-workshop chart reviews showed significant improvement in how consistently employees documented pain characteristics (ie, location, intensity, duration) in resident charts and in their use of targeted pain assessments for residents with cognitive dysfunction. The proportion of charts that included a documented plan for pain assessment was high at baseline and remained stable throughout the study. Overall, the findings suggest a QI initiative is an effective way to improve pain care practices in the LTC setting. PMID:25949232

  6. Army Justified Initial Production Plan for the Paladin Integrated Management Program but Has Not Resolved Two Vehicle Performance Deficiencies (Redacted)

    DTIC Science & Technology

    2016-08-05

    Department of Defense Report No. DODIG-2016-118 A U G U S T 5 , 2 0 1 6 Army Justified Initial Production Plan for the Paladin Integrated Management ...DODIG-2016-118 (Project No. D2016-D000AU-0003.000) │ i Results in Brief Army Justified Initial Production Plan for the Paladin Integrated Management ...effectively managed the Paladin Integrated Management (PIM) program during the production and deployment phase. Specifically, we evaluated whether

  7. Coagulation disorders and their cutaneous presentations: Diagnostic work-up and treatment.

    PubMed

    Dabiri, Ganary; Damstetter, Elizabeth; Chang, Yunyoung; Baiyee Ebot, Emily; Powers, Jennifer Gloeckner; Phillips, Tania

    2016-05-01

    Both inherited and acquired hypercoagulable states can present with nonspecific clinical manifestations, such as petechiae, purpura, livedo reticularis, and ulcerations. A good history and physical examination are crucial to diagnoses of these conditions. Inherited conditions tend to present either in neonatal period or later in life, while acquired conditions typically occur later in life. Diagnostic studies are performed to identify the coagulation cascade deficiency or defect. Treatment primarily hinges on anticoagulation and wound care. In this article, we provide an in-depth analysis of the clinical manifestations, diagnostic considerations, and management options of patients in hypercoagulable states.

  8. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours

    PubMed Central

    2011-01-01

    Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity. PMID:22035338

  9. Nephrocutaneous fistula as the initial manifestation of asymptomatic nephrolithiasis: A call for radical management

    PubMed Central

    Tanwar, Raman; Rathore, Kirti Vijay; Rohilla, Mahesh Kumar

    2015-01-01

    Renal stones are a common affliction presenting in an acute setting. We report a case of asymptomatic renal stone in an elderly gentleman presenting initially as a discharging lumbar sinus managed by subcapsular nephrectomy and radical excision of the fistula tract. Nephrocutaneous fistula is most commonly associated with tuberculosis, xanthogranulomatous pyelonephritis, and rarely with complicated calyceal stones, and its occurrence with asymptomatic pelvic stones is rare. We present the points in favor of radical open surgery in the management of such patients. PMID:25657555

  10. Children with Developmental Language Delay at 24 Months of Age: Results of a Diagnostic Work-Up

    ERIC Educational Resources Information Center

    Buschmann, Anke; Jooss, Bettina; Rupp, Andre; Dockter, Sonja; Blaschtikowitz, Heike; Heggen, Iris; Pietz, Joachim

    2008-01-01

    The aim of this study was to evaluate if a diagnostic work-up should be recommended for 2-year-old children with developmental language delay (LD), or if the widely chosen "wait and see" strategy is adequate. Children with LD were identified in paediatric practices during routine developmental check-ups using a German parent-report…

  11. Transjugular Intrahepatic Portosystemic Shunt: Indications, Contraindications, and Patient Work-Up

    PubMed Central

    Copelan, Alexander; Kapoor, Baljendra; Sands, Mark

    2014-01-01

    The transjugular intrahepatic portosystemic shunt (TIPS) procedure is effective in achieving portal decompression and in managing some of the major complications of portal hypertension. While many clinicians are familiar with the two most common indications for TIPS placement, secondary prophylaxis of esophageal variceal hemorrhage and treatment of refractory ascites, evidence for its usefulness is growing in other entities, where it has been less extensively studied but demonstrates promising results. Newer indications include early utilization in the treatment of esophageal variceal hemorrhage, Budd–Chiari syndrome, ectopic varices, and portal vein thrombosis. The referring clinician and interventionist must remain cognizant of the contraindications to the procedure to avoid complications and potential harm to the patient. This review is designed to provide an in-depth analysis of the most common as well as less typical indications for TIPS placement, and to discuss the contraindications and appropriate patient evaluation for this procedure. PMID:25177083

  12. [Key messages for the initial management of the elderly patient with acute heart failure].

    PubMed

    Martín-Sánchez, F Javier; Rodríguez-Adrada, Esther; Llorens, Pere; Formiga, Francesc

    2015-01-01

    Acute heart failure is a high prevalence geriatric syndrome that has become one of the most frequent causes of visits to emergency departments, as well as hospital admission, and is associated with high morbidity, mortality and functional impairment. There has been an increasing amount of information published in recent years on the initial management of acute heart failure and the results of the short-term outcomes, as well as the natural history of the disease. The objective of this study is to provide several recommendations that should be taken into account in the initial management of the elderly patient with acute heart failure in the emergency departments, and to review the most interesting currently on-going clinical trials.

  13. DoD CPB-ECMO Initiative - A Suspended Animation Front Lines Casualty Management System

    DTIC Science & Technology

    2004-12-01

    DOD CPB- ECMO INITIATIVE – A SUSPENDED ANIMATION FRONT LINES CASUALTY MANAGEMENT SYSTEM Fernando Casas*1, Andrew Reeves1, David Dudzinski1...adjacent main blood vessels. Extracorporeal membrane oxygenation ( ECMO ) uses similar equipment, with the primary goal of temporary pulmonary support by...low cost CPB/ ECMO components to treat front lines emergency trauma casualties. By cooling the patient to a low temperature of about 10°C and

  14. Percutaneous Necrosectomy and Sinus Tract Endoscopy in the Management of Infected Pancreatic Necrosis: An Initial Experience

    PubMed Central

    Carter, C. Ross; McKay, Colin J.; Imrie, Clement W.

    2000-01-01

    Objective To describe the development of a minimally invasive technique aimed at surgical debridement in addition to simple drainage of the abscess cavity. Summary Background Data Surgical intervention for secondary infection of pancreatic necrosis is associated with a death rate of 25% to 40%. Although percutaneous approaches may drain the abscess, they have often failed in the long term as a result of inability to remove the necrotic material adequately. Methods Fourteen consecutive patients with infected necrosis secondary to acute pancreatitis were studied. The initial four patients underwent sinus tract endoscopy along a drainage tract for secondary sepsis after prior open necrosectomy. This technique was then modified to allow primary debridement for proven sepsis to be carried out percutaneously in a further 10 patients. The techniques and initial results are described. Results Additional surgery for sepsis was successfully avoided in the initial four patients managed by sinus tract endoscopy, and none died. Of the following 10 patients managed by percutaneous necrosectomy, 2 died. The median inpatient stay was 42 days. There was one conversion for intraoperative bleeding. Eight patients recovered and were discharged from the hospital after a median of three percutaneous explorations. Only 40% of patients required intensive care management after surgery. Conclusions These initial results in an unselected group of patients are encouraging and show that unlike with percutaneous or endoscopic techniques, both resolution of sepsis and adequate necrosectomy can be achieved. The authors’ initial impression of a reduction in postoperative organ dysfunction is particularly interesting; however, the technique requires further evaluation in a larger prospective series. PMID:10903593

  15. Wyoming Landscape Conservation Initiative Science and Management Workshop Proceedings, May 12-14, 2009, Laramie, Wyoming

    USGS Publications Warehouse

    Nuccio, Vito F.; D'Erchia, Frank D.; Parady, K.(compiler); Mellinger, A.

    2010-01-01

    The U.S. Geological Survey (USGS) hosted the second Wyoming Landscape Conservation Initiative (WLCI) Science and Management Workshop at the University of Wyoming Conference Center and Hilton Garden Inn on May 12, 13, and 14, 2009, in Laramie, Wyo. The workshop focused on six topics seen as relevant to ongoing WLCI science and management activities: mapping and modeling resources for decisionmaking; data information and management; fish and wildlife research; changing landscapes; monitoring; and reclamation and offsite mitigation. Panelists gave presentations on ongoing research in these six areas during plenary sessions followed by audience discussions. Three breakout groups focused on discussing wildlife, reclamation, and monitoring. Throughout the plenary sessions, audience discussions, and breakout groups, several needs were repeatedly emphasized by panelists and workshop participants: developing a conservation plan and identifying priority areas and species for conservation actions; gaining a deeper understanding of sagebrush ecology; identifying thresholds for wildlife that can be used to create an 'early warning system' for managers; continuing to collect basic data across the landscape; facilitating even greater communication and partnership across agencies and between scientists and land managers; and engaging proactively in understanding new changes on the landscape such as wind energy development and climate change. Detailed proceedings from the workshop are captured and summarized in this report.

  16. Defense Enterprise Accounting and Management System (DEAMS) Increment 1 Release 3 Initial Operational Test and Evaluation Report

    DTIC Science & Technology

    2015-08-01

    Director, Operational Test and Evaluation Defense Enterprise Accounting and Management System (DEAMS) Increment 1 Release 3 Initial...Operational Test and Evaluation Report August 2015 This report on the Defense Enterprise Accounting and Management System (DEAMS) fulfills the...suitability, and cybersecurity posture of the DEAMS. J. Michael Gilmore Director Defense Enterprise Accounting and Management System (DEAMS

  17. Sustaining the Bamako Initiative in the Gambia--some management implications.

    PubMed

    Ceesay, N; Kalliecharan, R V

    1994-01-01

    There is increasing pressure in developing countries to improve the social, political and economic status of their people. For former colonies such as the Gambia, pre-independence promises of equity in health, education, water supply and sanitation were vaguely presented in political manifestos. Some of these promises were not translated into concrete plans because of the economic difficulties that the countries experienced. The Alma Ata Declaration on Primary Health Care in 1978 was seen as a strategy to improve the deteriorating health status in developing countries. The economic crisis however, which these countries were facing forced them into implementing Structural Adjustment Programmes (SAP). This resulted in a search for alternative methods of financing health care including that of the Bamako Initiative in 1987 to strengthen the implementation of PHC. The Gambia adopted The Bamako Initiative in 1993 to help in strengthening its already well-developed PHC infrastructure. The Bamako Initiative, like any other form of financing health services, is however not without shortcomings. This paper assesses the structural bottlenecks likely to affect the sustainability of the programme in the Gambia. It examines the political and operational management issues such as political stability, donor commitment and support, effective community management, health sector support and the availability of financial resources.

  18. An assessment of technology alternatives for telecommunications and information management for the space exploration initiative

    NASA Technical Reports Server (NTRS)

    Ponchak, Denise S.; Zuzek, John E.

    1991-01-01

    On the 20th anniversary of the Apollo 11 lunar landing, President Bush set forth ambitious goals for expanding human presence in the solar system. The Space Exploration Initiative (SEI) addresses these goals beginning with Space Station Freedom, followed by a permanent return to the Moon, and a manned mission to Mars. A well designed, adaptive Telecommunications, Navigation, and Information Management (TNIM) infrastructure is vital to the success of these missions. Utilizing initial projections of user requirements, a team under the direction of NASA's Office of Space Operations developed overall architectures and point designs to implement the TNIM functions for the Lunar and Mars mission scenarios. Based on these designs, an assessment of technology alternatives for the telecommunications and information management functions was performed. This technology assessment identifies technology developments necessary to meet the telecommunications and information management system requirements for SEI. Technology requirements, technology needs and alternatives, the present level of technology readiness in each area, and a schedule for development are presented.

  19. Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups.

    PubMed

    Tobe, S W; Moy Lum-Kwong, M; Von Sychowski, S; Kandukur, K; Kiss, A; Flintoft, V

    2014-01-01

    The Heart and Stroke Foundation of Ontario's Hypertension Management Initiative (HMI) was a pragmatic implementation of clinical practice guidelines for hypertension management in primary care clinics. The HMI was a prospective delayed phase cohort study of 11 sites enrolling patients in two blocks starting 9 months apart in 2007. The intervention was an evidence-informed chronic disease management program consisting of an interprofessional educational intervention with practice tools to implement the Canadian Hypertension Education Program's clinical practice guidelines. This study compares the change in blood pressure (BP) from baseline to 9 months after the intervention between groups. In the immediate intervention group, the mean BP at baseline was 134.6/79.1 mm Hg (18.2/11.5) and in the delayed intervention group 134.2/77.1 mm Hg (18.9/11.8). The fall in BP in the immediate intervention group from baseline to 9 months after the intervention was 7.3/3.6 mm Hg (95% confidence interval (CI): 5.9-8.7/2.6-4.5) and in the delayed group 8.1/3.3 mm Hg (95% CI: 7.0-9.3/2.5-4.1) (all P<0.0001 were compared from baseline to the end of 9 months of the program in both groups). This study is the first to demonstrate that implementation of an interprofessional knowledge integration initiative for the control of hypertension can rapidly lead to lower BP levels.

  20. Initiatives and outcomes of green supply chain management implementation by Chinese manufacturers.

    PubMed

    Zhu, Qinghua; Sarkis, Joseph; Lai, Kee-hung

    2007-10-01

    This paper aims to explore the green supply chain management (GSCM) initiatives (implementation) of various manufacturing industrial sectors in China and examine the links between GSCM initiatives and performance outcomes. We conducted a survey to collect data from four typical manufacturing industrial sectors in China, namely, power generating, chemical/petroleum, electrical/electronic and automobile, and received 171 valid organizational responses for data analysis. Analysis of variance (ANOVA) was used to analyze the data. The results are consistent with our prediction that the different manufacturing industry types display different levels of GSCM implementation and outcomes. We specifically found that the electrical/electronic industry has relatively higher levels of GSCM implementation and achieves better performance outcomes than the other three manufacturer types. Implications of the results are discussed and suggestions for further research on the implementation of GSCM are offered.

  1. Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

    PubMed

    Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

    2012-04-01

    Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution.

  2. Herbal Medicine Offered as an Initiative Therapeutic Option for the Management of Hepatocellular Carcinoma.

    PubMed

    Chen, Shao-Ru; Qiu, Hong-Cong; Hu, Yang; Wang, Ying; Wang, Yi-Tao

    2016-06-01

    Hepatocellular carcinoma (HCC) is a common malignant cancer and is the third leading cause of death worldwide. Effective treatment of this disease is limited by the complicated molecular mechanism underlying HCC pathogenesis. Thus, therapeutic options for HCC management are urgently needed. Targeting the Wnt/β-catenin, Hedgehog, Notch, and Hippo-YAP signaling pathways in cancer stem cell development has been extensively investigated as an alternative treatment. Herbal medicine has emerged as an initiative therapeutic option for HCC management because of its multi-level, multi-target, and coordinated intervention effects. In this article, we summarized the recent progress and clinical benefits of targeting the above mentioned signaling pathways and using natural products such as herbal medicine formulas to treat HCC. Proving the clinical success of herbal medicine is expected to deepen the knowledge on herbal medicine efficiency and hasten the adoption of new therapies. Copyright © 2016 John Wiley & Sons, Ltd.

  3. A science and technology initiative within the office of civilian radioactive waste management

    USGS Publications Warehouse

    Budnitz, R.J.; Kiess, T.E.; Peters, M.; Duncan, D.

    2003-01-01

    In 2002, by following a national decision-making process that had been specified in the 1982 Nuclear Waste Policy Act, Yucca Mountain (YM) was designated as the site for the nation's geologic repository for commercial spent nuclear fuel (SNF). The U.S. Department of Energy's (DOE's) Office of Civilian Radioactive Waste Management (OCRWM) must now obtain regulatory approval to construct and operate a repository there, and to develop transportation and infrastructure needed to support operations. The OCRWM has also recently begun a separate Science and Technology (S&T) initiative, whose purposes, beginnings, current projects, and future plans are described here.

  4. Development of the BUILDER Engineered Management System for Building Maintenance: Initial Decision and Concept Report

    DTIC Science & Technology

    1990-07-01

    Laboratory AD- A225 950 Development of the BUILDER Engineered Management System for Building Maintenance: Initial Decision and Concept Report DT C by ELECTE...identification of the MDR value and the subcomponent condition ratings, the computer assigns a building component Condition Rating ( CR ) based on the...8217 CR = 3 F2.2 WALLS $ 0 CR = 4 F2.3 PAINTING S 9000 CR = 3 F2.4 DOORS/HARDWARE S 1000 CR = 3 F2.5 WINDOWS $ 0 CR = 4 F2.6 ROOF S 100000 CR = 2 F2.7 SITE

  5. Initial manifestation of primary hyperoxaluria type I in adults-- recognition, diagnosis, and management.

    PubMed Central

    Kuiper, J J

    1996-01-01

    Primary hyperoxaluria type I may initially manifest as urolithiasis, renal insufficiency, or symptoms of systemic oxalosis. This hereditary disorder was fatal until effective therapies evolved during the past two decades. Difficulty in recognizing and diagnosing this disorder in adults is illustrated in a report of a patient eventually restored to good health by high-flux dialysis and combined renal and hepatic transplantation. I explore the molecular processes of the genetic defect and discuss clinical indicators of primary hyperoxaluria type I, manifestations of oxalosis, the pathogenesis of chronic oxalate nephropathy, and the diagnosis and management of this disease. Images Figure 2. Figure 3. Figure 4. PMID:8779202

  6. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    PubMed Central

    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack

    2016-01-01

    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  7. MRI compared to conventional diagnostic work-up in the detection and evaluation of invasive lobular carcinoma of the breast: a review of existing literature

    PubMed Central

    Hoogeveen, Yvonne L.; Blickman, Johan G.; Boetes, Carla

    2007-01-01

    Purpose The clinical diagnosis and management of invasive lobular carcinoma (ILC) of the breast presents difficulties. Magnetic resonance imaging (MRI) has been proposed as the imaging modality of choice for the evaluation of ILC. Small studies addressing different aspects of MRI in ILC have been presented but no large series to date. To address the usefulness of MRI in the work-up of ILC, we performed a review of the currently published literature. Materials and methods We performed a literature search using the query “lobular AND (MRI OR MR OR MRT OR magnetic)” in the Cochrane library, PubMed and scholar.google.com, to retrieve all articles that dealt with the use of MRI in patients with ILC. We addressed sensitivity, morphologic appearance, correlation with pathology, detection of additional lesions, and impact of MRI on surgery as different endpoints. Whenever possible we performed meta-analysis of the pooled data. Results Sensitivity is 93.3% and equal to overall sensitivity of MRI for malignancy in the breast. Morphologic appearance is highly heterogeneous and probably heavily influenced by interreader variability. Correlation with pathology ranges from 0.81 to 0.97; overestimation of lesion size occurs but is rare. In 32% of patients, additional ipsilateral lesions are detected and in 7% contralateral lesions are only detected by MRI. Consequently, MRI induces change in surgical management in 28.3% of cases. Conclusion This analysis indicates MRI to be valuable in the work-up of ILC. It provides additional knowledge that cannot be obtained by conventional imaging modalities which can be helpful in patient treatment. PMID:18043894

  8. CIOMS and ICH initiatives in pharmacovigilance and risk management: overview and implications.

    PubMed

    Tsintis, Panos; La Mache, Edith

    2004-01-01

    In this article we review the current initiatives by the Council for International Organizations of Medical Sciences (CIOMS) and the International Conference on Harmonisation (ICH) on pharmacovigilance planning that are due for general release during 2004. These initiatives could form the basis for applying concepts of risk management to medicines throughout their life cycle, from preclinical and clinical development to marketed use. The CIOMS VI Working Group (with 28 senior scientists worldwide from drug regulatory authorities and pharmaceutical companies) is currently developing scientific guidance that relates to clinical trials for medicines during development. It recommends a developmental pharmacovigilance concept - a 'living' concept that would start early in drug development supporting the science and ethics of research leading up to licensing (marketing authorisation) and continuing to post-authorisation (postmarketing) pharmacovigilance. This approach is seen as complementary to current ICH initiatives called 'Pharmacovigilance Planning'. ICH will introduce two concepts in pharmacovigilance management of medicinal products: the 'Pharmacovigilance Specification' and the 'Pharmacovigilance Plan'. The 'Pharmacovigilance Specification' will summarise important knowns and unknowns about the medicine. It will include safety risks identified at the licensing stage, potential risks and any key missing information. These elements will be essential to the formulation of pharmacovigilance plans. Dialogue and common understanding between regulators and the pharmaceutical industry will be a key factor for developing pharmacovigilance plans during the life cycle of medicines. Appropriate interaction with health professionals and patients should also be planned for the future as regulatory systems become more transparent. Where no significant issues are apparent at the licensing (marketing authorisation) stage, routine pharmacovigilance practices will be followed

  9. The Data Management System for the Shipboard Automated Meteorological and Oceanographic System (SAMOS) Initiative

    NASA Astrophysics Data System (ADS)

    Smith, S. R.; Arko, R. A.; Bourassa, M. A.; Hu, J.; McDonald, M.; Rettig, J.; Rolph, J.

    2009-12-01

    The data assembly center (DAC) for the SAMOS initiative has developed and implemented an automated data management system that collects, formats, quality controls, distributes, and archives near real-time surface marine data from research vessels. A SAMOS is a computerized data logging system that continuously records navigational (ship’s position, course, speed, and heading), meteorological (winds, air temperature, pressure, moisture, rainfall, and radiation), and near-surface oceanographic (sea temperature, salinity, conductivity, florescence) parameters while the vessel is at sea. The SAMOS initiative relies on the high-quality instrumentation purchased and deployed by the research vessel operators and does not provide instrumentation to the vessels. Currently, the SAMOS initiative receives measurements recorded at 1-min intervals and derived from higher frequency samples (on the order of 1 Hz). As of 2009, 21 research vessels provide routine SAMOS observations to the DAC. The data management system automatically tracks progress of the daily data acquisition and quality processing, stores metadata on instrumentation and ships, and provides data monitoring capability via a user-friendly web interface. An SQL database stores essential parameters to support tracking, data quality control, and version control for each file throughout the process. Presently, SAMOS data are acquired directly from research vessels at sea via a daily email transfer protocol. The steps of this NOAA funded protocol will be described along with lessons learned through the development process. A new DAC initiative, funded by NSF, to develop a 2nd SAMOS data acquisition protocol, via collaboration with the Rolling deck to Repository (R2R) project, will be outlined. The new protocol is envisioned to include transmission of the higher frequency meteorological and surface oceanic samples from participating vessels to real-time servers at R2R. The SAMOS DAC will access these samples for data

  10. Diagnostic Work-up and Follow-up in Children with Tall Stature: A Simplified Algorithm for Clinical Practice

    PubMed Central

    Stalman, Susanne E.; Pons, Anke; Wit, Jan M.; Kamp, Gerdine A.; Plötz, Frans B.

    2015-01-01

    Objective: No evidence-based guideline has been published about optimal referral criteria and diagnostic work-up for tall stature in children. The aim of our study was to describe auxological and clinical characteristics of a cohort of children referred for tall stature, to identify potential candidates for adult height reduction, and to use these observations for developing a simple algorithm for diagnostic work-up and follow-up in clinical practice. Methods: Data regarding family and medical history, auxological measurements, bone age development, physical examination, additional diagnostic work-up, and final diagnosis were collected from all children referred for tall stature, irrespective of their actual height standard deviation score (HSDS). Predicted adult height (PAH) was calculated in children above 10 years. Characteristics of patients with an indication for adult height reduction were determined. Results: Hundred thirty-two children (43 boys) with a mean ± SD age of 10.9±3.2 (range 0.5-16.9) years were included in the study. Fifty percent of the referred children had an HSDS ≤2.0 (n=66). Two pathological cases (1.5%) were found (HSDS 2.3 and 0.9). Tall children without pathology were diagnosed as idiopathic tall, further classified as familial tall stature (80%), constitutional advancement of growth (5%), or unexplained non-familial tall stature (15%). Of the 74 children in whom PAH was calculated, epiphysiodesis was considered in six (8%) and performed in four (5%) patients. Conclusion: The incidence of pathology was very low in children referred for tall stature, and few children were potential candidates for adult height reduction. We propose a simple diagnostic algorithm for clinical practice. PMID:26777036

  11. NORTH AMERICA'S SOUND MANAGEMENT OF CHEMICALS INITIATIVE: APPLICATION OF SELECTION CRITERIA TO DIOXINS/FURANS, HEXACHLOROBENZENE, AND HEXACHLOROCYCLOHEXANES

    EPA Science Inventory

    In October 1997, the North American Commission for Environmental Cooperation finalized its process for identifying candidate substances for regional action under the Sound Management of Chemicals Initiative. Regional action plans will be prepared if substantive risk to human he...

  12. Factors predicting Behavior Management Problems during Initial Dental Examination in Children Aged 2 to 8 Years

    PubMed Central

    Kumar, Dipanshu; Anand, Ashish; Mittal, Vipula; Singh, Aparna; Aggarwal, Nidhi

    2017-01-01

    Aim The aim of the present study was to identify the various background variables and its influence on behavior management problems (BMP) in children. Materials and methods The study included 165 children aged 2 to 8 years. During the initial dental visit, an experienced operator obtained each child’s background variables from accompanying guardians using a standardized questionnaire. Children’s dental behavior was rated by Frankel behavior rating scale. The behavior was then analyzed in relation to the answers of the questionnaire, and a logistic regression model was used to determine the power of the variables, separately or combined, to predict BMP. Results The logistic regression analysis considering differences in background variables between children with negative or positive behavior. Four variables turned out to be as predictors: Age, the guardian’s expectation of the child’s behavior at the dental examination, the child’s anxiety when meeting unfamiliar people, and the presence and absence of toothache. Conclusion The present study concluded that by means of simple questionnaire BMP in children may be expected if one of these attributes is found. Clinical significance Information on the origin of dental fear and uncooperative behavior in a child patient prior to treatment process may help the pediatric dentist plan appropriate behavior management and treatment strategy. How to cite this article Sharma A, Kumar D, Anand A, Mittal V, Singh A, Aggarwal N. Factors predicting Behavior Management Problems during Initial Dental Examination in Children Aged 2 to 8 Years. Int J Clin Pediatr Dent 2017;10(1):5-9. PMID:28377646

  13. 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

  14. 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.

  15. Health Sector Initiatives for Disaster Risk Management in Ethiopia: A Narrative Review

    PubMed Central

    Tadesse, Luche; Ardalan, Ali

    2014-01-01

    Background: Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector. Methods: Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to. Results: Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system. Conclusions: Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster

  16. Research Initiatives and Preliminary Results In Automation Design In Airspace Management in Free Flight

    NASA Technical Reports Server (NTRS)

    Corker, Kevin; Lebacqz, J. Victor (Technical Monitor)

    1997-01-01

    The NASA and the FAA have entered into a joint venture to explore, define, design and implement a new airspace management operating concept. The fundamental premise of that concept is that technologies and procedures need to be developed for flight deck and ground operations to improve the efficiency, the predictability, the flexibility and the safety of airspace management and operations. To that end NASA Ames has undertaken an initial development and exploration of "key concepts" in the free flight airspace management technology development. Human Factors issues in automation aiding design, coupled aiding systems between air and ground, communication protocols in distributed decision making, and analytic techniques for definition of concepts of airspace density and operator cognitive load have been undertaken. This paper reports the progress of these efforts, which are not intended to definitively solve the many evolving issues of design for future ATM systems, but to provide preliminary results to chart the parameters of performance and the topology of the analytic effort required. The preliminary research in provision of cockpit display of traffic information, dynamic density definition, distributed decision making, situation awareness models and human performance models is discussed as they focus on the theme of "design requirements".

  17. Laboratory information management system for membrane protein structure initiative--from gene to crystal.

    PubMed

    Troshin, Petr V; Morris, Chris; Prince, Stephen M; Papiz, Miroslav Z

    2008-12-01

    Membrane Protein Structure Initiative (MPSI) exploits laboratory competencies to work collaboratively and distribute work among the different sites. This is possible as protein structure determination requires a series of steps, starting with target selection, through cloning, expression, purification, crystallization and finally structure determination. Distributed sites create a unique set of challenges for integrating and passing on information on the progress of targets. This role is played by the Protein Information Management System (PIMS), which is a laboratory information management system (LIMS), serving as a hub for MPSI, allowing collaborative structural proteomics to be carried out in a distributed fashion. It holds key information on the progress of cloning, expression, purification and crystallization of proteins. PIMS is employed to track the status of protein targets and to manage constructs, primers, experiments, protocols, sample locations and their detailed histories: thus playing a key role in MPSI data exchange. It also serves as the centre of a federation of interoperable information resources such as local laboratory information systems and international archival resources, like PDB or NCBI. During the challenging task of PIMS integration, within the MPSI, we discovered a number of prerequisites for successful PIMS integration. In this article we share our experiences and provide invaluable insights into the process of LIMS adaptation. This information should be of interest to partners who are thinking about using LIMS as a data centre for their collaborative efforts.

  18. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas.

    PubMed

    Bilotta, Federico; Stazi, Elisabetta; Titi, Luca; Lalli, Diana; Delfini, Roberto; Santoro, Antonio; Rosa, Giovanni

    2014-06-01

    Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey < 3). Postoperative evaluation was scheduled at early (within 21 days) and long-term follow-up (3-6 months). Twenty consecutive patients were prospectively recruited. Preoperative language testings were normal in 9 patients (45%), showed mild to moderate language deficit in 8 (40%) and severe language deficit or aphasic disorders in 3 (15%). Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.

  19. 77 FR 74224 - OSHA Data Initiative (ODI); Extension of the Office of Management and Budget's (OMB) Approval of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-13

    ... Occupational Safety and Health Administration OSHA Data Initiative (ODI); Extension of the Office of Management... requirements for OSHA's Data Initiative program. DATES: Comments must be submitted (postmarked, sent, or... injury and illness data and information on the number of workers employed and the number of hours...

  20. 78 FR 34372 - TGP Energy Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission TGP Energy Management, LLC; Supplemental Notice That Initial Market-Based... above-referenced proceeding, of TGP Energy Management, LLC's application for market-based rate...

  1. 75 FR 74038 - Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-30

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Twin Eagle Resource Management, LLC; Supplemental Notice That Initial Market... supplemental notice in the above-referenced proceeding, of Twin Eagle Resource Management, LLC's ]...

  2. 76 FR 65718 - Tenaska Power Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing Includes...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-24

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Tenaska Power Management, LLC; Supplemental Notice That Initial Market-Based... above-referenced proceeding of Tenaska Power Management, LLC's application for market-based...

  3. 75 FR 25234 - EquiPower Resources Management, LLC; Supplemental Notice That Initial Market-Based Rate Filing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-07

    ... Energy Regulatory Commission EquiPower Resources Management, LLC; Supplemental Notice That Initial Market... supplemental notice in the above-referenced proceeding of EquiPower Resources Management, LLC's application for market-based rate authority, with an accompanying rate ] tariff, noting that such application includes...

  4. Impact of Initial Central Venous Pressure on Outcomes of Conservative versus Liberal Fluid Management in Acute Respiratory Distress Syndrome

    PubMed Central

    Semler, Matthew W.; Wheeler, Arthur P.; Thompson, B. Taylor; Bernard, Gordon R.; Wiedemann, Herbert P.; Rice, Todd W.

    2016-01-01

    Objective In acute respiratory distress syndrome (ARDS), conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients’ initial central venous pressure (CVP). We hypothesized initial CVP would modify the effect of fluid management on outcomes. Design Retrospective analysis of the Fluid and Catheter Treatment Trial, a multicenter randomized trial comparing conservative to liberal fluid management in ARDS. We examined the relationship between initial CVP, fluid strategy, and 60-day mortality in univariate and multivariable analysis. Setting Twenty acute care hospitals. Patients Nine hundred and thirty-four ventilated ARDS patients with a CVP available at enrollment, 609 without baseline shock (for whom fluid balance was managed by study protocol). Interventions None. Measurements and Main Results Among patients without baseline shock, those with initial CVP > 8 mmHg experienced similar mortality with conservative and liberal fluid management (18% versus 18%, p=0.928), whereas those with CVP ≤8 mmHg experienced lower mortality with a conservative strategy (17% versus 36%, p=0.005). Multivariable analysis demonstrated an interaction between initial CVP and the effect of fluid strategy on mortality (p=0.031). At higher initial CVPs, the difference in treatment between arms was predominantly furosemide administration, which was not associated with mortality (p=0.122). At lower initial CVPs, the difference between arms was predominantly fluid administration, with additional fluid associated with increased mortality (p=0.013). Conclusions Conservative fluid management decreases mortality for ARDS patients with a low initial central venous pressure. In this population, the administration of intravenous fluids appears to increase mortality. PMID:26741580

  5. Environmental Management Technology Leveraging Initiative. Topical report, October 1, 1995--September 30, 1996

    SciTech Connect

    1996-12-31

    The ``Environmental Management Technology Leveraging Initiative,`` a cooperative agreement between the Global Environment and Technology Foundation and the Department of Energy-Morgantown Energy Technology Center, has completed its second year. This program, referred to as the Global Environmental Technology Enterprise (GETE) is an experiment to bring together the public and private sectors to identify, formulate, promote and refine methods to develop more cost-effective clean-up treatments. Working closely with Department of Energy officials, National Laboratory representatives, business people, academia, community groups, and other stakeholders, this program attempts to commercialize innovative, DOE-developed technologies. The methodology to do so incorporates three elements: business assistance, information, and outreach. A key advance this year was the development of a commercialization guidance document which can be used to diagnose the commercialization level and needs for innovative technologies.

  6. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    PubMed

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  7. Project W-211, initial tank retrieval systems, retrieval control system software configuration management plan

    SciTech Connect

    RIECK, C.A.

    1999-02-23

    This Software Configuration Management Plan (SCMP) provides the instructions for change control of the W-211 Project, Retrieval Control System (RCS) software after initial approval/release but prior to the transfer of custody to the waste tank operations contractor. This plan applies to the W-211 system software developed by the project, consisting of the computer human-machine interface (HMI) and programmable logic controller (PLC) software source and executable code, for production use by the waste tank operations contractor. The plan encompasses that portion of the W-211 RCS software represented on project-specific AUTOCAD drawings that are released as part of the C1 definitive design package (these drawings are identified on the drawing list associated with each C-1 package), and the associated software code. Implementation of the plan is required for formal acceptance testing and production release. The software configuration management plan does not apply to reports and data generated by the software except where specifically identified. Control of information produced by the software once it has been transferred for operation is the responsibility of the receiving organization.

  8. Suicide risk of your client: initial identification and management for the allied health professional.

    PubMed

    Donley, Euan

    2013-01-01

    Allied health professionals treat clients in varying degrees of distress with complex needs in a wide range of services. A client could be experiencing a chronic or life-changing illness, have a trauma from a critical event, have preexisting mental illness, be dealing with significant health or personal loss, be using substances, or experiencing a depression. At some point an allied health professional will treat a client who may have a diagnosed depression, appear depressed, or have thoughts of suicide. Mental health of clients is everyone's responsibility, especially those working in health. This article aims to increase allied health professionals' understanding of some risk factors and clinical features a client at risk may have and will discuss some initial options of management. It is recommended the allied health professional and organisation be aware of risk factors for suicide but not rely too heavily on risk screening. The worker should have basic skills in recognising poor mood and have a list of useful questions to ask in a crisis. Know your local crisis and supportive mental health services, create links with them, have ongoing professional education and protocols for managing clients at-risk, and be acutely aware of your role and limitations.

  9. Common Ground: An Investigation of Environmental Management Alcohol Prevention Initiatives in a College Community*

    PubMed Central

    Wood, Mark D.; DeJong, William; Fairlie, Anne M.; Lawson, Doreen; Lavigne, Andrea M.; Cohen, Fran

    2009-01-01

    Objective: This article presents an evaluation of Common Ground, a media campaign-supported prevention program featuring increased enforcement, decreased alcohol access, and other environmental management initiatives targeting college student drinking. Method: Phase 1 of the media campaign addressed student resistance to environmentally focused prevention by reporting majority student support for alcohol policy and enforcement initiatives. Phase 2 informed students about state laws, university policies, and environmental initiatives. We conducted student telephone surveys, with samples stratified by gender and year in school, for 4 consecutive years at the intervention campus and 3 years at a comparison campus. We did a series of one-way between-subjects analyses of variance and analyses of covariance, followed by tests of linear trend and planned comparisons. Targeted outcomes included perceptions of enforcement and alcohol availability, alcohol use, and alcohol-impaired driving. We examined archived police reports for student incidents, primarily those resulting from loud parties. Results: There were increases at the intervention campus in students' awareness of formal alcohol-control efforts and perceptions of the alcohol environment, likelihood of apprehension for underage drinking, consequences for alcohol-impaired driving, and responsible alcohol service practices. There were decreases in the perceived likelihood of other students' negative behavior at off-campus parties. Police-reported incidents decreased over time; however, perceived consequences for off-campus parties decreased. No changes were observed for difficulty finding an off-campus party, self-reported alcohol use, or alcohol-impaired driving. Conclusions: The intervention successfully altered perceptions of alcohol enforcement, alcohol access, and the local alcohol environment. This study provides important preliminary information to researchers and practitioners engaged in collaborative

  10. Children with developmental language delay at 24 months of age: results of a diagnostic work-up.

    PubMed

    Buschmann, Anke; Jooss, Bettina; Rupp, André; Dockter, Sonja; Blaschtikowitz, Heike; Heggen, Iris; Pietz, Joachim

    2008-03-01

    The aim of this study was to evaluate if a diagnostic work-up should be recommended for 2-year-old children with developmental language delay (LD), or if the widely chosen 'wait and see' strategy is adequate. Children with LD were identified in paediatric practices during routine developmental check-ups using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). A standardized German instrument and the Netherlands version of Bayley Scales of Infant Development (2nd ed.) were used to assess language ability and nonverbal cognitive development respectively in 100 children with LD (65 males, 35 females; mean age 24.7 mo [SD 0.9]) and a control group of 53 children with normal language development (33 males, 20 females; mean age 24.6 mo [SD 0.8]). Neurological and audiometric testing were also performed. Sixty-one per cent of the LD group had specific expressive LD and 17% specific receptive-expressive LD. In 22%, LD was associated with other neurodevelopmental problems, 6% showed significant deficits in nonverbal cognitive abilities, and in 12%, nonverbal cognitive abilities were borderline. Four per cent fulfilled the criteria of childhood autism. LD at 2 years proved to represent a sensitive marker for different developmental problems. Adequate early intervention requires a clear distinction between specific expressive or receptive-expressive LD and LD associated with other neurodevelopmental problems. Though catch-up development is to be expected in a substantial proportion of 'late talkers', our data demonstrate that a general 'wait and see' approach is not justified in young children with LD. A proposal for a rational diagnostic work-up is presented.

  11. Knowledge Management Initiatives Used to Maintain Regulatory Expertise in Transportation and Storage of Radioactive Materials - 12177

    SciTech Connect

    Lindsay, Haile; Garcia-Santos, Norma; Saverot, Pierre; Day, Neil; Gambone Rodriguez, Kimberly; Cruz, Luis; Sotomayor-Rivera, Alexis; Vechioli, Lucieann; Vera, John; Pstrak, David

    2012-07-01

    The U.S. Nuclear Regulatory Commission (NRC) was established in 1974 with the mission to license and regulate the civilian use of nuclear materials for commercial, industrial, academic, and medical uses in order to protect public health and safety, and the environment, and promote the common defense and security. Currently, approximately half (∼49%) of the workforce at the NRC has been with the Agency for less than six years. As part of the Agency's mission, the NRC has partial responsibility for the oversight of the transportation and storage of radioactive materials. The NRC has experienced a significant level of expertise leaving the Agency due to staff attrition. Factors that contribute to this attrition include retirement of the experienced nuclear workforce and mobility of staff within or outside the Agency. Several knowledge management (KM) initiatives have been implemented within the Agency, with one of them including the formation of a Division of Spent Fuel Storage and Transportation (SFST) KM team. The team, which was formed in the fall of 2008, facilitates capturing, transferring, and documenting regulatory knowledge for staff to effectively perform their safety oversight of transportation and storage of radioactive materials, regulated under Title 10 of the Code of Federal Regulations (10 CFR) Part 71 and Part 72. In terms of KM, the SFST goal is to share critical information among the staff to reduce the impact from staff's mobility and attrition. KM strategies in place to achieve this goal are: (1) development of communities of practice (CoP) (SFST Qualification Journal and the Packaging and Storing Radioactive Material) in the on-line NRC Knowledge Center (NKC); (2) implementation of a SFST seminar program where the seminars are recorded and placed in the Agency's repository, Agency-wide Documents Access and Management System (ADAMS); (3) meeting of technical discipline group programs to share knowledge within specialty areas; (4) development of

  12. The Zymark BenchMate™. A compact, fully-automated solution-phase reaction work-up facility for multiple parallel synthesis

    PubMed Central

    Hamlin, Gordon A.

    2000-01-01

    The rapid growth of multiple parallel synthesis in our laboratories has created a demand for a robust, easily accessed automated system for solution-phase reaction work-up, since the manual work-up of large numbers of small-scale reactions is both time-consuming and tedious, and is a rate limiting step in the generation of large numbers of compounds for test. Work-up in chemical organic synthesis consists of a series of post-reaction operations designed using differential chemical properties to remove excess reagent or starting material, reagent products and, where possible reaction by-products. Careful consideration of post-reaction operations as a clean-up step can obviate the requirement for purification. Generally, work-up can be resolved into four operations: filtration, solvent addition (dilution, trituration), washing and separation (partition) and it is the selection and ordering of these four basic operations that constitutes a chemical work-up. Following the proven success of centralized Zymate robotic systems in the compilation, execution and work-up of complex reaction sequences, a centralized chemical work-up service has been in operation for over 12 months. It now seemed prudent that the needs of multiple parallel synthesis would be better served by the development of a compact, automated system, capable of operating in a standard chemistry laboratory fume-hood. A Zymark BenchMate platform has been configured to perform the four basic operations of chemical solution work-up. A custom-built filtration station, incorporating an integrated tipping facility for the sample tube has also been developed. Compilation of each work-up is through a set of Visual Basic procedure screens, each dedicated to a particular work-up scenario. Methods are compiled at the chemist's own PC and transferred to the BenchMate via a diskette. PMID:18924692

  13. The Gulf of Mexico Research Initiative: Managing a Multidisciplinary Data Explosion

    NASA Astrophysics Data System (ADS)

    Howard, M. K.; Gibeaut, J. C.; Reed, D.

    2011-12-01

    On April 20, 2010 the Deepwater Horizon drilling unit located in the northeastern Gulf of Mexico, experienced a catastrophic wellhead blowout. Roughly 5 billion barrels of oil and 1 million U.S. gallons of dispersant were released near the wellhead over the next three months. Within weeks of the blowout, BP announced the Gulf of Mexico Research Initiative (GRI) and pledged 50M/yr over 10 years for independent scientific research on the spill's impact on the ecosystem. Two months after the blowout three institutions were awarded a total of 25M in fast-track grants (Louisiana State University, Northern Gulf Institute, and Florida Institute of Oceanography). Soon after the Alabama Marine Environmental Sciences Consortium and the National Institutes of Health were awarded 5M and 10M, respectively. These five institutions began to generate data almost immediately. First year grants funded 100's of researchers from nearly 100 research units. Their activities included numerical modeling, field data collection, and laboratory experiments. Measured parameters included those associated with chemical analyses of oil, gas, and dispersants, studies of bacteria, plants and animals -from phytoplankton to marsh grasses, from zooplankton to cetaceans. Studies were conducted from estuaries to the deep Gulf, from atmosphere to sediments. Parameters from physical oceanography, marine meteorology, and biogeochemistry were measured in abundance. Additionally, impact studies on human mental, physical health and businesses were made. Proposals for years 2-4 of the program were to be awarded in August 2011 supporting 4-8 research consortia. Consortia may have up to 20 named researchers. In aggregate, these studies yielded a multidisciplinary data explosion. Following the fast-track awards the GRI Administrative Unit (AU) was established and a data management activity initiated. That activity became the GRI Information and Data Cooperative (GRIIDC). "Cooperative" emphasizes the

  14. The Western Energy Corridor Initiative: Unconventional Fuel Development Issues, Impacts, and Management Assessment

    NASA Astrophysics Data System (ADS)

    Wolfsberg, A.; Hagood, M.; Pasqualini, D.; Wood, T.; Wilson, C.; Witkowski, M.; Levitt, D.; Pawar, R.; Keating, G.; Ziock, H.

    2008-12-01

    The United States is increasingly dependent on imported oil and gas; commodities for which other nations are competing and for which future supply may be inadequate to support our transportation fuel needs. Therefore, a renewed interest in 'harder-to-get' unconventional fuels has emerged in both industry and government with directed focus on world class hydrocarbon resources within a corridor extending from Canada southward through the Rocky Mountain States. Within this Western Energy Corridor, co-located with significant conventional hydrocarbon and renewable energy resources, lie some of the world's richest unconventional hydrocarbon resources in oil shales, oil sands and coal for coal-to-liquid conversion. However, development of these resources poses substantial environmental concerns as well as increasing competition for limited resources of water and habitat. With large-scale energy development in the predominantly rural region, local communities, infrastructures, and economies will face increasing demands for roads, electricity, law enforcement, labor, and other support services. The Western Energy Corridor Initiative (WECI) seeks to develop an integrated assessment of the impacts of unconventional fuel development, the interrelationships of planned energy developments in different basins, and the resultant demands placed on the region. This initial WECI study focuses on two of the most important current issues for industry, regulators, and stakeholders -- the assessment of carbon and water resources issues, impacts, and management strategies. Through scenario analyses using coupled systems and process level models, this study investigates the viability of integrated development of multiple energy resources in a carbon neutral and environmentally acceptable manner, and the interrelationships of various energy resource development plans. The modeling framework is designed to extend to include infrastructure, employment, training, fiscal and economic demands

  15. Why don’t families initiate treatment? A qualitative multicentre study investigating parents’ reasons for declining paediatric weight management

    PubMed Central

    Perez, Arnaldo; Holt, Nicholas; Gokiert, Rebecca; Chanoine, Jean-Pierre; Legault, Laurent; Morrison, Katherine; Sharma, Arya; Ball, Geoff

    2015-01-01

    BACKGROUND: Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. OBJECTIVE: To understand parents’ reasons for declining tertiary-level health services for paediatric weight management. METHOD: Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents’ responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. RESULTS: Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents’ reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children’s lack of motivation); and situational factors (eg, weather). CONCLUSION: Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents’ intention to initiate treatment and address reasons for noninitiation that are within their control. PMID:26038633

  16. Extending stakeholder theory to promote resource management initiatives to key stakeholders: a case study of water transfers in Alberta, Canada.

    PubMed

    Lafreniere, Katherine C; Deshpande, Sameer; Bjornlund, Henning; Hunter, M Gordon

    2013-11-15

    Many attempts to implement resource management initiatives in Canadian and international communities have been resisted by stakeholders despite inclusion of their representatives in the decision-making process. Managers' failure to understand stakeholders' perspectives when proposing initiatives is a potential cause of this resistance. Our study uses marketing thought to enhance stakeholder theory by bringing in an audience-centric perspective. We attempt to understand how stakeholders perceive their interests in an organization and consequently decide how to influence that organization. By doing so, we investigate whether a disconnect exists between the perceptions of managers and those of stakeholders. Natural resource managers can utilize this knowledge to garner stakeholder support for the organization and its activities. We support this claim with findings from a water transfer plebiscite held in the Canadian province of Alberta. Sixteen personal interviews employing narrative inquiry were conducted to document voters' (i.e., irrigators') interpretations.

  17. Global Threat Reduction Initiative Fuel Thermo-Physical Characterization Project: Sample Management Plan

    SciTech Connect

    Casella, Amanda J.; Pereira, Mario M.; Steen, Franciska H.

    2013-01-01

    This sample management plan provides guidelines for sectioning, preparation, acceptance criteria, analytical path, and end-of-life disposal for the fuel element segments utilized in the Global Threat Reduction Initiative (GTRI), Fuel Thermo-Physical Characterization Project. The Fuel Thermo-Physical Characterization Project is tasked with analysis of irradiated Low Enriched Uranium (LEU) Molybdenum (U-Mo) fuel element samples to support the GTRI conversion program. Sample analysis may include optical microscopy (OM), scanning electron microscopy (SEM) fuel-surface interface analysis, gas pycnometry (density) measurements, laser flash analysis (LFA), differential scanning calorimetry (DSC), thermogravimetry and differential thermal analysis with mass spectroscopy (TG /DTA-MS), Inductively Coupled Plasma Spectrophotometry (ICP), alpha spectroscopy, and Thermal Ionization Mass Spectroscopy (TIMS). The project will utilize existing Radiochemical Processing Laboratory (RPL) operating, technical, and administrative procedures for sample receipt, processing, and analyses. Test instructions (TIs), which are documents used to provide specific details regarding the implementation of an existing RPL approved technical or operational procedure, will also be used to communicate to staff project specific parameters requested by the Principal Investigator (PI). TIs will be developed, reviewed, and issued in accordance with the latest revision of the RPL-PLN-700, RPL Operations Plan. Additionally, the PI must approve all project test instructions and red-line changes to test instructions.

  18. Antacids in the initial management of metallic zinc ingestion in dogs.

    PubMed

    van der Merwe, D; Tawde, S

    2009-04-01

    Zinc poisoning in dogs, following ingestion of post-1982 U.S. one cent coins is an increasingly common toxicological syndrome causing gastrointestinal abnormalities, hemolytic anemia, pancreatitis and renal failure. Thermodynamic laws predict that the rate of the chemical reaction between HCl and metallic zinc, which releases absorbable zinc anions, is dependent on pH. The significance of the relation between pH and dissolution is, however, apparently contradicted by the fact that recent veterinary toxicology texts are silent on the use of antacids in the early management of zinc ingestion in dogs. A series of experiments were conducted to test the hypotheses that the degree to which zinc dissolution is pH dependent is likely to be of clinical importance and that the use of antacids will be of benefit in preventing zinc poisoning in dogs that had ingested metallic zinc. Zinc dissolution was strongly dependent on pH in an exponential manner, indicating that clinically achievable upward adjustment of gastric pH using antacids is likely to have significant effects on the rate of zinc absorption in dogs. These data clearly support the use of antacids during the initial treatment of metallic zinc ingestion in dogs.

  19. Monozygotic twins with fetal akinesia: the importance of clinicopathological work-up in predicting risks of recurrence.

    PubMed

    Ho, N C

    2000-10-01

    Fetal Akinesia Deformation Sequence (FADS) or Pena-Shokeir Sequence is a heterogeneous group of disorders in which prolonged decrease or absence of fetal movements results in a series of deformational anomalies: multiple contractures, pulmonary hypoplasia, craniofacial anomalies, polyhydramnios, intrauterine growth retardation, and short umbilical cord. Three sets of monozygotic twins, and their affected sibs, are presented. Detailed pathological work-up established that the two pairs of twins concordant for FADS were of myogenic etiology while the set discordant was due to anoxic-ischemic damage. In the myogenic cases, the rate of recurrence was high, in agreement with the findings from the study on arthrogryposis multiplex congenita of myogenic origin. In light of these findings, in sporadic cases of myogenic FADS, counselling, a recurrence risk of 25% seems prudent. In neurogenic cases associated with primary cerebral malformations, there are cases cited in the literature that are clearly recessive as indicated by affected sibs, but many reported are isolated occurrences. Therefore, in this scenario, giving a recurrent risk of 10-15% appears appropriate. In light of autosomal recessive spinal muscular atrophy and reports of familial FADS due to primary anterior horn cell loss, counselling a 25% risk seems prudent. In cases due to anoxic-ischemic damage, offering a low recurrent risk of 1% appears justified.

  20. The value of the Thomas-plot in the diagnostic work up of anemic patients referred by general practitioners.

    PubMed

    Leers, M P G; Keuren, J F W; Oosterhuis, W P

    2010-12-01

    In patients with inflammatory conditions, diagnosing classic iron deficiency or anemia of chronic disease is challenging. In this study, we assessed the diagnostic value of the so-called Thomas'-plot [soluble transferrin receptor (sTfR)/log ferritin (sTfr/log Ferr) and the reticulocyte hemoglobin equivalent (Ret-HE)] in the anemia work up of patients referred by general practitioners. During July 2008-March 2009, 337 consecutive patients were included because of lowered Hb values. The laboratory results of the first 133 consecutive patients were used to determine the cut-off values for the diagnostic plot. The laboratory results of these patients were assessed and interpreted independently by two investigators, blinded from sTfR/log Ferr and Ret-HE values. The following 204 patients were used to test the plot in practice. In 32% of the first 133 patients, no indication of the cause of anemia could be found. However, when using the diagnostic plot in the following 204 patients, this fraction decreased to 14%. The 'Thomas'-plot is of diagnostic value for distinguishing functional iron deficiency from classic iron deficiency in a patient population referred by general practitioners.

  1. The yield of diagnostic work-up of patients presenting with myalgia, exercise intolerance, or fatigue: A prospective observational study.

    PubMed

    Te Riele, M G E; Schreuder, T H A; van Alfen, N; Bergman, M; Pillen, S; Smits, B W; van der Wilt, G J; Groenewoud, H; Voermans, N C; van Engelen, B G M

    2017-03-01

    Myalgia, fatigue, and exercise intolerance are cause for referral to a neurologist. However, the diagnostic value of history, neurological examination, and ancillary investigations in patients with these symptoms is unknown. This study provides a sound footing for deciding which ancillary investigations should be conducted. A prospective observational study of the diagnostic approach in 187 patients with myalgia, exercise intolerance, or fatigue as their predominant symptom was performed. The primary outcomes were independent contribution of referral letter, history, examination, and ancillary investigations to a myopathy diagnosis. The secondary outcome was diagnostic value of combined ancillary investigations. 27% of patients had a myopathy. Positive family history (OR 3.2), progressive symptoms (OR 2.2), atrophy (OR 9.7), weakness (OR 10.9), and hyporeflexia (OR 4.4) were associated with a myopathy. Positive predictive values for myopathy were calculated for CK (0.32), EMG (0.66), ultrasound (0.47), and muscle biopsy (0.78). All contributed significantly in predicting myopathy. Multivariate analysis yielded a diagnostic algorithm facilitating a more efficient work-up in future patients. CK levels, EMG, ultrasound, and muscle biopsy independently contribute to predicting a myopathy. The diagnostic algorithm shows which combination of ancillary investigations should be employed in different subgroups and when to omit invasive techniques. This algorithm may drastically improve diagnostic efficiency.

  2. Evaluation of the Pilot Program of the Truancy Case Management Partnership Initiative in the District of Columbia, 2011-12

    ERIC Educational Resources Information Center

    Liberman, Akiva; Cahill, Meagan

    2012-01-01

    This evaluation of the Case Management Partnership Initiative (CPMI) found that the program successfully linked high-need families with services designed to prevent truancy. The truancy prevention program, implemented at Anacostia and Ballou High Schools in 2011-2012, links chronically truant ninth graders and their families to social services and…

  3. Prospects for Learning in River Management: Exploring the Initial Implementation of the Water Framework Directive in a Swedish River Basin

    ERIC Educational Resources Information Center

    Lundmark, Carina; Jonsson, Gunnar

    2014-01-01

    This case study explores the initial implementation of the EU Water Framework Directive (WFD) in the Lule River basin, Sweden, examining how and to what extent administrative procedures enable learning through dialogue and stakeholder collaboration. Theorising on adaptive co-management and social learning is used to structure what is to be learnt,…

  4. SDIO (Strategic Defense Initiative Office) Technical Information Management Center Bibliography of unclassified reports: January-December 1985

    SciTech Connect

    Not Available

    1985-12-01

    This bibliography lists to Strategic Defense Initiative Organization Technical Information Management Centers holdings of publications pertaining to such topics as Liquid Droplet Radiators, Relay Lasers, Precision-Guided Munitions, Short-Wavelength Chemical Laser, Electromagnetic Rocket Guns, Space Weapon, and Antimissile Defense Systems.

  5. "Life Could Be a Dream": What US-Based Management PhD Students Desire in an Initial Academic Appointment

    ERIC Educational Resources Information Center

    Flynn, C. Brian; Feild, Hubert S.; Bedeian, Arthur G.

    2011-01-01

    Purpose: The purpose of this paper is to first identify the work- and non-work-related criteria US-based management doctoral students consider important in selecting an initial academic appointment, and second, to explore whether gender and race/ethnicity are associated with the importance attached to these criteria. Design/methodology/approach:…

  6. A Randomized Trial Adapting Contingency Management Targets Based on Initial Abstinence Status of Cocaine-Dependent Patients

    ERIC Educational Resources Information Center

    Petry, Nancy M.; Barry, Danielle; Alessi, Sheila M.; Rounsaville, Bruce J.; Carroll, Kathleen M.

    2012-01-01

    Objective: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive.…

  7. SDIO (Strategic Defense Initiative Office) Technical Information Management Center Bibliography of unclassified books: January-December 1986

    SciTech Connect

    Not Available

    1986-12-01

    This bibliography lists the Strategic Defense Initiative Organization Technical Information Management Center's holdings of publications pertaining to such topics as ballistic missile defense, arms control impact statements, beam weapons, strategic decision making, aluminum-lithium alloys, laser weapons, military space policy, and radar electronic counter countermeasures.

  8. Modeling the effects of irrigation frequencies, initial water and nitrogen on corn yield responses for best management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Competing demands for fresh water resources necessitate adaptation of limited water irrigations in agriculture. In this context, the Crop Water Production Functions (CWPF) used in limited water irrigation management need to integrate the effects of climate, initial soil water content at planting, an...

  9. Hydrologic modification to improve habitat in riverine lakes: Management objectives, experimental approach, and initial conditions

    USGS Publications Warehouse

    Johnson, Barry L.; Barko, John W.; Gerasimov, Yuri; James, William F.; Litvinov, Alexander; Naimo, Teresa J.; Wiener, James G.; Gaugush, Robert F.; Rogala, James T.; Rogers, Sara J.; Schoettger, R.A.

    1996-01-01

    The Finger Lakes habitat-rehabilitation project is intended to improve physical and chemical conditions for fish in six connected back water lakes in Navigation Pool 5 of the upper Missouri River. The primary management objective is to improve water temperature, dissolved oxygen concentration and current velocity during winter for bluegills, Lepomis macrochirus, and black crappies, Pomoxis nigromaculatus, two of the primary sport fishes in the lakes. The lakes will be hydrologically altered by Installing culverts to Introduce controlled flows of oxygenated water into four lakes, and an existing unregulated culvert on a fifth lake will be equipped with a control gate to regulate inflow. These habitat modifications constitute a manipulative field experiment that will compare pre-project (1991 to summer 1993) and post-project (fall 1993 to 1996) conditions in the lakes, including hydrology, chemistry, rooted vegetation, and fish and macroinvertebrate communities. Initial data indicate that the Finger Lakes differ in water chemistry, hydrology, and macrophyte abundance. Macroinvertebrate communities also differed among lakes: species diversity was highest in lakes with dense aquatic macrophytes. The system seems to support a single fish community, although some species concentrated in individual lakes at different times. The introduction of similar flows into five of the lakes will probably reduce the existing physical and chemical differences among lakes. However, our ability to predict the effects of hydrologic modification on fish populations is limited by uncertainties concerning both the interactions of temperature, oxygen and current in winter and the biological responses of primary and secondary producers. Results from this study should provide guidance for similar habitat-rehabilitation projects in large rivers.

  10. The Effects of a State-Wide Conflict Management Initiative in Schools.

    ERIC Educational Resources Information Center

    Tschannen-Moran, Megan

    2001-01-01

    Describes qualitative and quantitative study of the impact of statewide grant program to implement conflict-management education programs in 50 high schools. Reports three approaches to conflict-management education: Curriculum infusion, peer mediation, and special events. Finds significant positive effects of conflict-management programs on…

  11. The Gulf of Mexico Research Initiative Information and Data Cooperative: Multidisciplinary data management from the ground up

    NASA Astrophysics Data System (ADS)

    Showalter, L. M.; Gibeaut, J. C.

    2015-12-01

    As more journals and funding organizations require data to be made available, more and more scientists are being exposed to the world of data science, metadata development, and data standards so they can ensure future funding and publishing success. The Gulf of Mexico Research Initiative Information and Data Cooperative (GRIIDC) is the vehicle by which the Gulf of Mexico Research Initiative (GOMRI) is making all data collected in this program publically available. This varied group of researchers all have different levels of experience with data management standards and protocols, thus GRIIDC has evolved to embrace the cooperative nature of our work and develop a number of tools and training materials to help ensure data managers and researchers in the GoMRI program are submitting high quality data and metadata that will be useful for years to come. GRIIDC began with a group of 8 data managers many of which had only ever managed their own data, who were then expected to manage the data of a large group of geographically distant researchers. As the program continued to evolve these data managers worked with the GRIIDC team to help identify and develop much needed resources for training and communication for themselves and the scientists they represented. This essential cooperation has developed a team of highly motivated scientists, computer programmers and data scientists who are working to ensure a data and information legacy that promotes continual scientific discovery and public awareness of the Gulf of Mexico Ecosystem and beyond.

  12. Race/Ethnicity and the Receipt of Watchful Waiting for the Initial Management of Prostate Cancer

    PubMed Central

    Shavers, Vickie L; Brown, Martin L; Potosky, Arnold L; Klabunde, Carrie N; Davis, WW; Moul, Judd W; Fahey, Angela

    2004-01-01

    INTRODUCTION Several recent studies have noted that African Americans disproportionately receive “watchful waiting” for the initial management of their prostate cancer. To determine whether racial/ethnic differences in the receipt of watchful waiting are explained by differences in clinical presentation and life expectancy at the time of diagnosis, we examined Surveillance, Epidemiology, and End Results (SEER)-Medicare data for men diagnosed with prostate cancer in 1994 to 1996. METHODS Race/ethnicity, comorbidity, stage, grade, age, and expected lifespan and their association with the receipt of watchful waiting were examined in multivariate logistic regression analyses. Race-stratified logistic regression analyses were also used to examine racial/ethnic variation in the association of clinical and demographic factors with the receipt of watchful waiting among African-American, Hispanic, and non-Hispanic white men. RESULTS African-American (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.3 to 1.6) and Hispanic men (OR, 1.3; 95% CI, 1.1 to 1.5) were significantly more likely than non-Hispanic white men to receive watchful waiting in a multivariate model adjusted for age, comorbidity, stage, grade, and life expectancy. Advanced stage and grade, lower life expectancy, older age, and high comorbidity indices were also significantly associated with an increase in the odds of receipt of watchful waiting in multivariate analyses. In general, the association between the receipt of watchful waiting and the clinical characteristics (i.e., stage, grade, and age) were similar for the three racial/ethnic groups. In race-stratified logistic regression analyses, life expectancy was associated with an increase in the odds of receiving watchful waiting but results were statistically significant for whites only. There was also a statistically significant increase in the odds of receiving watchful waiting for African-American and white men with high comorbidity indices but

  13. 40 CFR 63.11584 - What are my initial and continuous compliance management practice requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... condition. (iii) An initial inspection of the internal components of a wet or dry particulate control system... activities in paragraph (a)(2) of this section. (1) Initial vent collection system and particulate control... wet particulate control system, you must verify the presence of water flow to the control...

  14. A Survey of Digital Cultural Heritage Initiatives and Their Sustainability Concerns. Managing Economic Challenges.

    ERIC Educational Resources Information Center

    Zorich, Diane M.

    In September 2002, the Council on Library and Information Re-sources (CLIR) commissioned a survey of North American-based digital cultural heritage initiatives (DCHIs). The purpose of the survey was to identify the scope, financing, organizational structure, and sustainability of DCHIs. To gain a funder's perspective on these initiatives, the…

  15. 78 FR 75238 - Federal Housing Administration (FHA) Risk Management Initiatives: New Manual Underwriting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... URBAN DEVELOPMENT 24 CFR Chapter II RIN 2502-AJ07 Federal Housing Administration (FHA) Risk Management... relationship between compensating factors and ``stretch ratios'' that permit borrowers to exceed the housing... through risk management practices. The lower costs are a gain to FHA. The target of the document is...

  16. Misfit and Match: The Frontline Management Initiative in the Community Services and Health Industry.

    ERIC Educational Resources Information Center

    Roos, Ian; Smith, Chris Selby; Wright, Liz

    The application of frontline management training in the community and health services (CS&H) industry in Victoria, Australia, was examined through interviews with managers of 11 user and 11 provider organizations in the public and private sectors. The study focused on the following topics: (1) the appropriateness of the Frontline Management…

  17. Predictors of Outcomes in Diabetic Foot Osteomyelitis Treated Initially With Conservative (Nonsurgical) Medical Management: A Retrospective Study.

    PubMed

    Zeun, Paul; Gooday, Catherine; Nunney, Ian; Dhatariya, Ketan

    2016-03-01

    The optimal way to manage diabetic foot osteomyelitis remains uncertain, with debate in the literature as to whether it should be managed conservatively (ie, nonsurgically) or surgically. We aimed to identify clinical variables that influence outcomes of nonsurgical management in diabetic foot osteomyelitis. We conducted a retrospective study of consecutive patients with diabetes presenting to a tertiary center between 2007 and 2011 with foot osteomyelitis initially treated with nonsurgical management. Remission was defined as wound healing with no clinical or radiological signs of osteomyelitis at the initial or contiguous sites 12 months after clinical and/or radiological resolution. Nine demographic and clinical variables including osteomyelitis site and presence of foot pulses were analyzed. We identified 100 cases, of which 85 fulfilled the criteria for analysis. After a 12-month follow-up period, 54 (63.5%) had achieved remission with nonsurgical management alone with a median (interquartile range) duration of antibiotic treatment of 10.8 (10.1) weeks. Of these, 14 (26%) were admitted for intravenous antibiotics. The absence of pedal pulses in the affected foot (n = 34) was associated with a significantly longer duration of antibiotic therapy to achieve remission, 8.7 (7.1) versus 15.9 (13.3) weeks (P = .003). Osteomyelitis affecting the metatarsal was more likely to be amputated than other sites of the foot (P = .016). In line with previous data, we have shown that almost two thirds of patients presenting with osteomyelitis healed without undergoing surgical bone resection.

  18. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach.

    PubMed

    Jordan, Joanne E; Briggs, Andrew M; Brand, Caroline A; Osborne, Richard H

    2008-11-17

    Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition. Self-management support is provided by health care and community services to enhance patients' ability to care for their chronic conditions in a cooperative framework. In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training). To date, there has been little coordination or integration of these self-management initiatives to enhance the patient-health professional clinical encounter. If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders - patients, carers, health professionals, and health care organisations. A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

  19. White-nose Syndrome management: Report on structured decision making initiative

    USGS Publications Warehouse

    Szymanski, Jennifer A.; Runge, Michael C.; Parkin, Mary J.; Armstrong, Mike

    2009-01-01

    This report describes an analysis undertaken to assist state and federal natural resources managers in addressing the following question: What management measures should be taken this year within a given area to control the spread and minimize the effects of white-nose syndrome (WNS) on hibernating bats at the individual and population levels? The answer depends upon specific characteristics of the bat species, the hibernacula, and the syndrome itself, all of which could vary across the geographic extent of WNS and change over time. It also depends on a large number of agency and societal judgments concerning how to balance disease management against other objectives.

  20. 76 FR 30147 - Application of the Energy Planning and Management Program Power Marketing Initiative to the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-24

    ... Area Power Administration Application of the Energy Planning and Management Program Power Marketing... Power Administration (Western), a Federal power marketing agency of the Department of Energy (DOE), is... General Consolidated Power Marketing Criteria or Regulations for Boulder City Area Projects...

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

    DTIC Science & Technology

    2011-02-01

    voluntary program • Evolving Risk Assessment Science & Process • Strict Chemical Management – Cradle to grave • Green Chemistry • International...Federal, & State Toxic Substances Laws – Restrictions or banning of chemicals/materials (e.g., BPA) – California Green Chemistry Law – Minnesota “Toxic...Directorate Portfolio • Emerging Contaminants Program • Green Chemistry & DoD Chemical Management Program – DoD REACH Strategic Plan signed in July 2010

  2. USMA Study of the Residential Communities Initiative (RCI) Portfolio and Asset Management (PAM)

    DTIC Science & Technology

    2006-03-01

    changes to this management structure should only be undertaken, if at all, after a careful and cautious examination of their impact on the host of...privatization program exists within a dynamically evolving environment whose perturbations have varying degrees of impact on the future success of the program...particularly true where installation staffs continue to own some of the functions on a project, such as managing the waiting list, which directly impacts the

  3. The Saudi Initiative for Asthma - 2016 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

    Al-Moamary, Mohamed S.; Alhaider, Sami A.; Idrees, Majdy M.; Al Ghobain, Mohammed O.; Zeitouni, Mohammed O.; Al-Harbi, Adel S.; Yousef, Abdullah A.; Al-Matar, Hussain; Alorainy, Hassan S.; Al-Hajjaj, Mohamed S.

    2016-01-01

    This is an updated guideline for the diagnosis and management of asthma, developed by the Saudi Initiative for Asthma (SINA) group, a subsidiary of the Saudi Thoracic Society. The main objective of SINA is to have guidelines that are up to date, simple to understand and easy to use by nonasthma specialists, including primary care and general practice physicians. SINA approach is mainly based on symptom control and assessment of risk as it is the ultimate goal of treatment. The new SINA guidelines include updates of acute and chronic asthma management, with more emphasis on the use of asthma control in the management of asthma in adults and children, inclusion of a new medication appendix, and keeping consistency on the management at different age groups. The section on asthma in children is rewritten and expanded where the approach is stratified based on the age. The guidelines are constructed based on the available evidence, local literature, and the current situation in Saudi Arabia. There is also an emphasis on patient–doctor partnership in the management that also includes a self-management plan. PMID:26933455

  4. [Management of patients with end-stage renal disease prior to initiation of renal replacement therapy in 2013 in France].

    PubMed

    Tuppin, Philippe; Cuerq, Anne; Torre, Sylvie; Couchoud, Cécile; Fagot-Campagna, Anne

    2017-04-01

    This study evaluated the management of patients with end-stage renal disease prior to initiation of renal replacement therapy. Among the 51 million national health insurance general scheme beneficiaries (77% of the population), persons 18 years and older, starting dialysis or undergoing preemptive renal transplantation in 2013, were included in this study. Data were derived from the French national health insurance system (SNIIRAM). In this population of 6674 patients (median age: 68 years), 88% initiated renal replacement therapy by haemodialysis, 8% by peritoneal dialysis, and 4% by renal transplantation. During the year preceding initiation of dialysis, 76% of patients had been hospitalised with at least one diagnostic code for renal disease in 83% of cases, 16% had not received any reimbursements for serum creatinine assay and 32% had not seen a nephrologist; 87% were taking at least one antihypertensive drug (60% were taking at least a renin-angiotensin system inhibitor) and 30% were taking a combination of 4 or more classes of antihypertensive drugs. For patients initiating haemodialysis in a haemodialysis centre, 39% had undergone a procedure related to arteriovenous fistula and 10% had been admitted to an intensive care unit. This study, based on the available reimbursement data, shows that, despite frequent use of the health care system by this population, there is still room for improvement of screening and management of patients with end-stage renal disease and preparation for renal replacement therapy.

  5. Medical Management of Parkinson's Disease after Initiation of Deep Brain Stimulation.

    PubMed

    Fasano, Alfonso; Appel-Cresswell, Silke; Jog, Mandar; Zurowkski, Mateusz; Duff-Canning, Sarah; Cohn, Melanie; Picillo, Marina; Honey, Christopher R; Panisset, Michel; Munhoz, Renato Puppi

    2016-09-01

    In this review, we have gathered all the available evidence to guide medication management after deep brain stimulation (DBS) in Parkinson's disease (PD). Surprisingly, we found that almost no study addressed drug-based management in the postoperative period. Dopaminergic medications are usually reduced, but whether the levodopa or dopamine agonist is to be reduced is left to the personal preference of the treating physician. We have summarized the pros and cons of both approaches. No study on the management of cognitive problems after DBS has been done, and only a few studies have explored the pharmacological management of such DBS-resistant symptoms as voice (amantadine), balance (donepezil) or gait disorders (amantadine, methylphenidate). As for the psychiatric problems so frequently reported in PD patients, researchers have directed their attention to the complex interplay between stimulation and reduction of dopaminergic drugs only recently. In conclusion, studies addressing medical management following DBS are still needed and will certainly contribute to the ultimate success of DBS procedures.

  6. Supporting 'Baby Friendly': a quality improvement initiative for the management of transitional neonatal hypoglycaemia.

    PubMed

    Stewart, Claire Elizabeth; Sage, Emma Louise Maitland; Reynolds, Peter

    2016-07-01

    We describe a quality improvement initiative conducted in a medium-sized district general hospital with a neonatal intensive care unit, which involved working with the multidisciplinary team to create a 'Baby Friendly' neonatal hypoglycaemia pathway with implementation of dextrose gel as a first-line treatment. As a result of the project, formula supplementation rates and admissions for transitional hypoglycaemia were reduced and breastfeeding rates at 3 months improved. This initiative demonstrates that evidence-based guidelines with multidisciplinary team input can improve standards of care.

  7. From Restaurants to Board Rooms: How Initiating Negotiations Teaches Management Principles and Theory

    ERIC Educational Resources Information Center

    Volkema, Roger J.; Kapoutsis, Ilias

    2016-01-01

    Negotiation is an interpersonal process common to everyday personal and professional success. Yet individuals often fail to recognize opportunities for initiating negotiations and the immediate and long-term implications of these oversights for themselves and others. This article describes a simple yet rich negotiation exercise that learners can…

  8. An Assessment of the Air Force Weather Agency’s Readiness for Knowledge Management Initiatives

    DTIC Science & Technology

    2009-03-01

    within the context of this paper. KM initiatives are typically organizational endeavors that seek to leverage the value of knowledge as an intangible ... asset (Liebowitz & Megbolugbe, 1998). “Such projects are attempts to do something useful with knowledge, to accomplish organizational objectives

  9. Estimating the Benefits of the Air Force Purchasing and Supply Chain Management Initiative

    DTIC Science & Technology

    2008-01-01

    challenge by developing an econometric model to account for such “co-occurring” factors. This monograph describes the resulting method and...Applying an Econometric Model to Estimate the Benefits of PSCM Initiatives...15 Applying the Econometric Model for NIIN-Level Outcomes

  10. 75 FR 12570 - Presence Sensing Device Initiation (PSDI); Extension of the Office of Management and Budget's...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... devices (``PSDs'') used to initiate the operation of mechanical power presses; a PSD (e.g., a photoelectric field or curtain) automatically stops the stroke of a mechanical power press when the device detects an operator entering a danger zone near the press. A mechanical power press using Presence...

  11. NSF/DARPA/NASA Digital Libraries Initiative: A Program Manager's Perspective.

    ERIC Educational Resources Information Center

    Griffin, Stephen M.

    1998-01-01

    Discusses the National Science Foundation (NSF)/United States Defense Advanced Research Projects Agency (DARPA)/National Aeronautics and Space Agency (NASA) Research in Digital Libraries Initiative (DLI). Highlights include benefits of digital libraries; the Federal High Performance Computing and Communications Program (HPCC); and program…

  12. Getting Results: Outcomes Management and the Annie E. Casey Foundations Jobs Initiative.

    ERIC Educational Resources Information Center

    Giloth, Robert; Phillips, William

    The Anne E. Casey Foundation (AECF) funded replications of effective jobs projects to achieve better job placement and retention for low-income, young adults. The six projects funded, collectively called the Jobs Initiative (JI), in Denver, Milwaukee, New Orleans, Philadelphia, Seattle, and St. Louis, used an outcomes framework developed by The…

  13. [Evaluation of disease management programmes--assessing methods and initial outcomes from a health economic perspective].

    PubMed

    Birnbaum, Dana Sophie; Braun, Sebastian

    2010-01-01

    Evaluation represents a substantial component of the concept of Disease Management Programmes. This and the fact that the implementation of Disease Management Programmes constitutes a major change in the German healthcare system require that the criteria established by the German Federal Social Insurance Authority (Bundesversicherungsamt) be carefully reviewed. The present paper focuses on the evaluation method and the economic data. The pre-/-post study design used in the evaluation is known to be vulnerable to threats to internal validity. The objective of this paper is to analyze whether these threats to internal validity which have been known theoretically are confirmed by the results of the final reports. A review of the final reports of health insurance companies like the AOK, Barmer and a group of the BKK in Westfalen-Lippe shows that this question can be answered in the affirmative. The pre-/-post design without control groups is unable to recognize the failure or success of the Disease Management concept. The reasons include a high drop-out rate as well as the lack of consideration of the characteristics of chronic disease. Hence the evaluation method has failed to prove the quality of Disease Management Programmes in Germany. This is why consistent further development is needed.

  14. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative.

    ERIC Educational Resources Information Center

    Brown, Sharon A.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2002-01-01

    In a culturally competent diabetes self-management intervention in Starr County, Texas, bilingual Mexican American nurses, dieticians, and community workers provided weekly instruction on nutrition, self-monitoring, exercise and other self-care topics. A biweekly support group promoted behavior change. Interviews and examinations with 256 Mexican…

  15. Quality Circle Effectiveness as a Function of Upper-Management Support, Circle Initiation, and Collar Color.

    ERIC Educational Resources Information Center

    Tang, Thomas Li-Ping; And Others

    Japanese management practices have attracted much interest in the United States. The use of quality circles (QCs) common in Japan, has been considered a promising approach to improving Americn workers' productivity. A quality circle is made up of workers from the same group who meet to discuss quality problems, recommend solutions, and implement…

  16. A Developmental Perspective of State Policy Initiatives in Instructional Management in the State of Mississippi.

    ERIC Educational Resources Information Center

    Woodruff, Jane Bruner

    This paper traces the evolution of curriculum reform in Mississippi from a state level, norm-referenced accountability system to a performance-based, centralized accreditation system that integrates instructional management requirements into improvement standards. Accountability legislation has primarily been concerned with quality of student…

  17. Initiation and management of adult veno-arterial extracorporeal life support

    PubMed Central

    Shukrallah, Bassam N.; Kilic, Arman; Whitson, Bryan A.

    2017-01-01

    Extracorporeal life support (ECLS) for patients suffering from acute cardiopulmonary collapse is the penultimate therapy to provide hemodynamic stability. Although it can be a life sustaining as well as life-saving therapy, there are important factors that contribute to its success. In this review, we will describe the indications, management, pitfalls and limitations of ECLS. PMID:28275612

  18. Investigation of the infertile couple: a basic fertility work-up performed within 12 months of trying to conceive generates costs and complications for no particular benefit.

    PubMed

    van der Steeg, Jan W; Steures, Pieternel; Hompes, Peter G A; Eijkemans, Marinus J C; van der Veen, Fulco; Mol, Ben W J

    2005-10-01

    The current approach of the basic fertility work-up has been questioned recently in this journal. Based on new data on human fecundity, the authors advocated starting the fertility work-up after just 6 months of trying to conceive instead of the usual 12 months. In women younger than 39 years and with a regular cycle, there are several arguments why the basic fertility work-up should not be done earlier than after 12 months of child wish. Firstly, 50% of couples who have tried to conceive for 6 months without success will conceive in the next 6 months without any treatment. Secondly, the prevalence of fertility diseases is lower in couples who have been trying to conceive for 6 months as compared with those who have been trying for 12 months. Performance of a fertility work-up at this stage will lead to an increase in false-positive diagnoses compared with performing them at 12 months of subfertility. Thirdly, fertility treatment will have fewer additional effects in couples with good spontaneous conception prospects (6-12 months child wish), compared with subfertile couples who have poor prospects. At present, none of the available fertility treatments have success rates comparable with no intervention in these women, and postponement of treatment in such couples will prevent complications such as ovarian hyperstimulation syndrome and multiple pregnancies. We argue that the fertility work-up should not be offered to couples with a duration of child wish of <12 months, except for women with ovulation disorders and women of 39 years and older.

  19. Information Technology: Leveraging Best Practices and Reform Initiatives Can Help Defense Manage Major Investments

    DTIC Science & Technology

    2014-02-26

    per year beginning in fiscal year 2016 . With a continued focus on this important effort, including obtaining support for estimated cost savings...remaining $34 billion, about one-quarter is to be spent on acquiring new investments, and the rest is to be spent operating and maintaining existing or...additional potential duplication within Defense’s health care and dental management investments, totaling over $30 million.20 We recently reported

  20. Care pathways in thrombosis management: the INNOVATE peer-to-peer educational initiative

    PubMed Central

    Patel, Raj K

    2017-01-01

    Context Anticoagulant options for the management of venous thromboembolism (VTE) now include the non-vitamin K antagonist oral anticoagulants (NOACs). The safe and effective integration of these agents into routine clinical practice within different health care settings presents common challenges. Bayer AG created the INternational Network fOr Venous and Arterial Thrombosis Excellence in practice (INNOVATE) program as a professional education network to foster best practice in thrombosis management in the NOAC era. Concept and format Since 2013, INNOVATE has been run as a series of educational 1.5-day global meetings at VTE centers of excellence. The format is based on expert-led discussion rather than lectures; all participants are encouraged to share their own expertise and experience. Through peer-to-peer exchange, less experienced professionals from an array of specialties learn from others in a small-group interactive setting. This format encourages positive engagement and discussion, and the establishment of relationships between health care professionals from different countries. Expansion and localization INNOVATE has successfully expanded to cover a broad spectrum of thromboembolic disorders in which anticoagulation with NOACs plays an important role; now including specific meetings focusing on the management of patients in the community. Local meetings are run in many countries in the local language, facilitating discussion and ensuring applicability to local or regional issues. Implementing learnings INNOVATE delegates have provided consistently positive feedback and have used their attendance to create and improve thrombosis management pathways in their own institutions. Overseen by a Steering Committee, the program responds to feedback, evolving to meet the needs of participants. Conclusion By showcasing best practice in the care of patients requiring anticoagulation, INNOVATE provides a model for the non-promotional support of medical education by

  1. [The management by the processes in a cancer center, an utopian initiative?].

    PubMed

    Verger, David; Mihura, Jeanne; Sallé, Françoise; Sarini, Jérôme; Colin, Valérie

    2008-01-01

    The process approach is a mode of quality improvement. It leans on the cartography's establishment, allows to redefine organization around patients trajectory, the measure of defects and their correction. The process pilot is a new actor in the management of the establishment. It is developed since 3 years in the Institute Claudius Regaud, regional cancer center treatment of Midi-Pyrénées.

  2. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases

    PubMed Central

    Schwartz, Jeremy I.; Dunkle, Ashley; Akiteng, Ann R.; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K.; Mutungi, Gerald; Rabin, Tracy L.; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda. PMID:25563451

  3. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases.

    PubMed

    Schwartz, Jeremy I; Dunkle, Ashley; Akiteng, Ann R; Birabwa-Male, Doreen; Kagimu, Richard; Mondo, Charles K; Mutungi, Gerald; Rabin, Tracy L; Skonieczny, Michael; Sykes, Jamila; Mayanja-Kizza, Harriet

    2015-01-01

    Background The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. Methods Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. Results In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. Discussion Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.

  4. 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

  5. Deep space telecommunications, navigation, and information management - Support of the Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    Hall, Justin R.; Hastrup, Rolf C.

    1990-01-01

    The principal challenges in providing effective deep space navigation, telecommunications, and information management architectures and designs for Mars exploration support are presented. The fundamental objectives are to provide the mission with the means to monitor and control mission elements, obtain science, navigation, and engineering data, compute state vectors and navigate, and to move these data efficiently and automatically between mission nodes for timely analysis and decision making. New requirements are summarized, and related issues and challenges including the robust connectivity for manned and robotic links, are identified. Enabling strategies are discussed, and candidate architectures and driving technologies are described.

  6. War wounds of the foot and ankle: causes, characteristics, and initial management.

    PubMed

    Bluman, Eric M; Ficke, James R; Covey, Dana C

    2010-03-01

    Foot and ankle trauma sustained in the Global War on Terror have unique causes and characteristics. At least one-quarter of all battle injuries involve the lower extremity. These severe lower extremity wounds require specialized early treatment. Ballistic mechanisms cause almost all injuries, and as such, most combat foot and ankle wounds are open in nature. Wounds are characteristically caused by blast mechanisms, but high velocity gunshot injuries are also common. The severe and polytraumatic nature of injuries sustained frequently call for damage control orthopaedics to be utilized. Cautious early treatment of irregular and highly exudative ballistic wounds with subatmospheric wound dressings may ease their early management.

  7. Expert initial review of Columbia River Basin salmonid management models: Summary report

    SciTech Connect

    Barnthouse, L.W.

    1993-10-01

    Over the past years, several fish passage models have been developed to examine the downstream survival of salmon during their annual migration through the Columbia River reservoir system to below Bonneville Dam. More recently, models have been created to simulate the survival of salmon throughout the entire life cycle. The models are used by various regional agencies and native American tribes to assess impacts of dam operation, harvesting, and predation on salmonid abundance. These models are now also being used to assess extinction probabilities and evaluate restoration alternatives for threatened and endangered salmonid stocks. Oak Ridge National Laboratory (ORNL) coordinated an initial evaluation of the principal models by a panel of outside, expert reviewers. None of the models were unequivocally endorsed by any reviewer. Significant strengths and weaknesses were noted for each with respect to reasonability of assumptions and equations, adequacy of documentation, adequacy of supporting data, and calibration procedures. Although the models reviewed differ in some important respects, all reflect a common conceptual basis in classical population dynamic theory and a common empirical basis consisting of the available time series of salmonid stock data, hydrographic records, experimental studies of dam passage parameters, and measurements of reservoir mortality. The results of this initial review are not to be construed as a comprehensive scientific peer review of existing Columbia River Basin (CRB) salmon population models and data. The peer review process can be enhanced further by a dynamic exchange regional modelers and scientific panel experts involving interaction and feedback.

  8. Depression Screening in Chronic Disease Management: A Worksite Health Promotion Initiative.

    PubMed

    Jensen, Elizabeth; Dumas, Bonnie P; Edlund, Barbara J

    2016-03-01

    This pilot project aimed to improve depression symptoms and quality-of-life measures for individuals in a worksite disease management program. Two hundred forty-three individuals were invited to participate, out of which 69 enrolled. The participants had a history of diabetes, hypertension, or hyperlipidemia, and demonstrated depression using the Patient Health Questionnaire-9 (PHQ-9). The project consisted of counseling sessions provided every 2 to 4 weeks by a family nurse practitioner. PHQ-9 scores and those of an instrument that measures quality of life, the Veteran's Rand-12 (VR-12), were compared pre-intervention and post-intervention to evaluate the effectiveness of the project. PHQ-9 and VR-12 Mental Health Component (MHC) scores improved significantly after 3 months of nurse practitioner-led individual counseling sessions. This project demonstrated that depression screening and therapeutic management, facilitated by a nurse practitioner, can improve depression and perceived quality of life in individuals with hypertension, hyperlipidemia, or type 2 diabetes.

  9. Identification and initial assessment of candidate BWR late-phase in-vessel accident management strategies

    SciTech Connect

    Hodge, S.A.

    1991-04-15

    Work sponsored by the United States Nuclear Regulatory Commission (USNRC) to identify and perform preliminary assessments of candidate BWR (boiling water reactor) in-vessel accident management strategies was completed at Oak Ridge National Laboratory (ORNL) during fiscal year 1990. Mitigative strategies for containment events have been the subject of a companion study at Brookhaven National Laboratory. The focus of this Oak Ridge effort was the development of new strategies for mitigation of the late phase events, that is, the events that would occur in-vessel after the onset of significant core damage. The work began with an investigation of the current status of BWR in-vessel accident management procedures and proceeded through a preliminary evaluation of several candidate new strategies. The steps leading to the identification of the candidate strategies are described. The four new candidate late-phase (in-vessel) accident mitigation strategies identified by this study and discussed in the report are: (1) keep the reactor vessel depressurized; (2) restore injection in a controlled manner; (3) inject boron if control blade damage has occurred; and (4) containment flooding to maintain core and structural debris in-vessel. Additional assessments of these strategies are proposed.

  10. Telecommunications, navigation and information management concept overview for the Space Exploration Initiative program

    NASA Technical Reports Server (NTRS)

    Bell, Jerome A.; Stephens, Elaine; Barton, Gregg

    1991-01-01

    An overview is provided of the Space Exploration Initiative (SEI) concepts for telecommunications, information systems, and navigation (TISN), and engineering and architecture issues are discussed. The SEI program data system is reviewed to identify mission TISN interfaces, and reference TISN concepts are described for nominal, degraded, and mission-critical data services. The infrastructures reviewed include telecommunications for robotics support, autonomous navigation without earth-based support, and information networks for tracking and data acquisition. Four options for TISN support architectures are examined which relate to unique SEI exploration strategies. Detailed support estimates are given for: (1) a manned stay on Mars; (2) permanent lunar and Martian settlements; short-duration missions; and (4) systematic exploration of the moon and Mars.

  11. International Atomic Energy Agency (IAEA) initiatives: Records management for deep and near surface geologic repositories

    SciTech Connect

    Warner, P.J.

    1996-09-01

    The international scientific community has long had an interest in determining methods by which information regarding nuclear waste repositories, and the inherent danger to humanity, could be passed from generation to generation and society to society. Because nuclear waste will remain radioactive for thousands of years future generations must be warned of the dangers thus eliminating intentional or inadvertent intrusion. Member States of the IAEA have determined that the principle safety of such sites must not rely solely on long term institutional arrangements for the retention of information. It is believed that repository siting, design, operation and postoperation information should be gathered, managed and retained so that this information remains accessible to future societies over a very long period of time. The radionuclide life is 10,000 years; thus the retention of information continues beyond current societies, cultures and languages, and must be continually migrated to new retrieval technologies to assure access.

  12. An initial assessment of the risk approach to antenatal management in Malaysia.

    PubMed

    Somboonsook, B; Wakerman, J; Hattch, C T; Collison, M; Barnes, A; Kyi, W; Karim, R

    1995-09-01

    This study was the first assessment of a nationwide risk approach system to antenatal management introduced to Malaysia in 1989. Three rapid, record-based surveys on three different study groups were conducted to determine risk factor prevalence, accuracy of risk assignment, action after risk assignment and the relationship of risk level and place of delivery. The most frequent risk factors were short birth interval, high parity and first pregnancy. Accuracy of risk assignment was highest at the lowest levels of risk and poorest at the highest levels. Women at the lowest levels of risk were more likely to be seen by a doctor than women at highest risk. These was a trend to deliver in hospital, rather than at home, as level of risk increased; but many women at high risk still delivered at home. Recommendations are made on modifications to the system prior to future evaluation.

  13. Community health workers as drivers of a successful community-based disease management initiative.

    PubMed

    Peretz, Patricia J; Matiz, Luz Adriana; Findley, Sally; Lizardo, Maria; Evans, David; McCord, Mary

    2012-08-01

    In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child's asthma increased to nearly 100%. Key to the program's success was the commitment and involvement of community partners from program inception to date.

  14. Culturally Competent Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative

    PubMed Central

    Brown, Sharon A.; Dougherty, James R.; Garcia, Alexandra A.; Kouzekanani, Kamiar; Hanis, Craig L.

    2007-01-01

    Objective To determine in Mexican Americans with type 2 diabetes the effects of a culturally competent diabetes self-management intervention. Research Design and Methods A prospective, randomized, repeated measures study was conducted on the Texas-Mexico border in Starr County. 256 randomly selected persons with type 2 diabetes were: (1) between 35 and 70 years of age; (2) diagnosed with type 2 diabetes after the age of 35 years; and (3) accompanied by a family member or friend. The intervention consisted of 52 contact hours over 12 months and was provided by bilingual Mexican American nurses, dietitians, and community workers. The intervention involved : (1) 3 months of weekly instructional sessions on nutrition, self-monitoring of blood glucose, exercise, and other self-care topics; and (2) 6 months of biweekly support group sessions to promote behavior changes. The approach was culturally competent in terms of language, diet, social emphasis, family participation, and incorporation of cultural health beliefs. Indicators of metabolic control (HbA1c and FBS), diabetes knowledge, and diabetes-related health beliefs. Results Experimental groups showed significantly lower levels of HbA1c and FBS at 6 months and at 12 months and higher diabetes knowledge scores. At 6 months, the mean HbA1c of the experimental subjects was 1.4% below the mean of the control group; however, the mean level of the experimental subjects was still high (over 10%). Conclusions This study confirms the effectiveness of culturally competent diabetes self-management education on improving health outcomes of Mexican Americans, particularly for those individuals with HbA1c levels above 10%. PMID:11815493

  15. Insulin therapy for management of type 2 diabetes mellitus: strategies for initiation and long-term patient adherence.

    PubMed

    Barag, Steven H

    2011-07-01

    Effective glycemic control is essential to minimize the long-term complications of type 2 diabetes mellitus (T2DM). However, it is well documented that many patients spend prolonged periods outside of the optimal glycemic range. The use of insulin is important to effectively control the disease process in patients with T2DM. Even so, resistance to insulin use among patients and healthcare providers often limits initiation and intensification of insulin therapy. With the increasing prevalence of T2DM across all socioeconomic strata, an expanded viewpoint of early and sustained insulin use is crucial to enhance glycemic control in patients. To manage the effects of T2DM on cardiovascular disease in the aging population, physicians can promote insulin therapy as an affordable and effective treatment option. The author reviews beliefs and myths about the use of insulin in the management of T2DM and discusses strategies to overcome barriers to initiation of insulin therapy in the primary care setting.

  16. Channel and perennial flow initiation in headwater streams: management implications of variability in source-area size.

    PubMed

    Jaeger, Kristin L; Montgomery, David R; Bolton, Susan M

    2007-11-01

    Despite increasing attention to management of headwater streams as sources of water, sediment, and wood to downstream rivers, the extent of headwater channels and perennial flow remain poorly known and inaccurately depicted on topographic maps and in digital hydrographic data. This study reports field mapping of channel head and perennial flow initiation locations in forested landscapes underlain by sandstone and basalt lithologies in Washington State, USA. Contributing source areas were delineated for each feature using a digital elevation model (DEM) as well as a Global Positioning System device in the field. Systematic source area-slope relationships described in other landscapes were not evident for channel heads in either lithology. In addition, substantial variability in DEM-derived source area sizes relative to field-delineated source areas indicates that in this area, identification of an area-slope relationship, should one even exist, would be difficult. However, channel heads and stream heads, here defined as the start of perennial flow, appear to be co-located within both of the lithologies, which together with lateral expansion and contraction of surface water around channel heads on a seasonal cycle in the basalt lithology, suggest a controlling influence of bedrock springs for that location. While management strategies for determining locations of channel heads and perennial flow initiation in comparable areas could assign standard source area sizes based on limited field data collection within that landscape, field-mapped source areas that support perennial flow are much smaller than recognized by current Washington State regulations.

  17. Healthy sand : a farmers initiative on soil protection and ecosystem service management

    NASA Astrophysics Data System (ADS)

    Smit, Annemieke; Verzandvoort, Simone; Kuikman, Peter; Stuka, Jason; Morari, Francesco; Rienks, Willem; Stokkers, Jan; Hesselink, Bertus; Lever, Henk

    2015-04-01

    In a small region in the Netherlands a group of dairy farmers (cooperated in a foundation HOE Duurzaam) cooperates with the drinking water company and together aim for a more healthy soil. They farm a sandy soil, which is in most of the parcels low in organic matter. The local farmers perceive loss of soil fertility and blame loss of soil organic matter for that. All farmers expect that increasing the soil organic matter content will retain more nitrates in the soil, leading to a reduction in nitrate leaching and a higher nutrient availability for the crops, forage and grass and probably low urgency for grassland renewal. The drinking water company in the area also has high expectations that a higher SOM content does relate to higher quality of the (drinking) water and lower costs to clean and filter the water to meet drinking water quality requirements. Most farmers in the area face suboptimal moisture conditions and thrive for increasing the soil organic matter content and improving the soil structure as key factors to relieve, soil moisture problems both in dry (drought) and wet (flooding) periods. A better water holding capacity of the soil provides benefits for the regional water board as this reduces leaching and run-off. The case study, which is part of the Recare-project, at first glance deals with soil management and technology to improve soil quality. However, the casus in fact deals with social innovation. The real challenge to this group of neighbours, farmers within a small region, and to science is how to combine knowledge and experience on soil management for increasing the content of soil organic matter and how to recognize the ecosystem services that are provided by the adapted and more 'healthy' soils. And also how to formalize relations between costs and benefits of measures taken in the field and how these could be financially rewarded from an agreed and acceptable financial awarding scheme based on payments for securing soil carbon stocks and

  18. A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism

    PubMed Central

    Singh, Inderpal; Fletcher, Rachel; Scanlon, Linda; Tyler, Mandy; Aithal, Shridhar

    2016-01-01

    The risk of falls is higher in patients with people with Parkinsonism (PwP) compared to those without Parkinsonism, and leads to adverse outcomes including fragility fractures. Osteoporosis is under-recognised, and the prevalence of fragility fractures in not well studied. The primary aim of this project is for 100% of new patient referrals to, and 80% of follow up patients within the movement disorder (MD) service with osteoporosis to be treated in accordance with evidence based osteoporosis guidance. Routinely captured information regarding demographics and fragility fractures was retrospectively extracted from the clinical workstation, clinic letters, and clinical coding between July and November 2015. The prevalence of fragility fracture was 22.6% (68/300), and only 40% (27/68) were on appropriate treatment for osteoporosis. A quality improvement (QI) methodology based on the model of improvement, Plan-Do-Study-Act (PDSA) cycles were used, and a monthly multidisciplinary team (MDT) meeting was introduced. This QI initiative has shown that MDT input can reduce referrals to physiotherapists; and also 100% of new patients, and 91% of follow up patients received evidence based osteoporosis treatment. PMID:27933155

  19. Initial Validation of a Knowledge-Based Measure of Social Information Processing and Anger Management

    PubMed Central

    Cassano, Michael; MacEvoy, Julie Paquette; Costigan, Tracy

    2010-01-01

    Over the past fifteen years many schools have utilized aggression prevention programs. Despite these apparent advances, many programs are not examined systematically to determine the areas in which they are most effective. One reason for this is that many programs, especially those in urban under-resourced areas, do not utilize outcome measures that are sensitive to the needs of ethnic minority students. The current study illustrates how a new knowledge-based measure of social information processing and anger management techniques was designed through a partnership-based process to ensure that it would be sensitive to the needs of urban, predominately African American youngsters, while also having broad potential applicability for use as an outcome assessment tool for aggression prevention programs focusing upon social information processing. The new measure was found to have strong psychometric properties within a sample of urban predominately African American youth, as item analyses suggested that almost all items discriminate well between more and less knowledgeable individuals, that the test-retest reliability of the measure is strong, and that the measure appears to be sensitive to treatment changes over time. In addition, the overall score of this new measure is moderately associated with attributions of hostility on two measures (negative correlations) and demonstrates a low to moderate negative association with peer and teacher report measures of overt and relational aggression. More research is needed to determine the measure's utility outside of the urban school context. PMID:20449645

  20. Day surgery management model in china: practical experience and initial evaluation

    PubMed Central

    Jiang, Huiyong; Han, Junyi; Lu, Aiguo; Liu, Xiufeng

    2014-01-01

    Objectives: Day surgery has been increasingly performed in some major teaching hospitals in China. We aimed to evaluate the current day surgery management model (DSMM) and compare the clinical outcome and health service utility of day surgery with inpatient surgery. Methods: We reviewed 14482 day surgery cases under the DSMM and 2591 inpatient surgery cases under the non-DSMM between September 2006 and September 2012 in Shanghai East Hospital. The endpoints of interest were hospitalization days, incision infection rate and hospital cost. Results: Among 14482 day surgery cases, only 52 (0.4%) were converted to hospitalization. The average hospitalization time of the patients was 2-10 hours. None of them had incision infection. Hospital cost of DSMM was less than 50% of non-DSMM (inpatient surgery). The most common postoperative complications were nausea, vomiting and dizziness. Nearly half of patients had mild to moderate pain after surgery. Conclusions: DSMM optimizes the utilization of healthcare resources by reducing hospital admission, hospital cost and incision infection in China. PMID:25550971

  1. Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors

    PubMed Central

    Bakris, George L.; Black, Henry R.; Chen, Helen X.; Durand, Jean-Bernard; Elliott, William J.; Ivy, S. Percy; Leier, Carl V.; Lindenfeld, JoAnn; Liu, Glenn; Remick, Scot C.; Steingart, Richard; Tang, W. H. Wilson

    2010-01-01

    Hypertension is a mechanism-based toxic effect of drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP). Substantial evidence exists for managing hypertension as a chronic condition, but there are few prospectively collected data on managing acute hypertension caused by VSP inhibitors. The Investigational Drug Steering Committee of the National Cancer Institute convened an interdisciplinary cardiovascular toxicities expert panel to evaluate this problem, to make recommendations to the Cancer Therapy Evaluation Program on further study, and to structure an approach for safe management by treating physicians. The panel reviewed: the published literature on blood pressure (BP), hypertension, and specific VSP inhibitors; abstracts from major meetings; shared experience with the development of VSP inhibitors; and established principles of hypertension care. The panel generated a consensus report including the recommendations on clinical concerns summarized here. To support the greatest possible number of patients to receive VSP inhibitors safely and effectively, the panel had four recommendations: 1) conduct and document a formal risk assessment for potential cardiovascular complications, 2) recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy, 3) actively monitor BP throughout treatment with more frequent assessments during the first cycle of treatment, and 4) manage BP with a goal of less than 140/90 mmHg for most patients (and to lower, prespecified goals in patients with specific preexisting cardiovascular risk factors). Proper agent selection, dosing, and scheduling of follow-up should enable maintaining VSP inhibition while avoiding the complications associated with excessive or prolonged elevation in BP. PMID:20351338

  2. Prospective pilot trial of PerMIT versus standard anticoagulation service management of patients initiating oral anticoagulation.

    PubMed

    Borgman, Mark P; Pendleton, Robert C; McMillin, Gwendolyn A; Reynolds, Kristen K; Vazquez, Sara; Freeman, Andrew; Wilson, Andrew; Valdes, Roland; Linder, Mark W

    2012-09-01

    We performed a randomised pilot trial of PerMIT, a novel decision support tool for genotype-based warfarin initiation and maintenance dosing, to assess its efficacy for improving warfarin management. We prospectively studied 26 subjects to compare PerMIT-guided management with routine anticoagulation service management. CYP2C9 and VKORC1 genotype results for 13 subjects randomly assigned to the PerMIT arm were recorded within 24 hours of enrolment. To aid in INR interpretation, PerMIT calculates estimated loading and maintenance doses based on a patient's genetic and clinical characteristics and displays calculated S-warfarin plasma concentrations based on planned or administered dosages. In comparison to control subjects, patients in the PerMIT study arm demonstrated a 3.6-day decrease in the time to reach a stabilised INR within the target therapeutic range (4.7 vs. 8.3 days, p = 0.015); a 12.8% increase in time spent within the therapeutic interval over the first 25 days of therapy (64.3% vs. 55.3%, p = 0.180); and a 32.9% decrease in the frequency of warfarin dose adjustments per INR measurement (38.3% vs. 57.1%, p = 0.007). Serial measurements of plasma S-warfarin concentrations were also obtained to prospectively evaluate the accuracy of the pharmacokinetic model during induction therapy. The PerMIT S-warfarin plasma concentration model estimated 62.8% of concentrations within 0.15 mg/l. These pilot data suggest that the PerMIT method and its incorporation of genotype/phenotype information may help practitioners increase the safety, efficacy, and efficiency of warfarin therapeutic management.

  3. Medical Image Communication System: Plan, Management And Initial Experience In Prototype At The University Of North Carolina

    NASA Astrophysics Data System (ADS)

    Staab, E. V.; Anderson, D. J.; Chaney, E. L.; Delany, D. J.; DiBianca, F. A.; Guilford, W. B.; Jaques, P. F.; Johnston, R. E.; McCartney, W. H.; Pizer, S. M.; Scatliff, J. H.; Thompson, B. G.; Washburn, D. B.

    1982-01-01

    The revolution in data handling associated with digital systems has excited the medical world into considering replacing existing methods. The integration of digital with analogue video systems into a complete electronic communications network holds tremendous promise. One area where these changes will have significant impact is in medical imaging. The potential of more and better information being,obtained from current studies, more rapid access to studies, intercomparison of images from different modalities, savings in space and equipment, reduced procedure time, improved communication in a distributed department, remote image consultation, and timely data base for management are only some of the advantages that can accrue from proper use of electronic systems. In the hospital, the traditional radiology department is becoming a medical imaging de-partment. To effect a change from the ubiquitous silver halide film base system into a more electronic department will necessitate much experimentation. At the University of North Carolina we are attempting to involve the entire department in these endeavors as well as others such as biomedical engineering, computer science and traditional clinical areas. To facilitate this, a management system has been developed and is being used. The system, our architectural draft of a future department and the initial problems and questions which have arisen from implementing a prototype system will be the subject of this report.

  4. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

    PubMed

    Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

    2015-10-01

    Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.

  5. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative.

    PubMed

    Dejaco, Christian; Singh, Yogesh P; Perel, Pablo; Hutchings, Andrew; Camellino, Dario; Mackie, Sarah; Abril, Andy; Bachta, Artur; Balint, Peter; Barraclough, Kevin; Bianconi, Lina; Buttgereit, Frank; Carsons, Steven; Ching, Daniel; Cid, Maria; Cimmino, Marco; Diamantopoulos, Andreas; Docken, William; Duftner, Christina; Fashanu, Billy; Gilbert, Kate; Hildreth, Pamela; Hollywood, Jane; Jayne, David; Lima, Manuella; Maharaj, Ajesh; Mallen, Christian; Martinez-Taboada, Victor; Maz, Mehrdad; Merry, Steven; Miller, Jean; Mori, Shunsuke; Neill, Lorna; Nordborg, Elisabeth; Nott, Jennifer; Padbury, Hannah; Pease, Colin; Salvarani, Carlo; Schirmer, Michael; Schmidt, Wolfgang; Spiera, Robert; Tronnier, David; Wagner, Alexandre; Whitlock, Madeline; Matteson, Eric L; Dasgupta, Bhaskar

    2015-10-01

    Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR.

  6. Together - a couples' program to improve communication, coping, and financial management skills: development and initial pilot-testing.

    PubMed

    Falconier, Mariana K

    2015-04-01

    The accumulated knowledge about the negative impact of financial strain on couple's relationship functioning and the magnitude of the latest economic downturn have brought together the fields of financial counseling and couples' therapy. This article describes the development of a new interdisciplinary program that aims at helping couples under financial strain improve their financial management, communication, and dyadic coping skills. The article also reports the results from its initial pilot-testing with data collected from 18 financially distressed couples before and after participation in the program and 3 months later. Results from repeated measures ANOVAs suggest that the program may help reduce both partners' financial strain and the male negative communication and improve both partners' financial management skills and strategies to cope together with financial strain, and the male relationship satisfaction. These findings together with the high satisfaction reported by participants regarding the structure and content of the sessions and homework suggest that this program may be a promising approach to help couples experiencing financial strain. Gender differences, clinical implications, and possibilities for further research are also discussed.

  7. Advanced Air Traffic Management Research (Human Factors and Automation): NASA Research Initiatives in Human-Centered Automation Design in Airspace Management

    NASA Technical Reports Server (NTRS)

    Corker, Kevin M.; Condon, Gregory W. (Technical Monitor)

    1996-01-01

    NASA has initiated a significant thrust of research and development focused on providing the flight crew and air traffic managers automation aids to increase capacity in en route and terminal area operations through the use of flexible, more fuel-efficient routing, while improving the level of safety in commercial carrier operations. In that system development, definition of cognitive requirements for integrated multi-operator dynamic aiding systems is fundamental. The core processes of control and the distribution of decision making in that control are undergoing extensive analysis. From our perspective, the human operators and the procedures by which they interact are the fundamental determinants of the safe, efficient, and flexible operation of the system. In that perspective, we have begun to explore what our experience has taught will be the most challenging aspects of designing and integrating human-centered automation in the advanced system. We have performed a full mission simulation looking at the role shift to self-separation on board the aircraft with the rules of the air guiding behavior and the provision of a cockpit display of traffic information and an on-board traffic alert system that seamlessly integrates into the TCAS operations. We have performed and initial investigation of the operational impact of "Dynamic Density" metrics on controller relinquishing and reestablishing full separation authority. (We follow the assumption that responsibility at all times resides with the controller.) This presentation will describe those efforts as well as describe the process by which we will guide the development of error tolerant systems that are sensitive to shifts in operator work load levels and dynamic shifts in the operating point of air traffic management.

  8. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department.

    PubMed

    Koenig, Kristi L; Almadhyan, Abdulmajeed; Burns, Michael J

    2016-05-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2-7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  9. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Zika Virus Patients in the Emergency Department

    PubMed Central

    Koenig, Kristi L.; Almadhyan, Abdulmajeed; Burns, Michael J.

    2016-01-01

    First isolated in 1947 from a monkey in the Zika forest in Uganda, and from mosquitoes in the same forest the following year, Zika virus has gained international attention due to concerns for infection in pregnant women potentially causing fetal microcephaly. More than one million people have been infected since the appearance of the virus in Brazil in 2015. Approximately 80% of infected patients are asymptomatic. An association with microcephaly and other birth defects as well as Guillain-Barre Syndrome has led to a World Health Organization declaration of Zika virus as a Public Health Emergency of International Concern in February 2016. Zika virus is a vector-borne disease transmitted primarily by the Aedes aegypti mosquito. Male to female sexual transmission has been reported and there is potential for transmission via blood transfusions. After an incubation period of 2–7 days, symptomatic patients develop rapid onset fever, maculopapular rash, arthralgia, and conjunctivitis, often associated with headache and myalgias. Emergency department (ED) personnel must be prepared to address concerns from patients presenting with symptoms consistent with acute Zika virus infection, especially those who are pregnant or planning travel to Zika-endemic regions, as well as those women planning to become pregnant and their partners. The identify-isolate-inform (3I) tool, originally conceived for initial detection and management of Ebola virus disease patients in the ED, and later adjusted for measles and Middle East Respiratory Syndrome, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for initial detection and management of patients under investigation for Zika virus. Following an assessment of epidemiologic risk, including travel to countries with mosquitoes that transmit Zika virus, patients are further investigated if clinically indicated. If after a rapid evaluation, Zika or other arthropod

  10. Characterizing the Assessment and Management of Vitamin D Levels in Patients with Osteoporosis in Clinical Practice: A Chart Review Initiative

    PubMed Central

    Adachi, Jonathan D.; Brown, Jacques P.; Ioannidis, George

    2015-01-01

    Though vitamin D is important for bone health, little is known about the monitoring and management of vitamin D levels in patients with osteoporosis in clinical practice—a deficit this chart review initiative aimed to remedy. A total of 52 physicians completed profiles for 983 patients being treated for osteoporosis between November 2008 and April 2009. Information collected included demographics; fracture risk factors; availability and level of serum vitamin D measurements; and information on osteoporosis medications and calcium and vitamin D supplementation. Physicians also evaluated patients' current regimens and detailed proposed changes, if applicable. Nearly 85% of patients were prescribed calcium and vitamin D supplements. Serum 25-hydroxy vitamin D levels were available for 73% of patients. Of these patients, approximately 50% had levels less than 80 nmol/L, which contrasts with the 37% thought to have “unsatisfactory” vitamin D levels based on physician perceptions. Physicians felt 26% of patients would benefit from additional vitamin D supplementation. However, no changes to the osteoporosis regimen were suggested for 48% of patients perceived to have “unsatisfactory” vitamin D levels. The results underscore the importance of considering vitamin D status when looking to optimize bone health. PMID:25709852

  11. Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases.

    PubMed

    Omoumi, Patrick; de Gheldere, Antoine; Leemrijse, Thibaut; Galant, Christine; Van den Bergh, Peter; Malghem, Jacques; Simoni, Paolo; Vande Berg, Bruno C; Lecouvet, Frédéric E

    2010-04-01

    Ganglion cysts are a common cause of tarsal tunnel syndrome. As in other locations, these cysts are believed to communicate with neighboring joints. The positive diagnosis and preoperative work-up of these cysts require identification and location of the cyst pedicles so that they may be excised and the risk of recurrence decreased. This can be challenging with ultrasonography and magnetic resonance (MR) imaging. We present three cases of symptomatic ganglion cysts of the tarsal tunnel, diagnosed by MR imaging, where computed tomography (CT) arthrography with delayed acquisitions helped to confirm the diagnosis and identify precisely the topography of the communication with the subtalar joint. These cases provide new evidence of the articular origin of ganglion cysts developing in the tarsal tunnel.

  12. Full Life-Cycle Defect Management Assessment: Initial Inspection Data Collection Results and Research Questions for Further Study

    NASA Technical Reports Server (NTRS)

    Shull, Forrest; Feldmann, Raimund; Haingaertner, Ralf; Regardie, Myrna; Seaman, Carolyn

    2007-01-01

    It is often the case in software projects that when schedule and budget resources are limited, the Verification and Validation (V&V) activities suffer. Fewer V&V activities can be afforded and moreover, short-term challenges can result in V&V activities being scaled back or dropped altogether. As a result, too often the default solution is to save activities for improving software quality until too late in the life-cycle, relying on late-term code inspections followed by thorough testing activities to reduce defect counts to acceptable levels. As many project managers realize, however, this is a resource-intensive way of achieving the required quality for software. The Full Life-cycle Defect Management Assessment Initiative, funded by NASA s Office of Safety and Mission Assurance under the Software Assurance Research Program, aims to address these problems by: Improving the effectiveness of early life-cycle V&V activities to make their benefits more attractive to team leads. Specifically, we focus on software inspection, a proven method that can be applied to any software work product, long before executable code has been developed; Better communicating this effectiveness to software development teams, along with suggestions for parameters to improve in the future to increase effectiveness; Analyzing the impact of early life-cycle V&V on the effectiveness and cost required for late life-cycle V&V activities, such as testing, in order to make the tradeoffs more apparent. This white paper reports on an initial milestone in this work, the development of a preliminary model of inspection effectiveness across multiple NASA Centers. This model contributes toward reaching our project goals by: Allowing an examination of inspection parameters, across different types of projects and different work products, for an analysis of factors that impact defect detection effectiveness. Allowing a comparison of this NASA-specific model to existing recommendations in the literature

  13. Preliminary results on the role of PET/CT in initial staging, restaging, and management of lung cancer

    NASA Astrophysics Data System (ADS)

    Malamitsi, J.; Valotassiou, B.; Iliadis, K.; Kosmidis, P.; Laspas, F.; Vasilaki, M.; Pipini, E.; Petounis, A.; Gogou, L.; Pagou, M.; Dalianis, K.; Efthimiadou, R.; Andreou, J.

    2006-12-01

    AimTo determine true-positive and true-negative rates of PET/CT studies in the staging of lung cancer as compared with conventional imaging (CT and bone scan and occasionally MRI) and the impact of PET/CT on the treatment strategy in patients with lung cancer. Materials and methodTwenty patients (21 studies) with known or suspected lung cancer (14 patients with non-small-cell lung cancer (NSCLC), three patients with small-cell lung cancer (SCLC), three patients with solitary pulmonary nodule underwent initial staging (seven studies) or restaging (14 studies) with combined FDG PET and CT scans on a PET/CT tomograph. PET/CT images were evaluated separately by two nuclear medicine physicians and two radiologists specialized on PET, CT, and MRI. Histology results and a more than 6 months follow-up served as the reference standards. ResultsAccurate diagnosis was achieved on 16 studies. Site-by-site analysis gave the following results: 16 true-positive sites (seven on histology, nine on >6 months follow-up), six true-negative sites (two on histology, four on >6 months follow-up). On PET/CT, six patients were correctly down-staged, three patients were correctly upstaged and seven patients were diagnosed correctly as being on the same stage (2/7 with increase of extent of disease, 5/7 with the same extent of disease). One patient was falsely upstaged and three patients were falsely down-staged. On the basis of PET/CT results, change of management was induced in six patients, while in 14 patients there was no change induced. In five cases PET/CT was partially accurate: on site-by-site analysis, four sites proved true positive (on histology), one site false positive (on histology), and four sites false negative (one on histology, three on >6 months follow-up). ConclusionIn our early experience, PET/CT contributed significantly to correct staging and management of patients with lung cancer.

  14. A questionnaire survey of resuscitation equipment carried by general practitioners and their initial management of ventricular fibrillation.

    PubMed Central

    West, R J; Penfold, N

    1997-01-01

    BACKGROUND: The early defibrillation of patients having a cardiac arrest and who are in ventricular fibrillation has been shown to increase survival and is recommended by the European Resuscitation Council (ERC) and the American Heart Association. General practitioners (GPs) may expect to encounter a cardiac arrest in 5% of patients they attend who have a suspected acute myocardial infarction. AIM: To establish whether GPs on call were equipped to treat a patient in ventricular fibrillation, and to investigate their knowledge of the early stages of the current ERC guidelines for this cardiac rhythm. METHOD: A postal questionnaire was sent to all the 175 GPs who regularly admit patients to the West Suffolk Hospital. It asked for details of equipment and drugs carried when on call, recognition of a cardiac rhythm strip of ventricular fibrillation, and treatment to be given for this rhythm. RESULTS: A total of 105 replies were returned (representing a 60% response rate). The distribution of practice size and location reflected primary health care in this area. Fourteen GPs (13%) had attended an advanced cardiac life-support course at some time, and 44 (41.9%) had read the current ERC guidelines. The majority of GPs (60%) carried advanced airway management equipment to allow endotracheal intubation, but only 37 (35%) would have been able to administer additional oxygen. Again, most (82%) would have been able to establish intravenous access, but only 39% carried 2 mg or more of adrenaline, the only recommended drug in the initial stages of resuscitation from ventricular fibrillation. A defibrillator was carried by 37 GPs (35%) when on call, but out of these only 14 had an integral monitor screen and 3 were semi-automatic defibrillators. Ninety-five GPs (91%) successfully identified ventricular fibrillation, but only 32 (31%) were able to state correctly the initial recommended treatment, and only 17 (16%) were able to quote the first two stages of the ERC guidelines of

  15. Assistive Technology as a Self-Management Tool for Prompting Students with Intellectual Disabilities to Initiate and Complete Daily Tasks: A Literature Review

    ERIC Educational Resources Information Center

    Mechling, Linda C.

    2007-01-01

    This paper summarizes the results of a review of the empirical literature (1990-2005) focusing on use of assistive technology as a self-management tool for persons with intellectual disabilities. Forty investigations were identified which provided information on assistive technology to assist persons with disabilities to initiate and complete…

  16. Public health incident management: Logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    PubMed

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

  17. Public health incident management: logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico.

    PubMed

    Cruz, Miguel A; Hawk, Nicole M; Poulet, Christopher; Rovira, Jose; Rouse, Edward N

    2015-01-01

    Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

  18. SDI (Strategic Defense Initiative) Battle Management/C3 (Command, Control, and Communications) Networking Technology Program Plan

    DTIC Science & Technology

    1988-12-01

    Copy 20 o5o 00 IDA MEMORANDUM REPORT M-305 CDNN N 3 SDI BATTLE MANAGEMENT/C NETWORKING ! TECHNOLOGY PROGRAM PLAN Robert Botta Sharon Noll December...Battle Management/C3 Networking Technology Program Plan 12. PERSONAL AUTHOR(S). Robert Botta, Sharon Noll 12. TYPE OF REPORT 3b. TIME COVERED 14. DATE OF...The Institute for Defense Analyses (IDA) has collected and analyzed information on network technology that is relevant to Battle Management Command

  19. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.

    PubMed

    Baughman, Kristin R; Aultman, Julie; Hazelett, Susan; Palmisano, Barbara; O'Neill, Anne; Ludwick, Ruth; Sanders, Margaret

    2012-01-01

    To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.

  20. Lesson of the month 2: Catecholamine-induced cardiomyopathy - pitfalls in diagnosis and medical management.

    PubMed

    Mamoojee, Yaasir; Arham, Munawar; Elsaify, Wael; Nag, Sath

    2016-04-01

    Cardiomyopathy as the initial presentation of phaeochromocytoma (PCA) is uncommon. Diagnostic work-up and perioperative management may be challenging within this context. We report three cases of PCA presenting with cardiomyopathy to illustrate the pitfalls in diagnosis and management. None of the patients had typical adrenergic symptoms and all three were established on beta-blockers prior to diagnosis. Their fractionated plasma catecholamine levels were elevated and the diagnosis of PCA was confirmed with various imaging modalities and post adrenalectomy. Interpretation of fractionated catecholamine levels in the context of established cardiomyopathy is difficult as cardiac failure of any aetiology generates an adrenergic response. Hence screening all patients with idiopathic cardiomyopathy is likely to generate a high false-positive rate. However, a high index of suspicion should prompt further diagnostic work-up in patients with idiopathic cardiomyopathy for occult PCAs. Peer-reviewed guidelines are required to guide the investigation and management of suspected catecholamine-induced cardiomyopathy.

  1. Opportunities and Challenges in Training Elementary School Teachers in Classroom Management: Initial Results from Classroom Management in Action, an Online Professional Development Program

    ERIC Educational Resources Information Center

    Marquez, Brion; Vincent, Claudia; Marquez, Jessie; Pennefather, Jordan; Smolkowski, Keith; Sprague, Jeffrey

    2016-01-01

    Classroom management remains a challenge for many teachers. The approach and delivery of professional development (PD) in classroom management may determine how well teachers are able to apply evidence-based approaches in their classrooms. We use existing literature to identify the key features that make in-service PD effective and present them as…

  2. Added value of semi-quantitative breast-specific gamma imaging in the work-up of suspicious breast lesions compared to mammography, ultrasound and 3-T MRI

    PubMed Central

    Seymer, A; Keinrath, P; Holzmannhofer, J; Pirich, C; Hergan, K; Meissnitzer, M W

    2015-01-01

    Objective: To prospectively analyse the diagnostic value of semi-quantitative breast-specific gamma imaging (BSGI) in the work-up of suspicious breast lesions compared with that of mammography (MG), breast ultrasound and MRI of the breast. Methods: Within a 15-month period, 67 patients with 92 breast lesions rated as Category IV or V according to the breast imaging reporting and data system detected with MG and/or ultrasound were included into the study. After the injection of 740–1110 MBq of Technetium-99m (99mTc) SestaMIBI intravenously, scintigrams were obtained in two projections comparable to MG. The BSGI was analysed visually and semi-quantitatively by calculating a relative uptake factor (X). With the exception of two patients with cardiac pacemakers, all patients underwent 3-T breast MRI. Biopsy results were obtained as the reference standard in all patients. Sensitivity, specificity, positive- and negative-predictive values, accuracy and area under the curve were calculated for each modality. Results: Among the 92 lesions, 67 (72.8%) were malignant. 60 of the 67 cancers of any size were detected by BSGI with an overall sensitivity of 90%, only exceeded by ultrasound with a sensitivity of 99%. The sensitivity of BSGI for lesions <1 cm declined significantly to 60%. Overall specificity of ultrasound was only 20%. Specificity, accuracy and positive-predictive value were the highest for BSGI (56%, 80% and 85%, respectively). X was significantly higher for malignant lesions (mean, 4.27) and differed significantly between ductal types (mean, 4.53) and the other histopathological entities (mean, 3.12). Conclusion: Semi-quantitative BSGI with calculation of the relative uptake factor (X) can help to characterize breast lesions. BSGI negativity may obviate the need for biopsy of breast lesions >1 cm with low or intermediate prevalence for malignancy. Advances in knowledge: Compared with morphological imaging modalities, specificity, positive

  3. Initial Cholecystectomy with Cholangiography Decreases Length of Stay Compared to Preoperative MRCP or ERCP in the Management of Choledocholithiasis.

    PubMed

    Lin, Christine; Collins, Jay N; Britt, Rebecca C; Britt, Lunzy D

    2015-07-01

    There are several treatments available for choledocholithiasis, but the optimal treatment is highly debated. Some advocate preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) with cholangiography (IOC). Others advocate initial LC + IOC followed by common bile duct exploration or ERCP. The purpose of this study was to determine whether initial LC + IOC had a shorter length of stay (LOS) compared with preoperative magnetic resonance cholangiopancreatography (MRCP) or ERCP. Patients who underwent cholecystectomy between 2012 and 2013 at two institutions were reviewed. Patients were selected if they had suspected choledocholithiasis, indicated by dilated CBD and/or elevated bilirubin, or confirmed choledocholithiasis. They were excluded if they had pancreatitis or cholangitis. There were 126 patients with suspected choledocholithiasis in this study. Of these, 97 patients underwent initial LC ± IOC with an average LOS of 3.9 days. IOC was negative in 47.4 per cent patients, and they had a shorter LOS compared with positive IOC patients (2.93 vs 4.82, P < 0.001). Laparoscopic common bile duct exploration was successful in 64.7 per cent and had a shorter LOS compared with postoperative ERCP patients (P = 0.01). Preoperative MRCP was performed in 21 patients with an average LOS of 6.48 days. Preoperative ERCP was performed in eight patients with an average LOS of seven days. Initial LC+IOC is associated with a shorter LOS compared to preoperative MRCP or ERCP. It is recommended as the optimal treatment choice for suspected choledocholithiasis.

  4. 75 FR 40759 - Initiation of Review of Management Plan/Regulations of the Hawaiian Islands Humpback Whale...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-14

    .../Regulations of the Hawaiian Islands Humpback Whale National Marine Sanctuary; Intent To Prepare Draft...) has initiated a review of the Hawaiian Islands Humpback Whale National Marine Sanctuary (HIHWNMS or... Hawaiian Islands Humpback Whale National Marine Sanctuary will be considered if received on or...

  5. Determinants of "Community Participation": The Tradition of Local Initiatives and the Institutionalisation of School Management Committees in Oromia Region, Ethiopia

    ERIC Educational Resources Information Center

    Yamada, Shoko

    2014-01-01

    A School Management Committee (SMC) is an administrative tool adopted in many developing countries to decentralise administrative and financial responsibilities at school level, while involving local people in decision-making and making education more responsive to demands. I question the assumption linking administrative decentralisation and…

  6. Student-Initiated Use of Multilingual Resources in English-Language Classroom Interaction: Next-Turn Management

    ERIC Educational Resources Information Center

    Ziegler, Gudrun; Sert, Olcay; Durus, Natalia

    2012-01-01

    This paper investigates the use of multilingual resources by plurilingual participants in two English language classrooms in Luxembourg. Using Conversation Analysis and drawing on transcriptions of video-recordings, we present three examples of student use of multilingual resources and their respective teacher next turn management (through…

  7. On the development and implementation of ecosystem management plans for water resources in the Great Lakes: A case study of the RAP initiative

    SciTech Connect

    MacKenzie, S.H.

    1991-01-01

    The ecosystem approach to water resource management is deceptively simple: one must recognize the interrelationships among water, land, air, and all living things and undertake resource planning in such a way that the integrity of the natural system is preserved. Significant features of the ecosystem approach include its watershed boundaries, its holistic orientation, and its assumption that humans should be viewed as part of, rather than apart from, the natural system. A theme of environmental ethics and education underlies the approach. Although it seems straightforward, the ecosystem approach has important implications for water management. In 1985, the International Joint Commission challenged government agencies to utilize the ecosystem approach to develop Remedial Action Plans to rehabilitate forty-two hotspots across the Great Lakes Basin. This initiative represented a first effort to implement the ecosystem approach in the Great Lakes. The research questions were: what does ecosystem management mean in the context of the RAP process, and how can one increase the likelihood of successful implementation of ecosystem management plans The research proposition suggests that there are three preconditions to ecosystem management: participation; decision making; and legitimacy. Comparative case studies of Green Bay, Wisconsin; Saginaw Bay, Michigan; and Hamilton Harbor, Ontario were undertaken. Thirty-five RAP participants were chosen for on-site indepth interviews. Data were arrayed by respondent, question, and case, and were analyzed for content.

  8. 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.

  9. An Examination of the Total Quality Management (TQM) Concept Given Current Federal/DoD Competition Initiatives

    DTIC Science & Technology

    1992-06-01

    Feigenbaum , Total Quality Control, p. 1) 15 Garvin also identifies what he believes are the components of quality . His list includes: 1) Performance 5 ...implementation has been directed for the entire Department of Defense (DoD) by the Secretary of Defense. TQM is an innovative approach to quality control. TQM...examine the numerous approaches to defining and, therefore, understanding the components of quality are found in the book Managing Quality and in

  10. The Benefits of Collaborative Processes for Establishing All Hazard Incident Management Teams in Urban Area Security Initiative Regions

    DTIC Science & Technology

    2013-09-01

    Metropolitan Medical Response System NAPA National Academy of Public Administration NIMS National Incident Management System NWCG National...Public Administration’s ( NAPA ) definition of partnership “as a mutually-beneficial and reciprocal relationship where entities share responsibilities...authority, and accountability for results.”51 NAPA defines collaboration as “joint work effort with shared responsibilities for mutually defined goals

  11. Defense Management: More Reliable Cost Estimates and Further Planning Needed to Inform the Marine Corps Realignment Initiatives in the Pacific

    DTIC Science & Technology

    2013-06-01

    approximately 200 Marines from Fox Company, 2nd Battalion, 3rd Marine Division from their home station at Marine Corps Base Hawaii, Kaneohe Bay, to Darwin ...Australia Page 37 GAO-13-360 Defense Management Task Force in Australia, the Marine Corps rotated approximately 200 Marines to Darwin ...addition to the contact named above, Laura Durland, Assistant Director; Jeff Hubbard; Gilbert Kim; Joanne Landesman; Ying Long; Charles Perdue

  12. An analysis of the effect of STEM initiatives on socially responsible diversity management in the US aerospace and defense industry

    NASA Astrophysics Data System (ADS)

    Johnson-Oliver, Patrick

    Workforce diversity is a growing concern at a global level and enlightened economic self-interest and corporate image compels industries to leverage it as a competitive advantage. The US aerospace and defense industry (US ADI) addresses workforce diversity through socially responsible diversity management. Prior research into the topic of approaching workforce diversity as a business rationale and a moral imperative has been limited. Scharmer and Kaufer's (2013) Theory U guided this longitudinal explanatory quantitative study, leading from the future as it emerged relative to socially responsible diversity management to compel industry to remove blind spots and co-create an economy that benefits all by promoting workforce diversity as a dual agenda. This study filled a research gap investigating the business case for diversity as a dual agenda in aerospace industry science, technology, engineering, and mathematics (STEM) disciplines. The study also investigated the America COMPETES Act as a moderator of the relationship between historically black colleges and universities (HBCUs) and industry. Data was retrieved for secondary data analysis from the National Science Foundation (NSF) and other public government services and agency websites. Two hypotheses were tested using quantitative analysis including descriptive statistics, linear regression, ANOVA, and two factor analysis. The statistical results were analyzed and deductive logic employed to develop conclusions for the study. There was a significant relationship found between both predictors and socially responsible diversity management. The results reinforce the necessity for the aerospace defense industry to promote the dual agenda of the business case for diversity as complementary; not as competing mandates.

  13. Total body computed tomography scan in the initial work-up of Binet stage A chronic lymphocytic leukemia patients: Results of the prospective, multicenter O-CLL1-GISL study.

    PubMed

    Gentile, Massimo; Cutrona, Giovanna; Fabris, Sonia; Pesce, Emanuela Anna; Baldini, Luca; Di Raimondo, Francesco; Musolino, Caterina; Di Tonno, Paolo; Di Renzo, Nicola; Molica, Stefano; Brugiatelli, Maura; Ilariucci, Fiorella; Zupo, Simona; Matis, Serena; Maura, Francesco; Vigna, Ernesto; Angrilli, Francesco; Recchia, Anna Grazia; Quarta, Giovanni; Iannitto, Emilio; Fragasso, Alberto; Musto, Pellegrino; Spriano, Mauro; Vincelli, Iolanda; Vallisa, Daniele; Cortelezzi, Agostino; Mauro, Francesca Romana; Foà, Robin; Federico, Massimo; Neri, Antonino; Ferrarini, Manlio; Morabito, Fortunato

    2013-07-01

    Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were restaged considering only radiological data. Following TB-CT scans, 20% of cases reclassified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P = 0.027), as well as a shorter PFS (P = 0.001). At multivariate analysis, r-Binet stage [HR = 2.48; P = 0.004] and IGHV mutational status [HR = 3.01; P = 0.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were redefined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P = 0.033) and CD38 expression (P = 0.029) and β2-microglobulin levels (P < 0.0001), as well as a shorter PFS than those with r-Rai low-risk (P = 0.008). r-Rai stage [HR = 2.78; P = 0.046] and IGHV mutational status [HR = 4.25; P = 0.009] retained a significant predictive value for PFS at multivariate analysis. Forty-two percent of cMBL patients were reclassified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.

  14. Implementation of novel biomarkers in the diagnosis, prognosis, and management of acute kidney injury: executive summary from the tenth consensus conference of the Acute Dialysis Quality Initiative (ADQI).

    PubMed

    McCullough, Peter A; Bouchard, Josee; Waikar, Sushrut S; Siew, Edward D; Endre, Zoltan H; Goldstein, Stuart L; Koyner, Jay L; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L; Meehan, Shane; Kellum, John A; Haase, Michael; Murray, Patrick T; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M; Chawla, Lakhmir S; Mehta, Ravindra L; Shaw, Andrew D; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures.

  15. Implementation of Novel Biomarkers in the Diagnosis, Prognosis, and Management of Acute Kidney Injury: Executive Summary from the Tenth Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

    PubMed Central

    McCullough, Peter A.; Bouchard, Josee; Waikar, Sushrut S.; Siew, Edward D.; Endre, Zoltan H.; Goldstein, Stuart L.; Koyner, Jay L.; Macedo, Etienne; Doi, Kent; Di Somma, Salvatore; Lewington, Andrew; Thadhani, Ravi; Chakravarthi, Raj; Ice, Can; Okusa, Mark D.; Duranteau, Jacques; Doran, Peter; Yang, Li; Jaber, Bertrand L.; Meehan, Shane; Kellum, John A.; Haase, Michael; Murray, Patrick T.; Cruz, Dinna; Maisel, Alan; Bagshaw, Sean M.; Chawla, Lakhmir S.; Mehta, Ravindra L.; Shaw, Andrew D.; Ronco, Claudio

    2013-01-01

    Detection of acute kidney injury is undergoing a dynamic revolution of biomarker technology allowing greater, earlier, and more accurate determination of diagnosis, prognosis, and with powerful implication for management. Biomarkers can be broadly considered as any measurable biologic entity or process that allows differentiation between normal function and injury or disease. The ADQI (Acute Dialysis Quality Initiative) had its Ninth Consensus Conference dedicated to synthesis and formulation of the existing literature on biomarkers for the detection of acute kidney injury in a variety of settings. In the papers that accompany this summary, ADQI workgroups fully develop key concepts from a summary of the literature in the domains of early diagnosis, differential diagnosis, prognosis and management, and concurrent physiologic and imaging measures. PMID:23689652

  16. Municipal initiatives for managing dunes in coastal residential areas: a case study of Avalon, New Jersey, USA

    NASA Astrophysics Data System (ADS)

    Nordstrom, Karl F.; Jackson, Nancy L.; Bruno, Michael S.; de Butts, Harry A.

    2002-10-01

    The characteristics of foredunes created in a municipal management program on a developed barrier island are evaluated to identify how landforms used as protection structures can be natural in appearance and function yet compatible with human values. Shoreline management zones include a naturally evolving, undeveloped segment; a noneroding, developed segment; eroding and noneroding segments of an "improved beach" where dunes have been built by artificial nourishment; and a privately built, artificially nourished dune on the shoreline of an inlet. A disastrous storm in 1962 resulted in an aggressive program for building dunes using sand fences, vegetation plantings, purchase of undeveloped lots, and sediment backpassing to maintain beach widths and dune elevations. The present nourished and shaped foredune in the improved beach is higher, wider, and closer to the berm crest than the natural dune. Restricted inputs of aeolian sand keep the surface flat and poorly vegetated. A stable section of this engineered shore has a wider beach, and sand fences have created a higher foredune with greater topographic diversity. The cross shore zonation of vegetation here is more typical of natural dunes, but the environmental gradient is much narrower. The privately built dune is low, narrow, and located where it could not be created naturally. Foreshore and aeolian sediments in the undeveloped segment and the improved beach are similar in mean grain size (0.16-0.21 mm) and sorting (0.31-0.39 φ), but sediment on the surface of the nourished dune is coarser (28.1% gravel) with a more poorly sorted sand fraction (1.30 φ) representing lag elements on the deflation surface. Willingness to enhance beaches and dunes for protection has reduced insurance premiums and allowed the municipality to qualify for funds from the Federal Emergency Management Agency (FEMA) to replace lost sediment, thus placing an economic value on dunes. Success of the management program is attributed to: (i

  17. Identify-Isolate-Inform: A Tool for Initial Detection and Management of Measles Patients in the Emergency Department

    PubMed Central

    Koenig, Kristi L.; Alassaf, Wajdan; Burns, Michael J.

    2015-01-01

    Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S. in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreak beginning in 2014 that has become a public health emergency. The “Identify-Isolate-Inform” tool will assist emergency physicians to be better prepared to detect and manage measles patients presenting to the emergency department. Measles typically presents with a prodrome of high fever, and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots. Two to four days later, an erythematous maculopapular rash begins on the face and spreads down the body. Suspect patients must be immediately isolated with airborne precautions while awaiting laboratory confirmation of disease. Emergency physicians must rapidly inform the local public health department and hospital infection control personnel of suspected measles cases. PMID:25834659

  18. Selective laser trabeculoplasty compared with medical treatment for the initial management of open angle glaucoma or ocular hypertension.

    PubMed

    Pérez, Efraín; Rada, Gabriel; Maul, Eugenio

    2015-12-16

    Selective laser trabeculoplasty is a relatively new therapeutic alternative for the management of open angle glaucoma and ocular hypertension. On the other hand, medical treatment has robust data supporting its efficacy and has progressed in last decades with the introduction of prostaglandin analogues. To compare these two therapies, we searched Epistemonikos database, which is maintained by screening 30 databases, and identified four systematic reviews including four randomized and one non-randomized clinical trial. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that selective laser trabeculoplasty leads to a smaller absolute intraocular pressure reduction than medical treatment. However, it is not clear if there are differences in treatment success rate or need of additional antiglaucomatous interventions, because the quality of the evidence is low.

  19. Identify-isolate-inform: a tool for initial detection and management of measles patients in the emergency department.

    PubMed

    Koenig, Kristi L; Alassaf, Wajdan; Burns, Michael J

    2015-03-01

    Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S. in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreak beginning in 2014 that has become a public health emergency. The "Identify-Isolate-Inform" tool will assist emergency physicians to be better prepared to detect and manage measles patients presenting to the emergency department. Measles typically presents with a prodrome of high fever, and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots. Two to four days later, an erythematous maculopapular rash begins on the face and spreads down the body. Suspect patients must be immediately isolated with airborne precautions while awaiting laboratory confirmation of disease. Emergency physicians must rapidly inform the local public health department and hospital infection control personnel of suspected measles cases.

  20. Public policy and risk financing strategies for global catastrophe risk management - the role of global risk initiatives

    NASA Astrophysics Data System (ADS)

    McSharry, Patrick; Mitchell, Andrew; Anderson, Rebecca

    2010-05-01

    Decision-makers in both public and private organisations depend on accurate data and scientific understanding to adequately address climate change and the impact of extreme events. The financial impacts of catastrophes on populations and infrastructure can be offset through effective risk transfer mechanisms, structured to reflect the specific perils and levels of exposure to be covered. Optimal strategies depend on the likely socio-econonomic impact, the institutional framework, the overall objectives of the covers placed and the level of both the frequency and severity of loss potential expected. The diversity of approaches across different countries has been documented by the Spanish "Consorcio de Compensación de Seguros". We discuss why international public/private partnerships are necessary for addressing the risk of natural catastrophes. International initiatives such as the Global Earthquake Model (GEM) and the World Forum of Catastrophe Programmes (WFCP) can provide effective guidelines for constructing natural catastrophe schemes. The World Bank has been instrumental in the creation of many of the existing schemes such as the Turkish Catastrophe Insurance Pool, the Caribbean Catastrophe Risk Insurance Facility and the Mongolian Index-Based Livestock Insurance Program. We review existing schemes and report on best practice in relation to providing protection against natural catastrophe perils. The suitability of catastrophe modelling approaches to support schemes across the world are discussed and we identify opportunities to improve risk assessment for such schemes through transparent frameworks for quantifying, pricing, sharing and financing catastrophe risk on a local and global basis.

  1. United States of America activities relative to the International Atomic Energy Agency (IAEA) initiative: Records management for deep geologic repositories

    SciTech Connect

    Warner, P.J.

    1997-03-01

    The International Atomic Energy Agency (IAEA) has conducted consultant and advisory meetings to prepare a Technical Document which is intended to provide guidance to all IAEA Member States (otherwise known as countries) that are currently planning, designing, constructing or operating a deep or near surface geological repository for the storage and protection of vitrified high-level radioactive waste, spent fuel waste and TRU-waste (transuranic). Eleven countries of the international community are presently in various stages of siting, designing, or constructing deep geologic repositories. Member States of the IAEA have determined that the principle safety of such completed and operation sites must not rely solely on long term institutional arrangements for the retention of information. It is believed that repository siting, design, operation and postoperation information should be gathered, managed and retained in a manner that will provide information to future societies over a very long period of time. The radionuclide life is 10,000 years thus the retention of information must outlive current societies, languages, and be continually migrated to new technology to assure retrieval. This presentation will provide an overview of the status of consideration and implementation of these issues within the United States efforts relative to deep geologic repository projects.

  2. Assistance to Oil and Gas State Agencies and Industry through Continuation of Environmental and Production Data Management and a Water Regulatory Initiative

    SciTech Connect

    Grunewald, Ben; Arthur, Dan; Langhus, Bruce; Gillespie, Tom; Binder, Ben; Warner, Don; Roberts, Jim; Cox, D.O.

    2002-05-31

    This grant project was a major step toward completion of the Risk Based Data Management System (RBDMS) project. Additionally the project addresses the needs identified during the projects initial phases. By implementing this project, the following outcomes were sought: (1) State regulatory agencies implemented more formalized environmental risk management practices as they pertain to the production of oil and gas, and injection via Class II wells. (2) Enhancement of oil and gas production by implementing a management system supporting the saving of abandoned or idle wells located in areas with a relatively low environmental risk of endangering underground sources of drinking water (USDWs) in a particular state. (3) Verification that protection of USDWs is adequate and additional restrictions of requirements are not necessary in areas with a relatively low environmental risk. (4) Standardization of data and information maintained by state regulatory agencies and decrease the regulatory cost burden on producers operating in multiple states, and (5) Development of a system for electronic data transfer among operators and state regulatory agencies and reduction of overall operator reporting burdens.

  3. Initial assessment of the benefits of implementing pharmacogenetics into the medical management of patients in a long-term care facility

    PubMed Central

    Saldivar, Juan-Sebastian; Taylor, David; Sugarman, Elaine A; Cullors, Ali; Garces, Jorge A; Oades, Kahuku; Centeno, Joel

    2016-01-01

    The health care costs associated with prescription drugs are enormous, particularly in patients with polypharmacy (taking more than five prescription medications), and they continue to grow annually. The evolution of pharmacogenetics has provided clinicians with a valuable tool that allows for a smarter, more fine-tuned approach to treating patients for a number of clinical conditions. Applying a pharmacogenetics approach to the medical management of patients can provide a significant improvement to their care, result in cost savings by reducing the use of ineffective drugs, and decrease overall health care utilization. AltheaDx has begun a study to look at the benefits associated with incorporating pharmacogenetics into the medical management of patients who are on five or more medications. Applying pharmacogenetic guided PharmD recommendations across this patient population resulted in the elimination and/or replacement of one to three drugs, for 50% of the polypharmacy patient population tested, and an estimated US$621 in annual savings per patient. The initial assessment of this study shows that there is a clear opportunity for concrete health care savings solely from prescription drug management when incorporating pharmacogenetic testing. PMID:26855597

  4. Introduction to cardiac imaging in infants and children: techniques, potential, and role in the imaging work-up of various cardiac malformations and other pediatric heart conditions.

    PubMed

    Bailliard, Frederique; Hughes, Marina L; Taylor, Andrew M

    2008-11-01

    The increasing prevalence of congenital heart disease (CHD) can be attributed to major improvements in diagnosis and treatment. Although echocardiography is the most commonly used imaging modality for diagnosis and follow-up of subjects with CHD, the evolution of cardiovascular magnetic resonance (MR) imaging and increasingly computed tomography (CT) does offer new ways to visualize the heart and the great vessels. The development of cardiovascular MR techniques allows for a comprehensive assessment of cardiac anatomy and function. This provides information about the long-term sequlae of the underlying complex anatomy, hemodynamic assessment of residual post-operative lesions and complications of surgery. As much of the functional data in CHD patients is usually acquired with invasive X-ray angiography, non-invasive alternatives such as cardiovascular MR (and CT) are desirable. This review evaluates the role of MR imaging in the management of subjects with CHD, particularly detailing recent developments in imaging techniques as they relate to the various CHD diagnoses we commonly encounter in our practice.

  5. A degree-day model initiated by pheromone trap captures for managing pecan nut casebearer (Lepidoptera: Pyralidae) in pecans.

    PubMed

    Knutson, Allen E; Muegge, Mark A

    2010-06-01

    Field observations from pecan, Carya illinoinensis (Wangenh.) Koch, orchards in Texas were used to develop and validate a degree-day model of cumulative proportional adult flight and oviposition and date of first observed nut entry by larvae of the first summer generation of the pecan nut casebearer, Acrobasis nuxvorella Nuenzig (Lepidoptera: Pyralidae). The model was initiated on the date of first sustained capture of adults in pheromone traps. Mean daily maximum and minimum temperatures were used to determine the sum of degree-days from onset to 99% moth flight and oviposition and the date on which first summer generation larvae were first observed penetrating pecan nuts. Cumulative proportional oviposition (y) was described by a modified Gompertz equation, y = 106.05 x exp(-(exp(3.11 - 0.00669 x (x - 1), with x = cumulative degree-days at a base temperature of 3.33 degrees C. Cumulative proportional moth flight (y) was modeled as y = 102.62 x exp(- (exp(1.49 - 0.00571 x (x - 1). Model prediction error for dates of 10, 25, 50, 75, and 90% cumulative oviposition was 1.3 d and 83% of the predicted dates were within +/- 2 d of the observed event. Prediction error for date of first observed nut entry was 2.2 d and 77% of model predictions were within +/- 2 d of the observed event. The model provides ample lead time for producers to implement orchard scouting to assess pecan nut casebearer infestations and to apply an insecticide if needed to prevent economic loss.

  6. Evaluation of computer-aided system design tools for SDI (Strategic Defense Initiative) Battle Management/C3 (command, control and communications) architecture development. Final report

    SciTech Connect

    Fife, D.W.; Campbell, K.; Chludzinski, J.; Corcoran, N.; Gonzalez, C.

    1987-10-01

    This IDA paper was prepared at the request of the Strategic Defense Initiative Organization. The paper documents findings of an evaluation on the capabilities of certain computer software/computer-aided software engineering (CASE) tools to provide computer-aided graphic design of Battle Management/C3 for the SDIO. Each tool (of the five selected on the basis of the best available at this time), was installed at IDA. After training by vendor tool staff, an IDA team, using a hands-on design experience determined the merits of the tools for SDI application. A comparative summary of the tools is given relative to envisaged SDI requirements and an extensive questionnaire is answered for each.

  7. A review of initial investigations to utilize ERTS-1 data in determining the availability and distribution of living marine resources. [fish harvesting and management in Gulf of Mexico

    NASA Technical Reports Server (NTRS)

    Stevenson, W. H.; Kemmerer, A. J.; Atwell, B. H.; Maughan, P. M.

    1974-01-01

    This study was initiated in July 1972 to determine the reliability of satellite and high altitude sensors to provide data about oceanographic parameters in coastal waters; demonstrate the use of remotely sensed oceanographic information to predict the distribution and abundance of adult menhaden; and, demonstrate the potential of using satellite acquired information for improving the harvest and management of a fishery resource. The study focused on coastal are as in the north central portion of the Gulf of Mexico including parts of Alabama, Mississippi and Louisiana. The area used in the final analysis was limited to the Mississippi Sound, which is approximately 145 kilometers (90 miles) long and 16 kilometers (10 miles) wide, has an average water depth of about 3.7 meters (12 feet), and in general characterizes an estuarine environment.

  8. From their own perspective - constraints in the Polio Eradication Initiative: perceptions of health workers and managers in a district of Pakistan's Punjab province

    PubMed Central

    2010-01-01

    Background The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions. Methods A qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis. Results The main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization. Conclusion The study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in

  9. A Critical Assessment of Marine Aquarist Biodiversity Data and Commercial Aquaculture: Identifying Gaps in Culture Initiatives to Inform Local Fisheries Managers

    PubMed Central

    Murray, Joanna M.; Watson, Gordon J.

    2014-01-01

    It is widely accepted that if well managed, the marine aquarium trade could provide socio-economic stability to local communities while incentivising the maintenance of coral reefs. However, the trade has also been implicated as having potentially widespread environmental impacts that has in part driven developments in aquaculture to relieve wild collection pressures. This study investigates the biodiversity in hobbyist aquaria (using an online survey) and those species currently available from an aquaculture source (commercial data and hobbyist initiatives) in the context of a traffic light system to highlight gaps in aquaculture effort and identify groups that require fisheries assessments. Two hundred and sixty nine species including clown fish, damsels, dotty backs, angelfish, gobies, sea horses and blennies, have reported breeding successes by hobbyists, a pattern mirrored by the European and US commercial organisations. However, there is a mismatch (high demand and low/non-existent aquaculture) for a number of groups including tangs, starfish, anemones and hermit crabs, which we recommend are priority candidates for local stock assessments. Hobbyist perception towards the concept of a sustainable aquarium trade is also explored with results demonstrating that only 40% of respondents were in agreement with industry and scientists who believe the trade could be an exemplar of a sustainable use of coral reefs. We believe that a more transparent evidence base, including the publication of the species collected and cultured, will go some way to align the concept of a sustainable trade across industry stakeholders and better inform the hobbyist when purchasing their aquaria stock. We conclude by proposing that a certification scheme established with government support is the most effective way to move towards a self-regulating industry. It would prevent industry “greenwashing” from multiple certification schemes, alleviate conservation concerns, and, ultimately

  10. A critical assessment of marine aquarist biodiversity data and commercial aquaculture: identifying gaps in culture initiatives to inform local fisheries managers.

    PubMed

    Murray, Joanna M; Watson, Gordon J

    2014-01-01

    It is widely accepted that if well managed, the marine aquarium trade could provide socio-economic stability to local communities while incentivising the maintenance of coral reefs. However, the trade has also been implicated as having potentially widespread environmental impacts that has in part driven developments in aquaculture to relieve wild collection pressures. This study investigates the biodiversity in hobbyist aquaria (using an online survey) and those species currently available from an aquaculture source (commercial data and hobbyist initiatives) in the context of a traffic light system to highlight gaps in aquaculture effort and identify groups that require fisheries assessments. Two hundred and sixty nine species including clown fish, damsels, dotty backs, angelfish, gobies, sea horses and blennies, have reported breeding successes by hobbyists, a pattern mirrored by the European and US commercial organisations. However, there is a mismatch (high demand and low/non-existent aquaculture) for a number of groups including tangs, starfish, anemones and hermit crabs, which we recommend are priority candidates for local stock assessments. Hobbyist perception towards the concept of a sustainable aquarium trade is also explored with results demonstrating that only 40% of respondents were in agreement with industry and scientists who believe the trade could be an exemplar of a sustainable use of coral reefs. We believe that a more transparent evidence base, including the publication of the species collected and cultured, will go some way to align the concept of a sustainable trade across industry stakeholders and better inform the hobbyist when purchasing their aquaria stock. We conclude by proposing that a certification scheme established with government support is the most effective way to move towards a self-regulating industry. It would prevent industry "greenwashing" from multiple certification schemes, alleviate conservation concerns, and, ultimately

  11. The spectral database Specchio: Data management, data sharing and initial processing of field spectrometer data within the Dimensions of Biodiversity project

    NASA Astrophysics Data System (ADS)

    Hueni, A.; Schweiger, A. K.

    2015-12-01

    Field spectrometry has substantially gained importance in vegetation ecology due to the increasing knowledge about causal ties between vegetation spectra and biochemical and structural plant traits. Additionally, worldwide databases enable the exchange of spectral and plant trait data and promote global research cooperation. This can be expected to further enhance the use of field spectrometers in ecological studies. However, the large amount of data collected during spectral field campaigns poses major challenges regarding data management, archiving and processing. The spectral database Specchio is designed to organize, manage, process and share spectral data and metadata. We provide an example for using Specchio based on leaf level spectra of prairie plant species collected during the 2015 field campaign of the Dimensions of Biodiversity research project, conducted at the Cedar Creek Long-Term Ecological Research site, in central Minnesota. We show how spectral data collections can be efficiently administered, organized and shared between distinct research groups and explore the capabilities of Specchio for data quality checks and initial processing steps.

  12. Engaging faith-based resources to initiate and support diabetes self-management among African Americans: a collaboration of informal and formal systems of care.

    PubMed

    Johnson, Patria; Thorman Hartig, Margaret; Frazier, Renee; Clayton, Mae; Oliver, Georgia; Nelson, Belinda W; Williams-Cleaves, Beverly J

    2014-11-01

    Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network.

  13. European porphyria initiative (EPI): a platform to develop a common approach to the management of porphyrias and to promote research in the field.

    PubMed

    Deybach, J-Ch; Badminton, M; Puy, H; Sandberg, S; Frank, J; Harper, P; Martasek, P; Minder, E; Parker, S; Thunell, S; Elder, G

    2006-01-01

    Porphyrias are uncommon inherited diseases of haem biosynthesis for which the diagnosis and treatment varies in individual countries. Despite the existence of guidelines recommended by porphyria experts concerning the diagnosis and management of the acute porphyrias, and of specialist centres in most European countries, many clinicians still do not apply these guidelines. The European Porphyia Initiative (EPI) network was formed in 2001 in order to compare experience among countries to attempt to develop a common approach to the management of the porphyrias, particularly concerning recommendation of safe and unsafe drugs, and to facilitate international collaborative clinical and biological research. The main achievements of EPI during this period have been: * Drafting and agreeing to consensus protocols for the diagnosis and management of acute hepatic porphyrias. * Creation of a multilingual website, particularly focusing on guidelines for common prescribing problems in acute porphyria and on providing information for patients that is now available in 10 languages: (www.porphyria-europe.org). EPI's current objectives are to develop the EPI platform, expand to new countries, extend to non-acute porphyrias and design European research and clinical trials in porphyria. The project will focus on: 1. Setting up a European laboratory external quality assurance scheme (EQAS) for biochemical and molecular investigations and their interpretation 2. Establishing a consensus drug list in collaboration with the Nordic porphyria network 3. Improving patient counseling 4. Developing large multi-centre, multi-national research projects. Due to the rarity of the porphyrias, it would be very difficult for any one country to provide this data with a sufficient number of patients and within a reasonable timescale. The progress achieved will facilitate improvements in the treatment and development of new therapeutic strategies. It will set a pattern for establishing, and

  14. FSGS: Diagnosis and Diagnostic Work-Up

    PubMed Central

    Sprangers, Ben; Meijers, Björn; Appel, Gerald

    2016-01-01

    Focal segmental glomerulosclerosis is a histologic lesion, rather than a clinical disease. FSGS is common cause of nephrotic syndrome in both adults and children worldwide. In the United States it is the most common primary glomerular disease resulting in end-stage renal disease and recent reports have suggested that its incidence might be on the rise. Currently the incidence is estimated to be 7 per million. The podocyte is the cellular target cell in FSGS and in recent years substantial insight in the pathogenesis and genetics of FSGS have accumulated. Furthermore the discovery of potential novel biomarkers to diagnose FSGS and monitor disease activity has renewed interest in this disease. In this review article we will focus on the clinical presentation and diagnosis of FSGS. PMID:27314022

  15. Work-up of the diabetic foot.

    PubMed

    Morrison, William B; Ledermann, Hans Peter

    2002-09-01

    Diabetes is a common disease with potentially devastating complications affecting the foot and ankle. A combination of vascular disease, peripheral neuropathy, and immunopathy results in a cascade of conditions including ischemia and infarction, tendinopathy, atrophy, edema, deformity, neuropathic osteoarthropathy, callus, ulceration, and infection. MRI is useful for evaluation of these complications, and assists the clinician in medical or surgical planning.

  16. Mineral bone disorder and its management among hemodialysis patients in the Gulf Cooperation Council: Initial findings from the dialysis outcomes and practice patterns study (2012-2015).

    PubMed

    Al Salmi, Issa; AlRukhaimi, Mona; AlSahow, Ali; Shaheen, Faisal A M; Al-Ghamdi, Saeed M G; AlAli, Fadwa; AlGhareeb, Sumaya; Al Maimani, Yacoub; AlGhonaim, Mohammed; Bieber, Brian; Tentori, Francesca; Pisoni, Ronald L

    2016-11-01

    The prospective cohort Dialysis Outcomes and Practice Patterns Study (DOPPS) initiated data collection in national samples of hemodialysis (HD) units (total of 41 study sites) in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in late 2012. Here, we report initial results regarding mineral bone disorders (MBDs) and its management in the GCC countries. Forty-one randomly selected HD facilities, treating >23 HD patients each, were sampled and represent care for >95% of GCC HD patients. Descriptive results for the GCC countries based on a random sample of 20-30 HD patients in each study facility. Initial results for the GCC are from 931 HD patients treated at 41 dialysis units (ranging from 1 unit in Bahrain to 21 in Saudi Arabia). Results are presented as weighted estimates, accounting for the sampling fraction in each unit. Baseline descriptive statistics (e.g., mean, median, or percentage), weighted by facility sampling fraction were calculated for the study sample. For analyses examining the percent of facility patients having (a) serum phosphorus >6.0 mg/dL or (b) parathyroid hormone (PTH) >600 pg/mL, analyses were restricted to facilities having at least 10 HD patients with a reported serum phosphorus or PTH measurement, respectively. Logistic regression analyses of the indicated binary outcomes were based on the use of generalized estimating equations and were adjusted for GCC country, patient age category (<45 years, 45-65 years, and >65 years old), sex, and whether the patient was diagnosed with diabetes mellitus. Logistic models accounted for clustering of patients within facilities, assuming an exchangeable working correlation matrix. Mean age of HD patients in the GCC countries was 53 years vs. 61-64 years in the three other DOPPS regions. MBD markers showed slightly lower mean serum Calcium in the GCC countries, similar mean serum phosphorus, and intermediate median PTH levels

  17. Expenditures associated with dose titration at initiation of therapy in patients with major depressive disorder: a retrospective analysis of a large managed care claims database.

    PubMed

    Camacho, Fabian; Kong, Meg C; Sheehan, David V; Balkrishnan, Rajesh

    2010-08-01

    OBJECTIVE.: Although selective serotonin reuptake inhibitors (SSRIs) are considered cost-effective medications for patients with major depressive disorder (MDD), significant dosage adjustments are often necessary when treatment is initiated. Our study was conducted to examine whether dose titration for SSRIs at initiation of therapy was associated with a greater use of health care resources and higher costs. STUDY DESIGN.: A retrospective database analysis was conducted. METHODS.: A nationally representative cohort of individuals with MDD was identified in a large managed care claims database between January 1, 2004, and December 31, 2006. A study-specific titration algorithm was used to identify patients who underwent dose titration, compared with those who did not, within the first eight weeks of initiating SSRI therapy. We calculated propensity scores and identified a 1:1 matched cohort of titration versus non-titration patients. We used univariate and multivariate statistical tests to compare the mean number of therapeutic days, health care service utilization, and expenditures between the two groups during the first eight weeks (56 days) of treatment and six months (180 days) after treatment began. RESULTS.: Over the first eight weeks, the titration cohort had a 32% decrease in the adjusted mean number of therapeutic days (38 vs. 56, respectively; P < 0.001), a 50% increase in depression-related outpatient visits (1.8 vs. 1.2; P < 0.001), a 38% increase in depression-related outpatient costs ($137 vs. $81; P ≤ 0.001), an increase in antidepressant pharmacy costs ($139 vs. $61; P < 0.001), and a 64% increase in psychiatric visits (0.69 vs. 0.42; P = 0.001), compared with the matched non-titration cohort. These differences were consistent among individual SSRI groups as well as during the six-month period. CONCLUSION.: Patients undergoing dose titration of SSRIs at the beginning of therapy consumed more medical resources and spent more days receiving a

  18. Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis.

    PubMed

    Reinhold, C; Haage, P; Hollenbeck, M; Mickley, V; Ranft, J

    2011-05-01

    In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients' constitution, and also on the availability and experience of the involved specialists.

  19. Development of an Assessment Tool for Agricultural Best Management Practice Implementation in the Great Lakes Restoration Initiative Priority Watersheds—Eagle Creek, Tributary to Maumee River, Ohio

    USGS Publications Warehouse

    Merriman, Katherine R.

    2015-11-19

    The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

  20. Development of an Assessment Tool for Agricultural Best Management Practice Iimplementation in the Great Lakes Restoration Initiative Priority Watersheds—Alger Creek, Tributary to Saginaw River, Michigan

    USGS Publications Warehouse

    Merriman, Katherine R.

    2015-11-19

    The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

  1. Development of an Assessment Tool for Agricultural Best Management Practice Implementation in the Great Lakes Restoration Initiative Priority Watersheds—Upper East River, Tributary to Green Bay, Wisconsin

    USGS Publications Warehouse

    Merriman, Katherine R.

    2015-11-19

    The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

  2. Ports Initiative

    EPA Pesticide Factsheets

    The purpose of the ports initiative is to assist EPA and other participants to formulate strategies for moving forward on actions addressing the transportation, air quality and climate issues raised in the National Conversations.

  3. Information Technology Initiative (Videorecording),

    DTIC Science & Technology

    Physical description: 1 VHS video; col.; sd.; mono.; standard playback sp.; 35:40 mins.; 1/2 in. In this video, Dr. Kurt Fisher, Deputy Director for Information Technology , introduces the Corporate Information Management (CIM) program and explains the following major technical initiatives: reuse/repositories; I-case; data administration; information technology architecture; software process improvement; standards.

  4. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...? A newly completed or recompleted well often has thermal casing pressure during initial startup. Bleeding casing pressure during the startup process is considered a normal and necessary operation to... diagnostic test. After 30 days of continuous production, the initial production startup operation is...

  5. Youth Initiatives.

    ERIC Educational Resources Information Center

    Employment and Training Administration (DOL), Washington, DC. Office of Youth Programs.

    Summarizing the first eight months of the planning, design, and implementation of the new federal youth programs created by the Youth Employment and Demonstration Projects Act of 1977 (YEDPA) and the efforts for expansion and enrichment of the Job Corps, this report explains the charters of the two projects and their initial successes in and…

  6. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... casing pressure during initial startup. Bleeding casing pressure during the startup process is considered... production startup operation is complete and you must perform casing diagnostic testing as required in §§...

  7. [Quality management according to the new SN EN ISO-Norm 9001:2000--experiences from initial certification of a hospital department].

    PubMed

    Steffen, Th; Hochberger, G; Eisner, L

    2002-04-24

    Those who want to implement a quality-management system at a hospital these days cannot fall back on a broad-based system proven over the years. Though quality management as defined by ISO norm 9001 has been established as the central standard in many industrial areas, applicability of this ISO norm in the hospital sector has stirred up much controversy during recent years. Introduction of the new ISO norm 9001:2000 has changed the situation. The 2000 version of the new standard seeks to meet the demand for service operations--especially by establishing a clear procedural orientation. This report describes the new standard and its introduction in the Department of Surgery at the Cantonal Hospital in Olten, Canton Solothurn, Switzerland. It indicates the steps taken, for instance in the spheres of top management, quality management, procedural guidance, as well as customer and staff counselling. It also discusses the project's cost/benefit ratio for the organization.

  8. 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.

  9. SCB initiator

    DOEpatents

    Bickes Jr., Robert W.; Renlund, Anita M.; Stanton, Philip L.

    1994-11-01

    A detonator for high explosives initiated by mechanical impact includes a cylindrical barrel, a layer of flyer material mechanically covering the barrel at one end, and a semiconductor bridge ignitor including a pair of electrically conductive pads connected by a semiconductor bridge. The bridge is in operational contact with the layer, whereby ignition of said bridge forces a portion of the layer through the barrel to detonate the explosive. Input means are provided for igniting the semiconductor bridge ignitor.

  10. SCB initiator

    SciTech Connect

    Bickes, Jr., Robert W.; Renlund, Anita M.; Stanton, Philip L.

    1994-01-01

    A detonator for high explosives initiated by mechanical impact includes a cylindrical barrel, a layer of flyer material mechanically covering the barrel at one end, and a semiconductor bridge ignitor including a pair of electrically conductive pads connected by a semiconductor bridge. The bridge is in operational contact with the layer, whereby ignition of said bridge forces a portion of the layer through the barrel to detonate the explosive. Input means are provided for igniting the semiconductor bridge ignitor.

  11. Analysis of California Condor (Gymnogyps californianus) use of six management units using location data from global positioning system transmitters, southern California, 2004-09-Initial report

    USGS Publications Warehouse

    Johnson, Matthew; Kern, Jeffrey; Haig, Susan M.

    2010-01-01

    This report provides an analysis of California Condor (Gymnogyps californianus) space use of six management units in southern California (Hopper Mountain and Bitter Creek National Wildlife Refuges, Wildlands Conservancy-Wind Wolves Preserve, Tejon Mountain Village Specific Plan, California Condor Study Area, and the Tejon Ranch excluding Tejon Mountain Village Specific Plan and California Condor Study Area). Space use was analyzed to address urgent management needs using location data from Global Positioning System transmitters. The U.S. Fish and Wildlife Service provided the U.S. Geological Survey with location data (2004-09) for California Condors from Global Positioning System transmitters and Geographic Information System data for the six management units in southern California. We calculated relative concentration of use estimates for each management unit for each California Condor (n = 21) on an annual basis (n = 39 annual home ranges) and evaluated resource selection for the population each year using the individual as our sampling unit. The most striking result from our analysis was the recolonization of the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units during 2008. During 2004-07, the home range estimate for two (25 percent) California Condors overlapped the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units (n = 8), and use within the annual home range generally was bimodal and was concentrated on the Bitter Creek and Hopper Mountain National Wildlife Refuges. However, 10 (77 percent) California Condor home ranges overlapped the Tejon Mountain Village Specific Plan, California Condor Study Area, and Tejon Ranch management units during 2008 (n = 13), and by 2009, the home range of every condor carrying a Global Positioning System transmitter (n = 14) overlapped these management units. Space use was multimodal within the home range during 2008-09 and was

  12. Initial Investigations of Controller Tools and Procedures for Schedule-Based Arrival Operations with Mixed Flight-Deck Interval Management Equipage

    NASA Technical Reports Server (NTRS)

    Callantine, Todd J.; Cabrall, Christopher; Kupfer, Michael; Omar, Faisal G.; Prevot, Thomas

    2012-01-01

    NASA?s Air Traffic Management Demonstration-1 (ATD-1) is a multi-year effort to demonstrate high-throughput, fuel-efficient arrivals at a major U.S. airport using NASA-developed scheduling automation, controller decision-support tools, and ADS-B-enabled Flight-Deck Interval Management (FIM) avionics. First-year accomplishments include the development of a concept of operations for managing scheduled arrivals flying Optimized Profile Descents with equipped aircraft conducting FIM operations, and the integration of laboratory prototypes of the core ATD-1 technologies. Following each integration phase, a human-in-the-loop simulation was conducted to evaluate and refine controller tools, procedures, and clearance phraseology. From a ground-side perspective, the results indicate the concept is viable and the operations are safe and acceptable. Additional training is required for smooth operations that yield notable benefits, particularly in the areas of FIM operations and clearance phraseology.

  13. Clinical utility of (18)F-FDG positron emission tomography/computed tomography scan vs. (99m)Tc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis.

    PubMed

    Lauridsen, Trine K; Iversen, Kasper K; Ihlemann, Nikolaj; Hasbak, Philip; Loft, Annika; Berthelsen, Anne K; Dahl, Anders; Dejanovic, Danijela; Albrecht-Beste, Elisabeth; Mortensen, Jann; Kjær, Andreas; Bundgaard, Henning; Bruun, Niels Eske

    2017-01-03

    The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether (18)FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify the numbers of positive findings detected by each imaging modality, to evaluate the clinical relevance of these findings and to define the reproducibility for extra-cardiac foci in patients with definite IE. Each modality was evaluated for numbers and location of positive extra-cardiac foci in patients with definite IE. A team of 2 × 2 cardiologists evaluated each finding to determine clinical relevance. Clinical utility was determined by 4 criteria converted into an ordinal scale. Using the manifestation with highest clinical utility rating in each patient, the clinical impact of the two imaging modalities was expressed in a clinical utility score. To evaluate reproducibility for each modality, an imaging core laboratory reviewed all findings. In 55 IE patients, 91 pathological foci were found by FDG-PET/CT and 37 foci were identified by WBC-SPECT/CT (p < 0.001). The clinical utility of FDG-PET/CT was significantly higher than that of WBC-SPECT/CT when comparing clinical utility score (2.06 vs. 1.17; p = 0.01). In assessment of extra-cardiac diagnostics in IE, inter-observer reproducibility was substantial for WBC-SPECT/CT (k 0.69, 95% CI 0.49-0.89) and substantial to excellent for FDG-PET/CT (k 0.79, 95% CI 0.61-0.98). FDG-PET/CT has a significantly higher clinical utility score than WBC SPECT/CT and is potentially superior to WBC-SPECT/CT in detection of extra-cardiac pathology in patients with IE.

  14. Initiatives (Part 1): Keystone; Cycle Time Puzzle, A Full-Scale Challenge; Foot to Foot, Face to Face; Change Management; Multi-Element Team Challenge.

    ERIC Educational Resources Information Center

    Schoel, Jim; Butler, Steve; Murray, Mark; Gass, Mike; Carrick, Moe

    2001-01-01

    Presents five group problem-solving initiatives for use in adventure and experiential settings, focusing on conflict resolution, corporate workplace issues, or adjustment to change. Includes target group, group size, time and space needs, activity level, overview, goals, props, instructions, and suggestions for framing and debriefing the…

  15. 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…

  16. Systematic Management of Change Is the Key to Successful Staff Development. An Initial Study of the Bloomfield Public Schools Staff Development Project. Teacher Essentials, Styles & Strategies (TESS).

    ERIC Educational Resources Information Center

    Celso, Nicholas; Morris, Harold

    Confronted by a maturing staff, lower teacher turnover rates, declining enrollments, and more sophisticated instructional methods, the Bloomfield (New Jersey) Public School District adopted an ambitious staff development initiative in 1983. This paper describes the planning and implementation strategies used to launch Bloomfield's Teaching…

  17. Identifying professional education gaps and barriers in multiple myeloma patient care: findings of the Managing Myeloma Continuing Educational Initiative Advisory Committee.

    PubMed

    Raje, Noopur; Faiman, Beth; Harvey, R Donald; Kurtin, Sandra E; Lonial, Sagar; Kumar, Shaji K; Cohen, Adam D; Conde, Miguel A; Giralt, Sergio A; Recine, Marie Sabo; Tombler, Eugene R; Stadtmauer, Edward; Jagannath, Sundar; Anderson, Kenneth C

    2014-10-01

    Advances in the past decade and a half have led to unprecedented improved outcomes for patients with multiple myeloma (MM), and this disease appears to be transitioning to one more characteristic of a chronic disease in large part due to rapid translation of clinical insights into practice at the community level. Although evidence-based guidelines and consensus recommendations remain an important resource for managing cancer patients, they do not fill the gap between the principles of disease management today and the translation of tailoring treatment for individual patient needs. Thus, there is a continuing need for concise, focused educational activities and resources that facilitate improved knowledge and understanding of appropriate, individualized therapeutic strategies for assessing and caring for patients with MM. The next several years will truly be a time of shifting paradigms in the treatment of MM in which new agents will be approved, response criteria will be updated, and new approaches to risk assessment and monitoring minimal residual disease will evolve and enter practice. New groundbreaking therapeutic approaches, such as immunotherapy, might result in significant changes in how MM is treated and managed over the entire life cycle of the disease. Even the definition of the disease might be further amended as insights grow regarding who should be treated and who might benefit more from observation. As such, oncology clinicians will have to carefully review and update their management approaches accordingly even as they begin to focus even more on the survivorship needs of their MM patients.

  18. Strategic Defense Initiative Demonstration/Validation Program Environmental Assessment. Battle Management/Command and Control, and Communications (BM/C3),

    DTIC Science & Technology

    1987-08-01

    computational pover, information display, telecomunications , and decision aids required by Strategic Defense System commanders to control and manage their...technology 2. Simulations: The use of softvare models representing both the test article and the environment to determine performance abilities 3. Component

  19. Towards Developing an Initial Programme Theory: Programme Designers and Managers Assumptions on the Antiretroviral Treatment Adherence Club Programme in Primary Health Care Facilities in the Metropolitan Area of Western Cape Province, South Africa

    PubMed Central

    Mukumbang, Ferdinand C.; van Belle, Sara; Marchal, Bruno; van Wyk, Brian

    2016-01-01

    Background The antiretroviral adherence club intervention was rolled out in primary health care facilities in the Western Cape province of South Africa to relieve clinic congestion, and improve retention in care, and treatment adherence in the face of growing patient loads. We adopted the realist evaluation approach to evaluate what aspects of antiretroviral club intervention works, for what sections of the patient population, and under which community and health systems contexts, to inform guidelines for scaling up of the intervention. In this article, we report on a step towards the development of a programme theory—the assumptions of programme designers and health service managers with regard to how and why the adherence club intervention is expected to achieve its goals and perceptions on how it has done so (or not). Methods We adopted an exploratory qualitative research design. We conducted a document review of 12 documents on the design and implementation of the adherence club intervention, and key informant interviews with 12 purposively selected programme designers and managers. Thematic content analysis was used to identify themes attributed to the programme actors, context, mechanisms, and outcomes. Using the context-mechanism-outcome configurational tool, we provided an explanatory focus of how the adherence club intervention is roll-out and works guided by the realist perspective. Results We classified the assumptions of the adherence club designers and managers into the rollout, implementation, and utilisation of the adherence club programme, constructed around the providers, management/operational staff, and patients, respectively. Two rival theories were identified at the patient-perspective level. We used these perspectives to develop an initial programme theory of the adherence club intervention, which will be tested in a later phase. Conclusion The perspectives of the programme designers and managers provided an important step towards developing

  20. Evaluation of Computer-Aided System Design Tools for SDI (Strategic Defense Initiative) Battle Management/C3 (Command, Control and Communications) Architecture Development

    DTIC Science & Technology

    1987-10-01

    Ft. Meade, MD 20755-6000 Lee Cooper 1 copy Advanced Technology 2121 Crystal Drive, Suite 200 Arlington, VA 22202 Larry Cox I copy TRW 1950 Sunwest...Richmond Street Providence, RI 02903 " - Mr. Larry Christina, Jr. 1 copy Technology Branch, CSSD-H-SBY Battle Management Division U.S. Army Strategic...copy ’_ Advanced System Architectures Johnson House 73-79 Park Street GU 15 3PE, United Kingdom s. - .%° N. % S CSED Review Panel Dr. Dan Alpert

  1. Openness initiative

    SciTech Connect

    Duncan, S.S.

    1995-12-31

    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  2. Innovative science and technology (IST) in support of SDI (Strategic Defense Initiative) BM/C3 (Battle Management/Command, Control and Communications). Final report, June 1987-March 1988

    SciTech Connect

    Balko, B.; Albini, F.A.; Cohen, L.; Penner, S.S.; Sworder, D.D.

    1988-08-01

    Battle Management and Command, Control and Communications (BM/C3) issues in the Strategic Defense Initiative (SDI) context were discussed at a two-day workshop at the Institute for Defense Analyses (IDA). Another workshop-probed civilian systems that require handling of large amounts of data and that have fault-tolerant features that may be useful in resolving the SDI BM/C3 problems. The findings are summarized in this report, with special emphasis on possible research to be supported by the Innovative Science and Technology Office of SDIO.

  3. Siting and Transportation for Consolidated Used Nuclear Fuel Management Facilities: A Proposed Approach for a Regional Initiative to Begin the Dialogue - 13562

    SciTech Connect

    Thrower, Alex W.; Janairo, Lisa

    2013-07-01

    The Blue Ribbon Commission on America's Nuclear Future (BRC) was formed in January 2010 to conduct a comprehensive review of policies for managing the back end of the nuclear fuel cycle, and to develop a new national strategy. Over two years, the BRC held dozens of meetings and heard from hundreds of Federal, State, Tribal, and local officials, as well as representatives of trade and labor organizations, technical groups, non-governmental organizations, and other stakeholders. The Commission's final report (issued January 26, 2012) offers a strategy to resolve longstanding challenges to responsible management of the United States' nuclear waste legacy. The Commission recommended Congressional action to rewrite parts of the Nuclear Waste Policy Act (NWPA); however, a comprehensive legislative overhaul will likely take years to fully implement. The nature and characteristics of nuclear waste, the activities that generated it, and the past history of federal efforts to manage the waste make it virtually certain that finding workable solutions will be controversial and difficult. As the BRC report suggests, this difficulty can be made insurmountable if top-down, federally-mandated efforts are forced upon unwilling States, Tribes, and local communities. Decades of effort and billions of ratepayer and taxpayer dollars have been spent attempting to site and operate spent fuel storage and disposal facilities in this manner. The experience thus far indicates that voluntary consent and active partnership of States, Tribes, and local governments in siting, designing, and operating such facilities are critical. Some States, Tribes, and local communities have indicated that, given adequate scientific and technical information, along with appropriate incentives, assurances, and authority, they might be willing to consider hosting facilities for consolidated storage and disposal of spent nuclear fuel. The authors propose a new regional approach to identifying and resolving issues

  4. Compatibility of technologies with regulations in the waste management of H-3, I-129, C-14, and Kr-85. Part I. Initial information base

    SciTech Connect

    Trevorrow, L.E.; Vandegrift, G.F.; Kolba, V.M.; Steindler, M.J.

    1983-08-01

    This report summarizes the information base that was collected and reviewed in preparation for carrying out an analysis of the compatibility with regulations of waste management technologies for disposal of H-3, I-129, C-14, and Kr-85. Based on the review of this literature, summaries are presented here of waste-form characteristics, packaging, transportation, and disposal methods. Also discussed are regulations that might apply to all operations involved in disposal of the four nuclides, including the processing of irradiated fuel in a fuel reprocessing plant, packaging, storage, transport, and final disposal. The compliance assessment derived from this information is reported in a separate document. 309 references.

  5. Microdrill Initiative - Initial Market Evaluation

    SciTech Connect

    Spears & Associates, Inc

    2003-07-01

    The U.S. Department of Energy (DOE) is launching a major research and development initiative to create a small, fast, inexpensive and environmentally friendly rig for drilling 5000 feet boreholes to investigate potential oil and gas reservoirs. DOE wishes to get input from petroleum industry operators, service companies and equipment suppliers on the operation and application of this coiled-tubing-based drilling unit. To that end, DOE has asked Spears & Associates, Inc. (SAI) to prepare a special state-of-the-market report and assist during a DOE-sponsored project-scoping workshop in Albuquerque near the end of April 2003. The scope of the project is four-fold: (1) Evaluate the history, status and future of demand for very small bore-hole drilling; (2) Measure the market for coiled tubing drilling and describe the state-of-the-art; (3) Identify companies and individuals who should have an interest in micro drilling and invite them to the DOE workshop; and (4) Participate in 3 concurrent workshop sessions, record and evaluate participant comments and report workshop conclusions.

  6. Status of Environmental Management Initiatives to Accelerate the Reduction of Environmental Risks and Challenges Posed by the Legacy of the Cold War

    SciTech Connect

    2009-01-01

    Fifty years of nuclear weapons production and energy research in the United States during the Cold War generated large amounts of radioactive wastes, spent nuclear fuel (SNF), excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. During most of that half century, the Nation did not have the environmental regulatory structure or nuclear waste cleanup technologies that exist today. The result was a legacy of nuclear waste that was stored and disposed of in ways now considered unacceptable. Cleaning up and ultimately disposing of these wastes is the responsibility of the U.S. Department of Energy (DOE). In 1989, DOE established the Office of Environmental Management (EM) to solve the large scale and technically challenging risks posed by the world's largest nuclear cleanup. This required EM to build a new nuclear cleanup infrastructure, assemble and train a technically specialized workforce, and develop the technologies and tools required to safely decontaminate, disassemble, stabilize, disposition, and remediate unique radiation hazards. The sites where nuclear activities produced legacy waste and contamination include the original Manhattan Project sites--Los Alamos, New Mexico; Hanford, Washington; and Oak Ridge, Tennessee--as well as major Cold War sites, such as Savannah River Site, South Carolina; the Idaho National Laboratory, Idaho; Rocky Flats Plant, Colorado; and Fernald, Ohio. Today EM has responsibility for nuclear cleanup activities at 21 sites covering more than two million acres in 13 states, and employs more than 30,000 Federal and contractor employees, including scientists, engineers and hazardous waste technicians. This cleanup poses unique, technically complex problems, which must be solved under the most hazardous of conditions, and which will require billions of dollars a year for several more decades. The EM program focus during its first 10 years was on managing the most urgent risks and

  7. [New tools for the management of renal function in the elderly: Berlin Initiative Study equation and hematocrit, urea and gender formulae].

    PubMed

    Heras, Manuel; Fernández-Reyes, María José

    2016-05-20

    In the last few years a debate has emerged on the range of normal renal function in the elderly, and if every elderly person with a glomerular filtration rate estimated using formulas (Cockroft-Gault, MDRD, CKD-EPI) of less than 60ml/min/1.73m(2) has kidney disease. In this review we analysed, based on the results of the study Elderly people with chronic kidney disease of the Hospital de Segovia, the new equations to measure kidney function in the elderly: the Berlin Initiative Study equation designed to estimate the glomerular filtration rate in people aged 70 or more, and the hematocrit, urea and gender formula to establish whether an elderly person with a glomerular filtration rate lower than 60mL/min/1.73m(2) has kidney disease.

  8. The MoSt Project--more steps in multiple sclerosis: a Delphi method consensus initiative for the evaluation of mobility management of MS patients in Italy.

    PubMed

    Capra, Ruggero; Battaglia, Mario Alberto; Gaudioso, Antonio; Lopes, Laura; Paolicelli, Damiano; Paoloni, Marco; Pozzilli, Carlo; Santilli, Valter; Solaro, Claudio; Trojano, Maria

    2014-03-01

    The aim of the study was to identify the main factors that impact mobility impairment in multiple sclerosis (MS) patients in Italy. Clinicians from a large number of Italian MS centers took part in a Delphi process aimed at obtaining consensus statements among the participants. Large consensus was obtained for statements grouped under the following main MS themes: identification of the most useful scales to evaluate mobility, integration of objective evaluation with patient perceptions, impact of walking impairment on daily life, management of the disabled patient using a rehabilitative and pharmacological approach. The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat MS patients with motor impairment.

  9. [Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin.

    PubMed

    Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

    2017-01-01

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care.

  10. Hanford tanks initiative plan

    SciTech Connect

    McKinney, K.E.

    1997-07-01

    Abstract: The Hanford Tanks Initiative (HTI) is a five-year project resulting from the technical and financial partnership of the U.S. Department of Energy`s Office of Waste Management (EM-30) and Office of Science and Technology Development (EM-50). The HTI project accelerates activities to gain key technical, cost performance, and regulatory information on two high-level waste tanks. The HTI will provide a basis for design and regulatory decisions affecting the remainder of the Tank Waste Remediation System`s tank waste retrieval Program.

  11. Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010.

    PubMed

    Anderson, Benjamin O; Cazap, Eduardo; El Saghir, Nagi S; Yip, Cheng-Har; Khaled, Hussein M; Otero, Isabel V; Adebamowo, Clement A; Badwe, Rajendra A; Harford, Joe B

    2011-04-01

    The purpose of the Breast Health Global Initiative (BHGI) 2010 summit was to provide a consensus analysis of breast cancer control issues and implementation strategies for low-income and middle-income countries (LMCs), where advanced stages at presentation and poor diagnostic and treatment capacities contribute to lower breast cancer survival rates than in high-income countries. Health system and patient-related barriers were identified that create common clinical scenarios in which women do not present for diagnosis until their cancer has progressed to locally advanced or metastatic stages. As countries progress to higher economic status, the rate of late presentation is expected to decrease, and diagnostic and treatment resources are expected to improve. Health-care systems in LMCs share many challenges including national or regional data collection, programme infrastructure and capacity (including appropriate equipment and drug acquisitions, and professional training and accreditation), the need for qualitative and quantitative research to support decision making, and strategies to improve patient access and compliance as well as public, health-care professional, and policy-maker awareness that breast cancer is a cost-effective, treatable disease. The biggest challenges identified for low-income countries were little community awareness that breast cancer is treatable, inadequate advanced pathology services for diagnosis and staging, and fragmented treatment options, especially for the administration of radiotherapy and the full range of systemic treatments. The biggest challenges identified for middle-resource countries were the establishment and maintenance of data registries, the coordination of multidisciplinary centres of excellence with broad outreach programmes to provide community access to cancer diagnosis and treatment, and the resource-appropriate prioritisation of breast cancer control programmes within the framework of existing, functional health

  12. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction.

    PubMed

    Yin, Zhuo; Wei, Y B; Liang, B L; Zhou, K Q; Gao, Y L; Yan, B; Wang, Z; Yang, J R

    2015-06-01

    To demonstrate the safety and efficacy of combine laparoscopy and flexible ureteroscopy to treat ectopic pelvic kidneys with ureteropelvic junction obstruction (UPJO) and stones. 16 patients of ectopic pelvic kidneys with ureteropelvic junction obstruction and stones were treated with laparoscopy and flexible ureteroscopy (FURS). The operative time, required dose of tramadol, visual analog pain scale (VAPS), postoperative day, stone-free rates (SFRs), perioperative complications, and serum creatinine were evaluated. The SFRs were evaluated with noncontrasted renal computed tomography (CT). Intravenous pyelography (IVP) and CT scan were used to evaluate the UPJO. Stone-free status was defined as absence of stone fragments in kidney or the size of that is less than 3 mm. Operation time from 118 to 225 min, average time (171 ± 28) min; lithotomy time from 16 to 45 min, average time (32 ± 6) min. Average tramadol required at the first day postoperation was (118 ± 49.6) mg; at the second day was (78 ± 24.8) mg. VAPS score at 24 h (5.0 ± 0.7), VAPS score at 48 h (2.5 ± 0.8). Postoperative day (3.9 ± 0.6) days. Stone-free rate was 100%. Average serum creatinine was (88.7 ± 24.3) mol/L before surgery and (92.8 ± 21.6) mol/L after surgery. No major complication. No stone and obstruction recurrence in the follow-up of average 29.3 months. Combined FUR and LC is a good option for patient of ectopic pelvic kidney with renal stone and UPJO. From our initial experience, the SFRs and the effect of pyeloplasty are satisfactory and without major complication, the operative time is acceptable.

  13. Long-Term Clinical Outcomes according to Initial Management and Thrombolysis In Myocardial Infarction Risk Score in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction

    PubMed Central

    Jeong, Hae Chang; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jin; Choi, Donghoon; Jang, Yang Soo; Yoon, Junghan; Chung, Wook Sung; Cho, Jeong Gwan; Seung, Ki Bae; Park, Seung Jung

    2010-01-01

    Purpose There is still debate about the timing of revascularization in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI). We analyzed the long-term clinical outcomes of the timing of revascularization in patients with acute NSTEMI obtained from the Korea Acute Myocardial Infarction Registry (KAMIR). Materials and Methods 2,845 patients with acute NSTEMI (65.6 ± 12.5 years, 1,836 males) who were enrolled in KAMIR were included in the present study. The therapeutic strategy of NSTEMI was categorized into early invasive (within 48 hours, 65.8 ± 12.6 years, 856 males) and late invasive treatment (65.3 ± 12.1 years, 979 males). The initial- and long-term clinical outcomes were compared between two groups according to the level of Thrombolysis In Myocardial Infarction (TIMI) risk score. Results There were significant differences in-hospital mortality and the incidence of major adverse cardiac events during one-year clinical follow-up between two groups (2.1% vs. 4.8%, p < 0.001, 10.0% vs. 13.5%, p = 0.004, respectively). According to the TIMI risk score, there was no significant difference of long-term clinical outcomes in patients with low to moderate TIMI risk score, but significant difference in patients with high TIMI risk score (≥ 5 points). Conclusions The old age, high Killip class, low ejection fraction, high TIMI risk score, and late invasive treatment strategy are the independent predictors for the long-term clinical outcomes in patients with NSTEMI. PMID:20046515

  14. Endoscopic Gold Fiducial Marker Placement into the Bladder Wall to Optimize Radiotherapy Targeting for Bladder-Preserving Management of Muscle-Invasive Bladder Cancer: Feasibility and Initial Outcomes

    PubMed Central

    Garcia, Maurice M.; Gottschalk, Alexander R.; Brajtbord, Jonathan; Konety, Badrinath R.; Meng, Maxwell V.; Roach, Mack; Carroll, Peter R.

    2014-01-01

    Background and Purpose Bladder radiotherapy is a management option for carefully selected patients with muscle-invasive bladder cancer. However, the inability to visualize the tumor site during treatment and normal bladder movement limits targeting accuracy and increases collateral radiation. A means to accurately and reliably target the bladder during radiotherapy is needed. Materials and Methods Eighteen consecutive patients with muscle-invasive bladder cancer (T1–T4) elected bladder-preserving treatment with maximal transurethral resection (TUR), radiation and concurrent chemotherapy. All underwent endoscopic placement of 24-K gold fiducial markers modified with micro-tines (70 [2.9×0.9 mm.]; 19 [2.1×0.7 mm.) into healthy submucosa 5-10 mm. from the resection margin, using custom-made coaxial needles. Marker migration was assessed for with intra-op bladder-filling cystogram and measurement of distance between markers. Set-up error and marker retention through completion of radiotherapy was confirmed by on-table portal imaging. Results Between 1/2007 and 7/2012, a total of 89 markers (3–5 per tumor site) were placed into 18 patients of mean age 73.6 years. Two patients elected cystectomy before starting treatment; 16/18 completed chemo-radiotherapy. All (100%) markers were visible with all on-table (portal, cone-beam CT), fluoroscopy, plain-film, and CT-scan imaging. In two patients, 1 of 4 markers placed at the tumor site fell-out (voided) during the second half of radiotherapy. All other markers (80/82, 98%) were present through the end of radio-therapy. No intraoperative (e.g. uncontrolled bleeding, collateral injury) or post-operative complications (e.g. stone formation, urinary tract infection, post-TUR hematuria >48 hours) occurred. Use of micro-tined fiducial tumor-site markers afforded a 2 to 6-fold reduction in bladder-area targeted with high-dose radiation. Discussion Placement of the micro-tined fiducial markers into the bladder was feasible and

  15. Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

    PubMed Central

    Colebatch, Alexandra N.; Buchbinder, Rachelle; Edwards, Christopher J.; Adams, Karen; Englbrecht, Matthias; Hazlewood, Glen; Marks, Jonathan L.; Radner, Helga; Ramiro, Sofia; Richards, Bethan L.; Tarner, Ingo H.; Aletaha, Daniel; Bombardier, Claire; Landewé, Robert B.; Müller-Ladner, Ulf; Bijlsma, Johannes W. J.; Branco, Jaime C.; Bykerk, Vivian P.; da Rocha Castelar Pinheiro, Geraldo; Catrina, Anca I.; Hannonen, Pekka; Kiely, Patrick; Leeb, Burkhard; Lie, Elisabeth; Martinez-Osuna, Píndaro; Montecucco, Carlomaurizio; Østergaard, Mikkel; Westhovens, Rene; Zochling, Jane; van der Heijde, Désirée

    2012-01-01

    Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA). Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008–09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice. Results. A total of 49 242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice. Conclusions. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice. PMID:22447886

  16. 15 CFR 921.21 - Initial acquisition and development awards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...) of this section; (3) Preparing the final management plan; and (4) Initial management costs, e.g., for... COASTAL RESOURCE MANAGEMENT NATIONAL ESTUARINE RESEARCH RESERVE SYSTEM REGULATIONS Acquisition, Development and Preparation of the Final Management Plan § 921.21 Initial acquisition and development...

  17. 15 CFR 921.21 - Initial acquisition and development awards.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...) of this section; (3) Preparing the final management plan; and (4) Initial management costs, e.g., for... COASTAL RESOURCE MANAGEMENT NATIONAL ESTUARINE RESEARCH RESERVE SYSTEM REGULATIONS Acquisition, Development and Preparation of the Final Management Plan § 921.21 Initial acquisition and development...

  18. 15 CFR 921.21 - Initial acquisition and development awards.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...) of this section; (3) Preparing the final management plan; and (4) Initial management costs, e.g., for... COASTAL RESOURCE MANAGEMENT NATIONAL ESTUARINE RESEARCH RESERVE SYSTEM REGULATIONS Acquisition, Development and Preparation of the Final Management Plan § 921.21 Initial acquisition and development...

  19. 15 CFR 921.21 - Initial acquisition and development awards.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) of this section; (3) Preparing the final management plan; and (4) Initial management costs, e.g., for... COASTAL RESOURCE MANAGEMENT NATIONAL ESTUARINE RESEARCH RESERVE SYSTEM REGULATIONS Acquisition, Development and Preparation of the Final Management Plan § 921.21 Initial acquisition and development...

  20. 15 CFR 921.21 - Initial acquisition and development awards.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...) of this section; (3) Preparing the final management plan; and (4) Initial management costs, e.g., for... COASTAL RESOURCE MANAGEMENT NATIONAL ESTUARINE RESEARCH RESERVE SYSTEM REGULATIONS Acquisition, Development and Preparation of the Final Management Plan § 921.21 Initial acquisition and development...

  1. Home initiation of parenteral nutrition.

    PubMed

    Newton, Alyce F; DeLegge, Mark H

    2007-02-01

    Parenteral nutrition (PN) has been successfully initiated in the home since the early 1990s. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards for Specialized Nutrition Support: Home Care Patients, Safe Practices for Parenteral Nutrition, and Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients do not contain specific information on the initiation of home PN (HPN). Peer-reviewed, published guidelines are necessary to provide safe and appropriate initiation of HPN. Certain patients should not have PN initiated in the home, such as those with organ failure, uncontrolled diabetes, or uncorrectable electrolyte abnormalities. Excellent candidates for initiation of HPN include patients who have failed enteral feedings, have gastrointestinal (GI) diseases without excessive GI losses, or those with an oncology diagnosis and inability to tube feed. One concern of initiation of HPN is the potential for refeeding syndrome. Refeeding syndrome can be prevented when patients are properly evaluated and managed before initiation of PN. Refeeding syndrome can be avoided by rehydration with fluid and electrolytes before initiation of HPN to normalize blood chemistry when necessary and by starting with a moderate-volume, low-carbohydrate HPN solution compounded with optimal potassium, phosphorus, and magnesium content, and slowly advanced to goal. The "start low and go slow" motto of nutrition support should continue to be followed, but more specific guidelines are needed to assist nutrition support clinicians with safe and appropriate initiation of HPN.

  2. Drug-induced sleep endoscopy changes snoring management plan very significantly compared to standard clinical evaluation.

    PubMed

    Pilaete, Karen; De Medts, Joris; Delsupehe, Kathelijne Godelieve

    2014-05-01

    Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41% of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting.

  3. The Knowledge Stealing Initiative?

    NASA Technical Reports Server (NTRS)

    Goshorn, Larry

    2005-01-01

    I have the honor of being on the Academy of Program and Project Leadership (APPL) Knowledge Sharing Feedback and Assessment Team (FAA), and as such, I am privileged to receive the feedback written by many of you as attendees of the Project Management (PM) Master s Forums. It is the intent of the FAA Team and APPL leadership to use this feedback as a tool for continuous program improvement. As a retired (sort of) PM in the payload contracting industry, I'm a big supporter of NASA s Knowledge Sharing Initiative (KSI), especially the Master's Forums. I really enjoy participating in them. Unfortunately I had to miss the 8th forum in Pasadena this past Spring, but I did get the feedback package for the Assessment Team work. So here I was, reviewing twelve pages of comments, reflections, learning notes and critiques from attendees of the 8th forum.

  4. Quality initiative at ESO

    NASA Astrophysics Data System (ADS)

    Rupprecht, Gero; Arsenault, Robin; Hanuschik, Reinhard; Kraus, Maximilian; Sivera, Paola; Tromp, Arnout; Verzichelli, Gianluca

    2016-08-01

    An initiative is under way at ESO Headquarters to optimise operations, in particular in the engineering, technical and associated management areas. A systematic approach to strengthen the operating processes is in preparation, starting with a mapping of the extensive existing process network. Processes identified as sufficiently important and complex to merit an in-depth analysis will be properly specified and their implementation optimised to strike a sensible balance between organisational overhead (documentation) and efficiency. By applying methods and tools tried and tested in industry we expect to achieve a more unified approach to address recurrent tasks. This will enable staff to concentrate more on new challenges and improvement and avoid spending effort on issues already resolved in the past.

  5. [Nutritional management in geriatric traumatology].

    PubMed

    Singler, K; Goisser, S; Volkert, D

    2016-08-01

    The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.

  6. Initial Diagnosis and Management of Coma.

    PubMed

    Traub, Stephen J; Wijdicks, Eelco F

    2016-11-01

    Coma represents a true medical emergency. Drug intoxications are a leading cause of coma; however, other metabolic disturbances and traumatic brain injury are also common causes. The general emergency department approach begins with stabilization of airway, breathing, and circulation, followed by a thorough physical examination to generate a limited differential diagnosis that is then refined by focused testing. Definitive treatment is ultimately disease-specific. This article presents an overview of the pathophysiology, causes, examination, and treatment of coma.

  7. Initial surgical management of thyroid cancer.

    PubMed

    Witt, Robert L

    2008-01-01

    The rapid increase in the rate of papillary thyroid cancer is likely caused by improved surveillance. A significant trend toward total thyroidectomy for low-risk differentiated thyroid cancer is present in the United States after a paradigm shift from treatment of macroscopic disease to the treatment of macroscopic and microscopic disease by increasingly sensitive tests. Compelling arguments for thyroid lobectomy and total thyroidectomy for low-risk thyroid cancer remain. The relatively small number of deaths from thyroid cancer, the small number of clinical thyroid cancers, and the huge number of incidental thyroid cancers are indicative of how little we understand the biology of this disease. Clinical medicine awaits biologic markers to refine treatment recommendations.

  8. Strategic defense initiative

    SciTech Connect

    Nichols, J.P.

    1985-01-01

    The Engineering Technology Division has a leading role, including that of program management, in a major new programmatic thrust of the Oak Ridge National Laboratory that is in support of the national Strategic Defense Initiative (SDI). It is appropriate for the Laboratory to become significantly involved in the program because several of the most promising SDI technologies are in areas for which ORNL (together with Y-12 and K-25) have strong capabilities and significant resources. The initial ORNL work in support of the SDI program is focused on three technologies in which ORNL has extensive experience and traditionally strong research and development programs: (1) space nuclear power, (2) flywheel energy storage, and (3) neutral particle beams. The space nuclear program will utilize our capabilities in areas such as refractory materials, high-temperature alkali metal systems, shielding, and instrumentation. Space nuclear reactors capable of supplying multimegawatt levels of electrical power on a continuous and long-term basis are envisioned to be required for a variety of SDI surveillance satellites and space-borne weapons platforms. The feasibility of an alkali metal Rankine power conversion cycle, which has promise of providing high power with a very low system mass, is planned for study.

  9. Recommendations for the management of candidemia in neonates in Latin America. Latin America Invasive Mycosis Network.

    PubMed

    Santolaya, María E; Alvarado Matute, Tito; de Queiroz Telles, Flavio; Colombo, Arnaldo Lopes; Zurita, Jeannete; Tiraboschi, Iris Nora; Cortes, Jorge Alberto; Thompson-Moya, Luis; Guzman-Blanco, Manuel; Sifuentes, Jose; Echevarría, Juan; Nucci, Marcio

    2013-01-01

    Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted. 'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia. This publication, 'Recommendations for the management of candidemia in neonates in Latin America', was written to provide guidance to healthcare professionals on the management of neonates who have, or who are at risk of, candidemia. Computerized searches of existing literature were performed by PubMed. The data were extensively reviewed and analyzed by members of the group. The group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations. 'Recommendations for the management of candidemia in neonates in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, central venous catheter management, and management of complications. This manuscript is the fourth of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in adults in Latin America', and 'Recommendations for the management of candidemia in children in Latin America'.

  10. [Recommendations for the management of candidemia in neonates in Latin America. Grupo Proyecto Épico].

    PubMed

    Santolaya, María E; Alvarado Matute, Tito; de Queiroz Telles, Flavio; Colombo, Arnaldo Lopes; Zurita, Jeannete; Tiraboschi, Iris Nora; Cortes, Jorge Alberto; Thompson-Moya, Luis; Guzman-Blanco, Manuel; Sifuentes, Jose; Echevarría, Juan; Nucci, Marcio

    2013-01-01

    Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted. 'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia. This publication, 'Recommendations for the management of candidemia in neonates in Latin America', was written to provide guidance to healthcare professionals on the management of neonates who have, or who are at risk of, candidemia. Computerized searches of existing literature were performed by PubMed. The data were extensively reviewed and analyzed by members of the group. The group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations. 'Recommendations for the management of candidemia in neonates in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, central venous catheter management, and management of complications. This manuscript is the fourth of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in adults in Latin America', and 'Recommendations for the management of candidemia in children in Latin America'.

  11. Partnering with the PESP Landscaping Initiative

    EPA Pesticide Factsheets

    The Landscaping Initiative works with its partners to educate do-it-yourself homeowners, lawn care customers, retailers and consumers at point-of-sale, and schools and school districts about pest management alternatives and proper pesticide use.

  12. Potential and Challenges of Low-Cost and High-Tech Crowd-sensing Approaches in Hydrometeorology for Better Water Resources Management - Insights and Learnings from the Global iMoMo Initiative

    NASA Astrophysics Data System (ADS)

    Siegfried, Tobias

    2016-04-01

    In developing and transition countries and despite significant global investments in hydrometeorology, data on water remain scarce/fragmented. One key reason is that traditional sensing in hydrology, hydro- and agro-meteorology does not scale because of high investment costs and difficult maintenance of traditional technology, esp. in remote and/or poor regions. Even where there are data, these are often difficult to access and interpret for local stakeholders due outdated data transmission and the lack of access to modern tools for data management/analysis/synthesis and exchange. In recent years, there have been substantial technology developments in environmental sensing and mobile communication technology that enable the application and deployment of affordable and scalable high-tech solutions for better water monitoring at different scales (local to transboundary levels). The WMO is acknowledging and promoting the potential for application of these technologies. One key aspect is to anchor these technologies in local communities that perform crowd-sensing tasks on a regular basis. The merits as well as challenges (including introduction of human factor, less accuracy as compared to traditional sensing, intermittency of data, …) of such approaches will be discussed in the context of the WMO-led Global iMoMo Initiative and its numerous activities on the ground in Eastern and Southern Africa as well as in Central Asia.

  13. Recommendations for the management of candidemia in adults in Latin America. Latin America Invasive Mycosis Network.

    PubMed

    Nucci, Marcio; Thompson-Moya, Luis; Guzman-Blanco, Manuel; Tiraboschi, Iris Nora; Cortes, Jorge Alberto; Echevarría, Juan; Sifuentes, Jose; Zurita, Jeannete; Santolaya, María E; Alvarado Matute, Tito; de Queiroz Telles, Flavio; Colombo, Arnaldo Lopes

    2013-01-01

    Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted. 'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia. This publication, 'Recommendations for the management of candidemia in adults in Latin America', was written to provide guidance to healthcare professionals on the management of adults who have, or who are at risk of, candidemia. Computerized searches of existing literature were performed by PubMed. The data were extensively reviewed and analyzed by members of the group. The group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations. 'Recommendations for the management of candidemia in adults in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, duration of candidemia treatment, and central venous catheter management in patients with candidemia. This manuscript is the second of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in children in Latin America', and 'Recommendations for the management of candidemia in neonates in Latin America'.

  14. [Recommendations for the management of candidemia in adults in Latin America. Grupo Proyecto Épico].

    PubMed

    Nucci, Marcio; Thompson-Moya, Luis; Guzman-Blanco, Manuel; Tiraboschi, Iris Nora; Cortes, Jorge Alberto; Echevarría, Juan; Sifuentes, Jose; Zurita, Jeannete; Santolaya, María E; Alvarado Matute, Tito; de Queiroz Telles, Flavio; Colombo, Arnaldo Lopes

    2013-01-01

    Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted. 'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia. This publication, 'Recommendations for the management of candidemia in adults in Latin America', was written to provide guidance to healthcare professionals on the management of adults who have, or who are at risk of, candidemia. Computerized searches of existing literature were performed by PubMed. The data were extensively reviewed and analyzed by members of the group. The group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations. 'Recommendations for the management of candidemia in adults in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, duration of candidemia treatment, and central venous catheter management in patients with candidemia. This manuscript is the second of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in children in Latin America', and 'Recommendations for the management of candidemia in neonates in Latin America'.

  15. Recommendations for the management of candidemia in children in Latin America. Latin America Invasive Mycosis Network.

    PubMed

    Santolaya, María E; de Queiroz Telles, Flavio; Alvarado Matute, Tito; Colombo, Arnaldo Lopes; Zurita, Jeannete; Tiraboschi, Iris Nora; Cortes, Jorge Alberto; Thompson-Moya, Luis; Guzman-Blanco, Manuel; Sifuentes, Jose; Echevarría, Juan; Nucci, Marcio

    2013-01-01

    Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted. 'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia. This publication, 'Recommendations for the management of candidemia in children in Latin America', was written to provide guidance to healthcare professionals on the management of children who have, or who are at risk of, candidemia. Computerized searches of existing literature were performed by PubMed. The data were extensively reviewed and analyzed by members of the group. The group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations. 'Recommendations for the management of candidemia in children in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, duration of candidemia treatment, and central venous catheter management in children with candidemia. This manuscript is the third of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in adults in Latin America', and 'Recommendations for the management of candidemia in neonates in Latin America'.

  16. [Recommendations for the management of candidemia in children in Latin America. Grupo Proyecto Épico].

    PubMed

    Santolaya, María E; de Queiroz Telles, Flavio; Alvarado Matute, Tito; Colombo, Arnaldo Lopes; Zurita, Jeannete; Tiraboschi, Iris Nora; Cortes, Jorge Alberto; Thompson-Moya, Luis; Guzman-Blanco, Manuel; Sifuentes, Jose; Echevarría, Juan; Nucci, Marcio

    2013-01-01

    Candidemia is one of the most frequent opportunistic mycoses worldwide. Limited epidemiological studies in Latin America indicate that incidence rates are higher in this region than in the Northern Hemisphere. Diagnosis is often made late in the infection, affecting the initiation of antifungal therapy. A more scientific approach, based on specific parameters, for diagnosis and management of candidemia in Latin America is warranted. 'Recommendations for the diagnosis and management of candidemia' are a series of manuscripts that have been developed by members of the Latin America Invasive Mycosis Network. They aim to provide a set of best-evidence recommendations for the diagnosis and management of candidemia. This publication, 'Recommendations for the management of candidemia in children in Latin America', was written to provide guidance to healthcare professionals on the management of children who have, or who are at risk of, candidemia. Computerized searches of existing literature were performed by PubMed. The data were extensively reviewed and analyzed by members of the group. The group also met on two occasions to pose questions, discuss conflicting views, and deliberate on a series of management recommendations. 'Recommendations for the management of candidemia in children in Latin America' includes prophylaxis, empirical therapy, therapy for proven candidemia, patient work-up following diagnosis of candidemia, duration of candidemia treatment, and central venous catheter management in children with candidemia. This manuscript is the third of this series that deals with diagnosis and treatment of invasive candidiasis. Other publications in this series include: 'Recommendations for the diagnosis of candidemia in Latin America', 'Recommendations for the management of candidemia in adults in Latin America', and 'Recommendations for the management of candidemia in neonates in Latin America'.

  17. The Plus 50 Initiative Evaluation: Initiative Impact

    ERIC Educational Resources Information Center

    American Association of Community Colleges (NJ1), 2012

    2012-01-01

    The American Association of Community Colleges (AACC), with funding from The Atlantic Philanthropies, created the Plus 50 Initiative (2008-2012). This initiative was designed to build the capacity of community colleges nationwide to develop programming that engages the plus 50 learner. This report contains: (1) An overview of the Plus 50…

  18. Vital Signs building work-up: The Museum of Anthropology

    SciTech Connect

    Millet, M.S.; Erwine, B.

    1997-12-31

    The paper will present the structure and the results of an in depth study of the Museum of Anthropology, designed by Arthur Erickson Architects for the University of British Columbia in Vancouver and completed in 1976. Part of the Vital Signs Curriculum Project created by Cris Benton and administered through the University of California at Berkeley, this analytic project was designed and carried out by a faculty/student team in the Department of Architecture at the University of Washington. The significance of this study is the simultaneous presentation of qualitative and quantitative information about the thermal and luminous environment of this building.

  19. [Sudden onset hearing loss: imaging work-up].

    PubMed

    Pons, Y; Ukkola-Pons, E; Kossowski, M

    2011-11-01

    Sudden onset hearing loss is idiopathic. It occurs in less than 24 h and spontaneously resolves within 15 days in two thirds of cases. Imaging is performed to exclude other causes of sudden onset hearing loss (vestibular schwannoma, vertebral artery dissection, stroke) and evaluate the inner ear structures. A few anatomical anomalies have been associated with an increased risk of hearing loss. Morphological anomalies involved the following structures in decreasing order of frequency: lateral semicircular canal (hypoplasia and dilatation), superior semicircular canal, posterior semicircular canal, vestibule and cochlea. Enlargement of the vestibular aqueduct also is frequently observed.

  20. WORK-UP OF STILLBIRTH: A REVIEW OF THE EVIDENCE

    PubMed Central

    SILVER, Robert M.; VARNER, Michael W.; REDDY, Uma; GOLDENBERG, Robert; PINAR, Halit; CONWAY, Deborah; BUKOWSKI, Radek; CARPENTER, Marshall; HOGUE, Carol; WILLINGER, Marian; DUDLEY, Donald; SAADE, George; STOLL, Barbara

    2009-01-01

    Despite improvements in antenatal and intrapartum care, stillbirth, defined as in utero fetal death at 20 weeks of gestation or greater, remains an important, largely unstudied, and poignant problem in obstetrics. Over 26,000 stillbirths were reported in the US in 2001. Although several conditions have been linked to stillbirth, it is difficult to define the precise etiology in many cases. This paper reviews known and suspected causes of stillbirth including genetic abnormalities, infection, fetal-maternal hemorrhage, and a variety of medical conditions in the mother. The proportion of stillbirths that have a diagnostic explanation is higher in centers that conduct a defined and systematic evaluation. Recommended diagnostic tests for stillbirth are discussed. The on-going work of the NICHD Stillbirth Collaborative Research Network, a consortium of 5 academic centers in the United States that are studying the scope and causes of stillbirth, is presented. PMID:17466694

  1. Initialized Fractional Calculus

    NASA Technical Reports Server (NTRS)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  2. Managing customer service.

    PubMed

    Paget, Zoe

    2015-02-28

    Zoe Paget is the customer services manager at YourVets. Her role includes managing the company's call centre, social media marketing, working with the marketing department to develop customer care initiatives and reporting service levels to the company's directors.

  3. 24 CFR 213.253 - Premiums upon initial endorsement.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... upon initial endorsement. (a) Management and Sales Types and Investor Sponsored Projects. The mortgagee... pursuant to the sale of an Investor Sponsored Project to such purchasing nonprofit cooperative...

  4. 24 CFR 213.253 - Premiums upon initial endorsement.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... upon initial endorsement. (a) Management and Sales Types and Investor Sponsored Projects. The mortgagee... pursuant to the sale of an Investor Sponsored Project to such purchasing nonprofit cooperative...

  5. Dioxin Exposure Initiative

    EPA Pesticide Factsheets

    The Dioxin Exposure Initiative (DEI) is no longer active. This page contains a summary of the dioxin exposure initiative with illustrations, contact and background information.Originally supported by scientist Matthew Lorber, who retired in Mar 2017.

  6. Initiation of vascular development.

    PubMed

    Ohashi-Ito, Kyoko; Fukuda, Hiroo

    2014-06-01

    The initiation of vascular development occurs during embryogenesis and the development of lateral organs, such as lateral roots and leaves. Understanding the mechanism underlying the initiation of vascular development has been an important goal of plant biologists. Auxin flow is a crucial factor involved in the initiation of vascular development. In addition, recent studies have identified key factors that regulate the establishment of vascular initial cells in embryos and roots. In this review, we summarize the recent findings in this field and discuss the initiation of vascular development.

  7. Initial Events in Bacterial Transcription Initiation

    PubMed Central

    Ruff, Emily F.; Record, M. Thomas; Artsimovitch, Irina

    2015-01-01

    Transcription initiation is a highly regulated step of gene expression. Here, we discuss the series of large conformational changes set in motion by initial specific binding of bacterial RNA polymerase (RNAP) to promoter DNA and their relevance for regulation. Bending and wrapping of the upstream duplex facilitates bending of the downstream duplex into the active site cleft, nucleating opening of 13 bp in the cleft. The rate-determining opening step, driven by binding free energy, forms an unstable open complex, probably with the template strand in the active site. At some promoters, this initial open complex is greatly stabilized by rearrangements of the discriminator region between the −10 element and +1 base of the nontemplate strand and of mobile in-cleft and downstream elements of RNAP. The rate of open complex formation is regulated by effects on the rapidly-reversible steps preceding DNA opening, while open complex lifetime is regulated by effects on the stabilization of the initial open complex. Intrinsic DNA opening-closing appears less regulated. This noncovalent mechanism and its regulation exhibit many analogies to mechanisms of enzyme catalysis. PMID:26023916

  8. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  9. Sustainable Forest Bioenergy Initiative

    SciTech Connect

    Breger, Dwayne; Rizzo, Rob

    2011-09-20

    associated with biomass usage, an understanding of forest management trends including harvesting and fuel processing methods, and the carbon profile of utilizing forest based woody biomass for the emerging biomass markets. Each of the tasks and subtasks have provided an increased level of understanding to support new directives, policies and adaptation of existing regulations within Massachusetts. The project has provided the essential information to allow state policymakers and regulators to address emerging markets, while ensuring forest sustainability and understanding the complex science on CO2 accounting and impacts as a result of biomass harvesting for power generation. The public at large and electricity ratepayers in Massachusetts will all benefit from the information garnered through this project. This is a result of the state’s interest to provide financial incentives to only biomass projects that demonstrate an acceptable carbon profile, an efficient use of the constrained supply of fuel, and the harvest of biomass to ensure forest sustainability. The goals of the Massachusetts Sustainable Forest Bioenergy Initiative as proposed in 2006 were identified as: increase the diversity of the Massachusetts energy mix through biomass; promote economic development in the rural economy through forest industry job creation; help fulfill the state’s energy and climate commitments under the Renewable Energy Portfolio Standard and Climate Protection Plan; assist the development of a biomass fuel supply infrastructure to support energy project demands; provide education and outreach to the public on the benefits and impacts of bioenergy; improve the theory and practice of sustainable forestry in the Commonwealth. Completed project activities summarized below will demonstrate the effectiveness of the project in meeting the above goals. In addition, as discussed above, Massachusetts DOER needed to make some modifications to its work plan and objectives during the term of this

  10. Progress in Initiator Modeling

    SciTech Connect

    Hrousis, C A; Christensen, J S

    2009-05-04

    There is great interest in applying magnetohydrodynamic (MHD) simulation techniques to the designs of electrical high explosive (HE) initiators, for the purpose of better understanding a design's sensitivities, optimizing its performance, and/or predicting its useful lifetime. Two MHD-capable LLNL codes, CALE and ALE3D, are being used to simulate the process of ohmic heating, vaporization, and plasma formation in the bridge of an initiator, be it an exploding bridgewire (EBW), exploding bridgefoil (EBF) or slapper type initiator. The initiation of the HE is simulated using Tarver Ignition & Growth reactive flow models. 1-D, 2-D and 3-D models have been constructed and studied. The models provide some intuitive explanation of the initiation process and are useful for evaluating the potential impact of identified aging mechanisms (such as the growth of intermetallic compounds or powder sintering). The end product of this work is a simulation capability for evaluating margin in proposed, modified or aged initiation system designs.

  11. Monitoring Abortive Initiation

    PubMed Central

    Hsu, Lilian M.

    2009-01-01

    Abortive initiation, when first discovered, was an enigmatic phenomenon, but fully three decades hence, it has been shown to be an integral step in the transcript initiation process intimately tied to the promoter escape reaction undergone by RNA polymerase at the initiation-elongation transition. A detailed understanding of abortive initiation-promoter escape has brought within reach a full description of the transcription initiation mechanism. This enormous progress was the result of convergent biochemical, genetic, and biophysical investigations propelled by parallel advances in quantitation technology. This chapter discusses the knowledge gained through the biochemical approach and a high-resolution method that yields quantitative and qualitative information regarding abortive initiation-promoter escape at a promoter. PMID:18948204

  12. Winning with Initiative

    ERIC Educational Resources Information Center

    Morgan, Matthew J.

    2004-01-01

    A common complaint among high school coaches is the lack of initiative shown by some of their players. Coaches expect a certain level of decision-making and independence, and more so from team captains and senior players. Developing leadership skills is a major benefit to athletes who participate at a competitive level, and taking initiative can…

  13. The Fostering Hope Initiative

    ERIC Educational Resources Information Center

    Rider, Steven; Winters, Katie; Dean, Joyce; Seymour, Jim

    2014-01-01

    The Fostering Hope Initiative is a neighborhood-based Collective Impact initiative that promotes optimum child and youth development by supporting vulnerable families, encouraging connections between neighbors, strengthening systems to ensure collective impact, and advocating for family-friendly public policy. This article describes the…

  14. Prioritizing Scientific Initiatives.

    ERIC Educational Resources Information Center

    Bahcall, John N.

    1991-01-01

    Discussed is the way in which a limited number of astronomy research initiatives were chosen and prioritized based on a consensus of members from the Astronomy and Astrophysics Survey Committee. A list of recommended equipment initiatives and estimated costs is provided. (KR)

  15. [Clinical management. Clinical management units. Management agreements].

    PubMed

    Ortega Moreno, A

    2003-12-01

    Clinical management (CM) as a concept includes different innovating experiences in health care services management among developed countries, which were initiated during the late eighties and the first nineties. They were mostly due to the concern that political leaders had about their financial viability. CM, as far as it is understood in Spain, is an organizing model which considers the patient as the centre of the health system. It is guided towards disease, looking for continuous assistance and facilitates an autonomous management together with decentralization at the time of taking decisions. It involves professionals whose clinical practice, based on guides, medical records and care planning, incorporate the knowledge and methodology of "evidence based medicine". Clinical management units (CMU) are organizational types of CM, which implantation is spreading rapidly in the different national health care systems. They include a person who assumes responsibility for them, who act as the hospital directorship interlocutor and are autonomous at the time of managing the allocated resources related to their medical programmes and services. They have an information system adapted to their own needs and an outcome evaluation system which allows them "process" re-engineering. CMU's strengths and weaknesses are highly dependent on the professionals that integrate them. The CMU responsible carries out a management contract with the hospital directorship in which CMU competences, directorship's obligations, essential aspects to meet agreed goals, an outcome evaluation system and an incentives scheme are included.

  16. 49 CFR 40.367 - Who initiates a PIE proceeding?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Who initiates a PIE proceeding? 40.367 Section 40... DRUG AND ALCOHOL TESTING PROGRAMS Public Interest Exclusions § 40.367 Who initiates a PIE proceeding? The following DOT officials may initiate a PIE proceeding: (a) The drug and alcohol program manager...

  17. 41 CFR 105-70.037 - Initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Initial decision. 105-70.037 Section 105-70.037 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  18. 41 CFR 105-70.038 - Reconsideration of initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Reconsideration of initial decision. 105-70.038 Section 105-70.038 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  19. Autonomous aircraft initiative study

    NASA Technical Reports Server (NTRS)

    Hewett, Marle D.

    1991-01-01

    The results of a consulting effort to aid NASA Ames-Dryden in defining a new initiative in aircraft automation are described. The initiative described is a multi-year, multi-center technology development and flight demonstration program. The initiative features the further development of technologies in aircraft automation already being pursued at multiple NASA centers and Department of Defense (DoD) research and Development (R and D) facilities. The proposed initiative involves the development of technologies in intelligent systems, guidance, control, software development, airborne computing, navigation, communications, sensors, unmanned vehicles, and air traffic control. It involves the integration and implementation of these technologies to the extent necessary to conduct selected and incremental flight demonstrations.

  20. Collaborative Procurement Initiative

    EPA Pesticide Factsheets

    GPP's Clean Energy Collaborative Procurement Initiative provides a platform for deploying clean energy technologies across multiple government and educational organizations for maximum impact on installed solar system capacity and local economic activity.

  1. About the RAS Initiative

    Cancer.gov

    The RAS Initiative, a "hub and spoke" model, connects researchers to better understand and target the more than 30% of cancers driven by mutations in RAS genes. Includes oversight and contact information.

  2. RAS Initiative - Community Outreach

    Cancer.gov

    Through community and technical collaborations, workshops and symposia, and the distribution of reference reagents, the RAS Initiative seeks to increase the sharing of knowledge and resources essential to defeating cancers caused by mutant RAS genes.

  3. RAS Initiative - Events

    Cancer.gov

    The NCI RAS Initiative has organized multiple events with outside experts to discuss how the latest scientific and technological breakthroughs can be applied to discover vulnerabilities in RAS-driven cancers.

  4. Advanced Concepts Research Initiative

    EPA Science Inventory

    This initiative is investigating various approaches to controlling and treating wet-weather flow (WWF) discharges in the urban watershed. WWF, including combined sewer overflow (CSO), sanitary sewer overflow (SSO) and stormwater discharges are leading causes of receiving water q...

  5. The RAS Initiative

    Cancer.gov

    NCI established the RAS Initiative to explore innovative approaches for attacking the proteins encoded by mutant forms of RAS genes and to ultimately create effective, new therapies for RAS-related cancers.

  6. Project Matching Initiative

    EPA Pesticide Factsheets

    The Green Power Partnership's Project Matching initiative works to connect green power users with new, not-yet-built renewable energy projects that may align with their energy, environmental, and financial objectives.

  7. PESP Landscaping Initiative

    EPA Pesticide Factsheets

    Landscaping practices can positively or negatively affect local environments and human health. The Landscaping Initiative seeks to enhance benefits of landscaping while reducing need for pesticides, fertilizers, etc., by working with partners.

  8. Initial Symptoms of ALS

    MedlinePlus

    ... Chapters Certified Centers and Clinics Support Groups About ALS About Us Our Research In Your Community Advocate ... Diagnosis En español Symptoms The initial symptoms of ALS can be quite varied in different people. One ...

  9. Midwest Clean Diesel Initiative

    EPA Pesticide Factsheets

    The Midwest Clean Diesel Initiative (MCDI) is a collaboration of federal, state and local agencies, along with communities, non-profit organizations and private companies working together by reducing exposure to emissions from diesel engines

  10. Piezoelectrically Initiated Pyrotechnic Igniter

    NASA Technical Reports Server (NTRS)

    Quince, Asia; Dutton, Maureen; Hicks, Robert; Burnham, Karen

    2013-01-01

    This innovation consists of a pyrotechnic initiator and piezoelectric initiation system. The device will be capable of being initiated mechanically; resisting initiation by EMF, RF, and EMI (electromagnetic field, radio frequency, and electromagnetic interference, respectively); and initiating in water environments and space environments. Current devices of this nature are initiated by the mechanical action of a firing pin against a primer. Primers historically are prone to failure. These failures are commonly known as misfires or hang-fires. In many cases, the primer shows the dent where the firing pin struck the primer, but the primer failed to fire. In devices such as "T" handles, which are commonly used to initiate the blowout of canopies, loss of function of the device may result in loss of crew. In devices such as flares or smoke generators, failure can result in failure to spot a downed pilot. The piezoelectrically initiated ignition system consists of a pyrotechnic device that plugs into a mechanical system (activator), which on activation, generates a high-voltage spark. The activator, when released, will strike a stack of electrically linked piezo crystals, generating a high-voltage, low-amperage current that is then conducted to the pyro-initiator. Within the initiator, an electrode releases a spark that passes through a pyrotechnic first-fire mixture, causing it to combust. The combustion of the first-fire initiates a primary pyrotechnic or explosive powder. If used in a "T" handle, the primary would ramp the speed of burn up to the speed of sound, generating a shock wave that would cause a high explosive to go "high order." In a flare or smoke generator, the secondary would produce the heat necessary to ignite the pyrotechnic mixture. The piezo activator subsystem is redundant in that a second stack of crystals would be struck at the same time with the same activation force, doubling the probability of a first strike spark generation. If the first

  11. 28 CFR 541.15 - Initial hearing.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT INMATE DISCIPLINE AND SPECIAL HOUSING UNITS Inmate Discipline and Special Housing Units § 541.15 Initial hearing. The... member(s) (hereinafter usually referred to as the Unit Discipline Committee (UDC)) may not be...

  12. Understanding the Early Years (UEY) Initiative

    ERIC Educational Resources Information Center

    Human Resources and Social Development Canada, 2007

    2007-01-01

    Internal Audit Services conducted an Early Implementation Review of the Understanding the Early Years (UEY) Initiative in 2006-07. This review is intended to provide assurance to senior management that program delivery has been established appropriately in order to meet its objectives and highlight any areas that require focused management…

  13. 5 CFR 831.1110 - Initial decision.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Initial decision. 831.1110 Section 831.1110 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS... decision of OPM unless the case is appealed or reviewed pursuant to § 831.1111....

  14. 32 CFR 286.23 - Initial determinations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Whenever possible, initial determinations to release or deny a record normally shall be made and the... the request is received by the DoD Component that manages the records requested. (h) Records of non-U... § 286.12(d)), that was obtained from a non-U.S. Government source, or for a record...

  15. Total Quality Management in Academic Libraries: Initial Implementation Efforts. Proceedings from the International Conference on TQM and Academic Libraries (1st, Washington, D.C., April 20-22, 1994).

    ERIC Educational Resources Information Center

    Rounds, Laura, Ed.; Matthews, Michael, Ed.

    This document contains conference papers, other speeches, and supplementary material from the first International Conference on Total Quality Management (TQM) and Academic Libraries, held in 1994. The conference was comprised of four sessions, and the introductory remarks of each are included, along with transcriptions of each session's…

  16. Research on diabatic initialization

    NASA Technical Reports Server (NTRS)

    Kasahara, Akira

    1990-01-01

    The objective of this research project is to contribute to improvement in the synoptic analyses in the tropics for numerical weather prediction and climate research. In addition to a prediction model, four dimensional data assimilation systems have two principal components. One is objective analysis and the other is initialization. Various methods of objective analysis are designed primarily to analyze the mass and rotational wind fields. Methods of initialization are developed to obtain the irrotational wind and its associated vertical velocity field which are balanced with the mass field and free from meteorological noise. There are essentially three approaches to the problem of initialization: quasi-geostrophic theory, bounded derivative method and nonlinear normal mode method. In the midlatitudes, these approaches generally produce satisfactory results even without diabatic effects for large-scale motions. In the tropics, the situation is quite different from that in the midlatitudes. Because of a small magnitude of the Coriolis parameter and a weak horizontal temperature gradient in the tropics, any method of initialization must incorporate diabatic effects. In fact, it can be said that understanding the problem of diabatic initialization is the key to improving the analysis and weather forecasting in the tropics.

  17. New initiatives against Africa's worms.

    PubMed

    Fenwick, Alan

    2006-03-01

    Since 1999, the funding available for the control of diseases of poverty (neglected diseases) has increased mainly due to leverage resulting from donations by the Bill and Melinda Gates Foundation and loans from the World Bank. Many countries have embarked on control programmes on a national scale due to drug donations by pharmaceutical companies through vertical programmes. The Schistosomiasis Control Initiative has expanded its operations to cover six countries in sub-Saharan Africa, but overlap of treatments between different vertical programmes is now a reality, and so care is needed to ensure that too many different drugs are not given together. Dialogue between programme managers has increased, and integration of some programmes may offer chances of synergy.

  18. Research on diabatic initialization

    NASA Technical Reports Server (NTRS)

    Kashara, Akira

    1993-01-01

    The objective of this research is to contribute to the improvement of the analyses of irrotational wind and moisture fields in the tropics through advancement in the technique of initialization, incorporating diabatic effects and use of satellite-derived, radiometric imagery data that are not used currently by operational centers. Significant accomplishments during the period of May 1991 - April 1992 in research involving the following are presented: impact of tropical initialization upon the spin-up of precipitation forecasts; and a unified approach to diabatic initialization for improvement in the analysis of divergence and water vapor fields in the tropics. Focus of current research and plans for next year are discussed with respect to the topics of controlling the precipitation over shoot during the early part of a numerical forecast and the use of satellite imagery data for improvement of the tropical analysis.

  19. A review of initial investigations to utilize ERTS-1 data in determining the availability and distribution of living marine resources. [harvest and management of fisheries resources in Mississippi Sound and Gulf waters

    NASA Technical Reports Server (NTRS)

    Stevenson, W. H.; Kemmerer, A. J.; Atwell, B. H.; Maughan, P. M.

    1974-01-01

    The National Marine Fisheries Service has been studying the application of aerospace remote sensing to fisheries management and utilization for many years. The 15-month ERTS study began in July 1972 to: (1) determine the reliability of satellite and high altitude sensors to provide oceanographic parameters in coastal waters; (2) demonstrate the use of remotely-sensed oceanographic information to predict the distribution and abundance of adult menhaden; and (3) demonstrate the potential use of satellites for acquiring information for improving the harvest and management of fisheries resources. The study focused on a coastal area in the north-central portion of the Gulf of Mexico, including parts of Alabama, Mississippi, and Louisiana. The test area used in the final analysis was the Mississippi Sound and the area outside the barrier islands to approximately the 18-meter (10-fathom) curve.

  20. Civil space technology initiative

    NASA Technical Reports Server (NTRS)

    1990-01-01

    The Civil Space Technology Initiative (CSTI) is a major, focused, space technology program of the Office of Aeronautics, Exploration and Technology (OAET) of NASA. The program was initiated to advance technology beyond basic research in order to expand and enhance system and vehicle capabilities for near-term missions. CSTI takes critical technologies to the point at which a user can confidently incorporate the new or expanded capabilities into relatively near-term, high-priority NASA missions. In particular, the CSTI program emphasizes technologies necessary for reliable and efficient access to and operation in Earth orbit as well as for support of scientific missions from Earth orbit.

  1. Shock initiation of nitromethane

    SciTech Connect

    Yoo, C.S.; Holmes, N.C.

    1993-12-31

    The shock initiation processes of nitromethane have been examined by using a fast time-resolved emission spectroscopy at a two-stage gas gun. a broad, but strong emission has been observed in a spectral range between 350 and 700 nm from shocked nitromethane above 9 GPa. The temporal profile suggests that shocked nitromethane detonates through three characteristic periods, namely an induction period, a hock initiation period, and a thermal explosion period. This paper discusses temporal and chemical characteristics of these periods and present the temperature of the shock-detonating nitromethane at pressures between 9 and 15 GPa.

  2. Research on diabatic initialization

    NASA Technical Reports Server (NTRS)

    Kasahara, Akira

    1991-01-01

    The objective was to contribute to the improvement of the analyses of irrotational wind and moisture fields in the trophics through advancement in the technique of initialization by incorporating diabatic effects. Significant accomplishments made during the period May 1990 to April 1991 in the following areas are presented: (1) estimation of the uncertainty of daily synoptic analyses in the tropics; (2) normal modes of Laplace's tidal equations for zonal wavenumber zero; and (3) tropical initialization to ameliorate the spin-up problem of precipitation forecasts. The focus of current research and plans for next year are also presented.

  3. STI Program Multimedia Initiative

    NASA Technical Reports Server (NTRS)

    Cotter, Gladys A.; Kaye, Karen

    1993-01-01

    This paper relates the experience of the NASA Scientific and Technical Information Program in introducing multimedia within the STI Program framework. A discussion of multimedia technology is included to provide context for the STI Program effort. The STI Program's Multimedia Initiative is discussed in detail. Parallels and differences between multimedia and traditional information systems project development are highlighted. Challenges faced by the program in initiating its multimedia project are summarized along with lessons learned. The paper concludes with a synopsis of the benefits the program hopes to provide its users through the introduction of multimedia illustrated by examples of successful multimedia projects.

  4. Managing Conflict in Today's Organizations.

    ERIC Educational Resources Information Center

    Lippitt, Gordon L.

    1982-01-01

    Management of conflict has assumed great importance among managers. It should be an essential part of the management development process. Human resource development planners should initiate skill training opportunities for supervisors, managers, and technical specialists in conflict resolution to allow for more effective problem solving and…

  5. Monolithic exploding foil initiator

    SciTech Connect

    Welle, Eric J; Vianco, Paul T; Headley, Paul S; Jarrell, Jason A; Garrity, J. Emmett; Shelton, Keegan P; Marley, Stephen K

    2012-10-23

    A monolithic exploding foil initiator (EFI) or slapper detonator and the method for making the monolithic EFI wherein the exploding bridge and the dielectric from which the flyer will be generated are integrated directly onto the header. In some embodiments, the barrel is directly integrated directly onto the header.

  6. The SEED Initiative

    ERIC Educational Resources Information Center

    Teich, Carolyn R.

    2011-01-01

    Committed to fulfilling the promise of the green economy, the American Association of Community Colleges (AACC) launched the Sustainability Education and Economic Development (SEED) initiative (www.theseedcenter.org) in October 2010. The project advances sustainability and clean energy workforce development practices at community colleges by…

  7. Mixed-Initiative Clustering

    ERIC Educational Resources Information Center

    Huang, Yifen

    2010-01-01

    Mixed-initiative clustering is a task where a user and a machine work collaboratively to analyze a large set of documents. We hypothesize that a user and a machine can both learn better clustering models through enriched communication and interactive learning from each other. The first contribution or this thesis is providing a framework of…

  8. Clean Energy Manufacturing Initiative

    SciTech Connect

    2013-04-01

    The initiative will strategically focus and rally EERE’s clean energy technology offices and Advanced Manufacturing Office around the urgent competitive opportunity for the United States to be the leader in the clean energy manufacturing industries and jobs of today and tomorrow.

  9. Kinesthetic Initial Training.

    ERIC Educational Resources Information Center

    Ostrom, Gladys

    1978-01-01

    The author's plans for Kinesthetic Initial Training (KIT), a system of interrelated subjects designed to teach handicapped and gifted students basic reading, writing, arithmetic, and grammar skills through the use of concrete materials, are described. KIT components are reviewed, and implications are considered for areas of psychomotor,…

  10. Envisioning Effective Laptop Initiatives

    ERIC Educational Resources Information Center

    Clausen, Jon M.; Britten, Jody; Ring, Gail

    2008-01-01

    A recent survey of 74 building-level school administrators in Indiana challenged many of the assumptions regarding 1:1 laptop initiatives and how 1:1 access would affect teaching and learning. It also revealed disturbing realities regarding instructional practices of teachers, as well as efforts to improve school technology integration. The intent…

  11. Ontario's Student Voice Initiative

    ERIC Educational Resources Information Center

    Courtney, Jean

    2014-01-01

    This article describes in some detail aspects of the Student Voice initiative funded and championed by Ontario's Ministry of Education since 2008. The project enables thousands of students to make their voices heard in meaningful ways and to participate in student-led research. Some students from grades 7 to 12 become members of the Student…

  12. Department-Initiated Change

    ERIC Educational Resources Information Center

    Watson, Anne; De Geest, Els

    2014-01-01

    This paper reports the activity of three secondary school mathematics departments in England in self-initiated states of change that led to overall improvements in students' achievements when compared to previous cohorts. This took place without intervention and without their participation in external projects. They provide examples of departments…

  13. Statistical initial orbit determination

    SciTech Connect

    Taff, L.G.; Belkin, B.; Schweiter, G.A.; Sommar, K. D.H. Wagner Associates, Inc., Paoli, PA )

    1992-02-01

    For the ballistic missile initial orbit determination problem in particular, the concept of 'launch folders' is extended. This allows to decouple the observational data from the initial orbit determination problem per se. The observational data is only used to select among the possible orbital element sets in the group of folders. Monte Carlo simulations using up to 7200 orbital element sets are described. The results are compared to the true orbital element set and the one a good radar would have been able to produce if collocated with the optical sensor. The simplest version of the new method routinely outperforms the radar initial orbital element set by a factor of two in future miss distance. In addition, not only can a differentially corrected orbital element set be produced via this approach - after only two measurements of direction - but also an updated, meaningful, six-dimensional covariance array for it can be calculated. This technique represents a significant advance in initial orbit determination for this problem, and the concept can easily be extended to minor planets and artificial satellites. 9 refs.

  14. Transformative Change Initiative

    ERIC Educational Resources Information Center

    Bragg, D. D.; Kirby, C.; Witt, M. A.; Richie, D.; Mix, S.; Feldbaum, M.; Liu, S.; Mason, M.

    2014-01-01

    The Transformative Change Initiative (TCI) is dedicated to assisting community colleges to scale up innovation in the form of guided pathways, programs of study, and evidence-based strategies to improve student outcomes and program, organization, and system performance. The impetus for TCI is the Trade Adjustment Assistance Community College and…

  15. Best Practices & Outstanding Initiatives

    ERIC Educational Resources Information Center

    Training, 2011

    2011-01-01

    In this article, "Training" editors recognize innovative and successful learning and development programs and practices. They share best practices from Automatic Data Processing, Inc., Farmers Insurance Group, FedEx Express, InterContinental Hotels Group, and Oakwood Temporary Housing. They also present the outstanding initiatives of EMD Serono,…

  16. Strategic Defense Initiative program

    SciTech Connect

    Conachan, F.C.

    1991-05-01

    This paper discusses the Strategic Defense Initiative (SDI) program. It summarizes the major programmatic and technological lessons learned from the SDI program over the past 7 years. It provides information on: past uses of SDI funds, persistent optimism in planning and starting projects, evolution of SDI architecture, and accuracy of cost estimates.

  17. Focusing educational initiatives

    NASA Technical Reports Server (NTRS)

    Parks, George K.

    1990-01-01

    The United States will soon be facing a critical shortage of aerospace scientists and engineers. To address this problem, Space Grant Colleges can assist in focusing interest in existing educational initiatives and in creating new educational opportunities, particularly for women and underrepresented minorities.

  18. America's Caribbean Basin Initiative.

    ERIC Educational Resources Information Center

    Kasten, Robert W.

    1983-01-01

    Nearly all of the countries that have succeeded in their development over the past 30 years have done so on the strength of market-oriented policies and vigorous participation in the international economy. Aid must be complemented by trade and investment. The Caribbean Basin Initiative puts these principles into practice. (RM)

  19. Initial Teaching Orthographies.

    ERIC Educational Resources Information Center

    Dewey, Godfrey

    To achieve its purpose, an initial teaching orthography (i.t.o.) should be as simple in form and substance as possible; it should be phonemic rather than phonetic. The 40 sounds distinguished by Pitmanic shorthand and some provision for schwa can serve as a basic code. The symbols can be derived from either of two major sources--standardizing the…

  20. Acute stroke initiative involving an acute care team.

    PubMed

    Roth, Sean M; Keyser, Gabrielle; Winfield, Michelle; McNeil, Julie; Simko, Leslie; Price, Karen; Moffa, Donald; Hussain, Muhammad Shazam; Peacock, W Frank; Katzan, Irene L

    2012-06-01

    The Acute Care Team Educational Initiative (ACTEI) was developed as a quality improvement initiative for the recognition and initial management of time-sensitive medical conditions. For our first time-sensitive disease process, we focused on acute stroke [acute stroke initiative (ASI)]. As part of the larger ACTEI, the ASI included creating an ACT that responds to all suspected emergency department stroke patients. In this article, we describe the planning, process, and development of the ACTEI/ASI as well as how we created an acute response team for the diagnosis and management of suspected acute stroke.

  1. Best Practices & Outstanding Initiatives

    ERIC Educational Resources Information Center

    Training, 2012

    2012-01-01

    In this article, "Training" editors recognize innovative and successful learning and development programs and practices submitted in the 2012 Training Top 125 application. Best practices: (1) Edward Jones: Practice Makes Perfect (sales training); (2) Grant Thornton LLP: Senior Manager Development Program (SMDP); (3) MetLife, Inc.: Top Advisor…

  2. Evaluation and management of pediatric hypertensive crises: hypertensive urgency and hypertensive emergencies

    PubMed Central

    Patel, Nirali H; Romero, Sarah K; Kaelber, David C

    2012-01-01

    Hypertension (HTN) in the pediatric population is estimated to have a world-wide prevalence of 2%–5%. As with adults, pediatric patients with HTN can present with hypertensive crises include hypertensive urgency and hypertensive emergencies. However, pediatric blood pressure problems have a greater chance of being from secondary causes of HTN, as opposed to primary HTN, than in adults. Thorough evaluation of a child with a hypertensive emergency includes accurate blood pressure readings, complete and focused symptom history, and appropriate past medical, surgical, and family history. Physical exam should include height, weight, four-limb blood pressures, a general overall examination and especially detailed cardiovascular and neurological examinations, including fundoscopic examination. Initial work-up should typically include electrocardiography, chest X-ray, serum chemistries, complete blood count, and urinalysis. Initial management of hypertensive emergencies generally includes the use of intravenous or oral antihypertensive medications, as well as appropriate, typically outpatient, follow-up. Emergency department goals for hypertensive crises are to (1) safely lower blood pressure, and (2) treat/minimize acute end organ damage, while (3) identifying underlying etiology. Intravenous antihypertensive medications are the treatment modality of choice for hypertensive emergencies with the goal of reducing systolic blood pressure by 25% of the original value over an 8-hour period. PMID:27147865

  3. NASA's Climate Data Services Initiative

    NASA Astrophysics Data System (ADS)

    McInerney, M.; Duffy, D.; Schnase, J. L.; Webster, W. P.

    2013-12-01

    Our understanding of the Earth's processes is based on a combination of observational data records and mathematical models. The size of NASA's space-based observational data sets is growing dramatically as new missions come online. However a potentially bigger data challenge is posed by the work of climate scientists, whose models are regularly producing data sets of hundreds of terabytes or more. It is important to understand that the 'Big Data' challenge of climate science cannot be solved with a single technological approach or an ad hoc assemblage of technologies. It will require a multi-faceted, well-integrated suite of capabilities that include cloud computing, large-scale compute-storage systems, high-performance analytics, scalable data management, and advanced deployment mechanisms in addition to the existing, well-established array of mature information technologies. It will also require a coherent organizational effort that is able to focus on the specific and sometimes unique requirements of climate science. Given that it is the knowledge that is gained from data that is of ultimate benefit to society, data publication and data analytics will play a particularly important role. In an effort to accelerate scientific discovery and innovation through broader use of climate data, NASA Goddard Space Flight Center's Office of Computational and Information Sciences and Technology has embarked on a determined effort to build a comprehensive, integrated data publication and analysis capability for climate science. The Climate Data Services (CDS) Initiative integrates people, expertise, and technology into a highly-focused, next-generation, one-stop climate science information service. The CDS Initiative is providing the organizational framework, processes, and protocols needed to deploy existing information technologies quickly using a combination of enterprise-level services and an expanding array of cloud services. Crucial to its effectiveness, the CDS

  4. Gravity wave initiated convection

    NASA Technical Reports Server (NTRS)

    Hung, R. J.

    1990-01-01

    The vertical velocity of convection initiated by gravity waves was investigated. In one particular case, the convective motion-initiated and supported by the gravity wave-induced activity (excluding contributions made by other mechanisms) reached its maximum value about one hour before the production of the funnel clouds. In another case, both rawinsonde and geosynchronous satellite imagery were used to study the life cycles of severe convective storms. Cloud modelling with input sounding data and rapid-scan imagery from GOES were used to investigate storm cloud formation, development and dissipation in terms of growth and collapse of cloud tops, as well as, the life cycles of the penetration of overshooting turrets above the tropopause. The results based on these two approaches are presented and discussed.

  5. The NLM Indexing Initiative.

    PubMed

    Aronson, A R; Bodenreider, O; Chang, H F; Humphrey, S M; Mork, J G; Nelson, S J; Rindflesch, T C; Wilbur, W J

    2000-01-01

    The objective of NLM's Indexing Initiative (IND) is to investigate methods whereby automated indexing methods partially or completely substitute for current indexing practices. The project will be considered a success if methods can be designed and implemented that result in retrieval performance that is equal to or better than the retrieval performance of systems based principally on humanly assigned index terms. We describe the current state of the project and discuss our plans for the future.

  6. Laser Initiated Actuator study

    SciTech Connect

    Watson, B.

    1991-06-27

    The program task was to design and study a laser initiated actuator. The design of the actuator is described, it being comprised of the fiber and body subassemblies. The energy source for all experiments was a Spectra Diode 2200-H2 laser diode. The diode is directly coupled to a 100 micron core, 0.3 numerical aperture fiber optic terminated with an SMA connector. The successful testing results are described and recommendations are made.

  7. Genetics of Fiber Initiation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To study the cellular mechanisms involved in fiber initiation, three fiberless lines were crossed with wildtype and fuzzless seed cotton and the F1, F2 and BC1 progeny ratios are presently being evaluated. The three fiberless lines included: MD17 (N1N1n2n2), SL1-7-1 (N1N1fl1fl1n3n3) and XZ142w. XZ...

  8. The space exploration initiative

    NASA Technical Reports Server (NTRS)

    Priest, Pete

    1991-01-01

    A number of view graph charts are presented which outline the presentation. Outlined are reasons for going to Mars, why it is necessary to go to the Moon first, and the presidential decision on the space exploration initiative. Other representative charts are entitled: Lunar transportation system requirement drivers; Mars transportation system requirement drivers; National space policy goals; Exploration hardware needed; Mars mission profile; Science on the Moon and Mars; and Two independent reviews.

  9. Burning Tongue as Initial Presentation of Celiac Disease in an Elderly Woman: A Case Report.

    PubMed

    Sherman, Andrea; Zamulko, Alla

    2016-06-01

    There are few reports in the literature where celiac disease presents with tongue manifestations, although atypical presentations of celiac disease are not uncommon. This case report highlights an atypical presentation of celiac disease in an elderly female. Our patient presented to clinic with complaints of a burning tongue for the past two years as well as occasional loose stools and fatigue. Work-up revealed iron deficiency anemia, zinc deficiency and an abnormal celiac panel. Complete symptom improvement was noted by 10 weeks into the initiation of a gluten free diet. Celiac disease can present at any age and should be considered as a differential in findings of malabsorption and gastrointestinal symptoms.

  10. MSI develops refugee initiative.

    PubMed

    1996-01-01

    This brief article highlights the new initiative by Marie Stopes International (MSI), which is part of a Reproductive Health for Refugees Consortium of four organizations formed in 1995. The new initiative will promote awareness about the need for reproductive health among refugees. Over 80% of refugees are women and children who fled a variety of disasters only to be at high risk from sexual violence, sexually transmitted infections, and the effects of unintended and unsafe pregnancies. The consortium members will work to increase donors' understanding of the health conditions of women and to significantly increase donor support for reproductive health initiatives. In addition to the role of advocacy, MSI will be introducing refugee services into its global network of reproductive health services. MSI gained experience in delivering reproductive health services in refugee situations in the former Yugoslavia and among Mozambican refugees in Malawi. MSI is investigating sources of information from several countries about refugees' needs. The consortium is also collecting information on the most effective ways of delivering reproductive health services in refugee situations. The aim is to institutionalize reproductive health services into all humanitarian responses. MSI has developed refugee programs over the past 3 years in the former Yugoslavia, Malawi, Sri Lanka, and Sierra Leone. MSI expects to establish projects in 1996 for refugees in Zaire, Guinea, and Mozambique. The numbers of displaced persons or refugees is continuing to increase worldwide, and there is a continued need to provide for these vulnerable communities.

  11. Initiation Train Experiments

    NASA Astrophysics Data System (ADS)

    Francois, Elizabeth; Johnson, Carl; Liechty, Gary; Whitley, Von

    2015-06-01

    In an effort to evaluate and qualify a new detonator diagnostic, booster selection and main charge configuration, a variety of small-scale tests have been conducted. This paper will describe the needs, testing approach and model validation. Because of the limited size available some novel approaches were made to understand the observed phenomenon. Function time and time of arrival at various locations in the initiation train are desirable data points. Knowing when each segment initiates the next segment and the time to run up to detonation is critical. Results of our experiments were modeled for timing accuracy, wave shape and pressure. Agreement between the experiments and models will be discussed. The testing that will be discussed is time of arrival wires, PDV, and fiber optic arrays. The time of arrival wire measures the detonator cup breakout time. When correlated to bridge burst, an absolute time is collected. This data point also gives time zero for the booster initiation. Many models actually start at the booster, rather than the detonator, so the inclusion of this data point will improve modeling efforts.

  12. VA INFORMATION TECHNOLOGY: Important Initiatives Begun, Yet Serious Vulnerabilities Persist

    DTIC Science & Technology

    2007-11-02

    Technology Management Issues United States General Accounting Office GAO Testimony Before the Subcommittee on Oversight and Investigations, Committee on...VA INFORMATION TECHNOLOGY Important Initiatives Begun, Yet Serious Vulnerabilities Persist Statement of David L. McClure Director, Information

  13. Diamond Technology Initiative

    DTIC Science & Technology

    1994-05-01

    thermal stresses of 10 million Watts per meter, 1,000 times better than Zerodur *. This property is also important for many thermal management...products UTD has coated to date include: • Optical windows, lenses, and mirrors . Zinc sulfide infrared windows coated with a 2.5 micron-thick...implants 16, 49 microwave plasma-enhanced CVD 2 mirrors , diamond-coated 49 models of diamond growth 10, 25, 33, 34, 39 moderators 10

  14. Army Efficiency Initiatives

    DTIC Science & Technology

    2011-04-28

    Service College Fellows. The views expressed in this student academic research paper are those of the author and do not reflect the official policy...this student academic research paper are those of the author and do not reflect the official policy or position of the Department of the Army...products, a large scale company managed to obtain significant results. Total cycle time was reduced by 60%; inventory was cut 43% from $6.3 million to

  15. Knowledge management: an innovative risk management strategy.

    PubMed

    Zipperer, Lorri; Amori, Geri

    2011-01-01

    Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success.

  16. The Epidemiologic, Microbiologic and Clinical Picture of Bacteremia among Febrile Infants and Young Children Managed as Outpatients at the Emergency Room, before and after Initiation of the Routine Anti-Pneumococcal Immunization

    PubMed Central

    Leibovitz, Eugene; David, Nuphar; Ribitzky-Eisner, Haya; Abo Madegam, Mouner; Abuabed, Said; Chodick, Gabriel; Maimon, Michal; Fruchtman, Yariv

    2016-01-01

    We described the occult bacteremia (OB) and bacteremia with diagnosed focus (BwF) picture among children managed as outpatients at the pediatric emergency room (PER) in southern Israel, before and after the introduction of pneumococcal conjugate vaccines (PCVs) introduction in a retrospective study enrolling all three- to 36-month-old patients with fever >38.0 °C during 2005–2014. Of 511 (0.82% of all febrile patients) true bacteremias, 230 (45%) were managed as outpatients; 96 of 230 (41.7%) had OB and 134 (3.59%) had BwF. OB and BwF rates were 0.22% and 3.02%, respectively. A significant decrease was noted in OB and BwF rates (p = 0.0008 and p = 0.02, respectively). S. pneumoniae (SP, 37.5%), K. kingae (11.4%) and Brucella spp. (8.7%) were the most common OB pathogens and SP (29.8%), S. viridans (13.4%), and Brucella spp. (12.7%) were the most common in BwF patients. PCV13 serotypes were not found among the serotypes isolated post-PCV13 introduction. During 2010–2014 there was an increase in non-PCV13 serotype isolation (p = 0.005). SP was the main pathogen isolated among patients with pneumonia, acute otitis media (AOM) and periorbital cellulitis (62.5%, 33.3% and 60%, respectively). OB and BwF decreased following the introduction of PCVs and SP was the main pathogen in both conditions. Vaccine-SP serotypes were not isolated in OB after PCV13 introduction and non-vaccine serotypes increased significantly. PMID:27447651

  17. 76 FR 55943 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-09

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  18. 76 FR 10388 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-24

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  19. 76 FR 79211 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-21

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  20. 77 FR 21806 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-11

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  1. 77 FR 46769 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-06

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  2. 78 FR 4870 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-23

    ... Bureau of Land Management Notice of Public Meeting, North Slope Science Initiative--Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative... Interior, North Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet...

  3. Reinfection following initial cerebrospinal fluid shunt infection

    PubMed Central

    Simon, Tamara D.; Hall, Matthew; Dean, J. Michael; Kestle, John R. W.; Riva-Cambrin, Jay

    2010-01-01

    Object Significant variation exists in the surgical and medical management of CSF shunt infection. The objectives of this study were to determine CSF shunt reinfection rates following initial CSF shunt infection in a large patient cohort and to determine management, patient, hospital, and surgeon factors associated with CSF shunt reinfection. Methods This retrospective cohort study included children who were in the Pediatric Health Information System (PHIS) database, who ranged in age from 0 to 18 years, and who underwent uncomplicated initial CSF shunt placement in addition to treatment for initial CSF shunt infection between January 1, 2001, and December 31, 2008. The outcome was CSF shunt reinfection within 6 months. The main predictor variable of interest was surgical approach to treatment of first infection, which was determined for 483 patients. Covariates included patient, hospital, surgeon, and other management factors. Results The PHIS database includes 675 children with initial CSF shunt infection. Surgical approach to treatment of the initial CSF shunt infection was determined for 483 children (71.6%). The surgical approach was primarily shunt removal/new shunt placement (in 286 children [59.2%]), but a substantial number underwent externalization (59 children [12.2%]), of whom a subset went on to have the externalized shunt removed and a new shunt placed (17 children [3.5% overall]). Other approaches included nonsurgical management (64 children [13.3%]) and complete shunt removal without shunt replacement (74 children [15.3%]). The 6-month reinfection rate was 14.8% (100 of 675 patients). The median time from infection to reinfection was 21 days (interquartile range [IQR] 5–58 days). Children with reinfection had less time between shunt placement and initial infection (median 50 vs 79 days, p = 0.06). No differences between those with and without reinfection were seen in patient factors (patient age at either shunt placement or initial infection, sex

  4. Through bulkhead initiator studies

    SciTech Connect

    Begeal, D.R.

    1997-03-01

    This report describes recent work done to demonstrate feasibility of a fail-safe Through Bulkhead Initiator with minimum dimensions and suitable for use in cyclical thermal environments. Much of the ground work for a fail-safe TBI was previously done by A.C. Schwartz. This study is an expansion of Schwartz`s work to evaluate devices with bulkheads of 304 stainless steel and Inconel 718; explosive donors of PETN, BNCP, and a 0.005 inch thick steel flying plate donor traveling at 2.6 mm/{micro}s; and explosive acceptors of PETN and BNCP. Bulkhead thickness were evaluated in the range of 0.040 to 0.180 inch. The explosive acceptors initiated a small HMX pellet to drive a 0.005 inch thick steel flying plate, and VISAR histories of the HMX-driven flying plates were the measure of acceptable performance. A companion set of samples used a PMMA acceptor to measure the particle velocities at the bulkhead/PMMA interface with VISAR. These data were used to compute the input pressure to the acceptor explosives in an attempt to measure initiation threshold. Unfortunately, the range of bulkhead thicknesses tested did not give any failures, thus the threshold was not determined. It was found that either explosive or the flying plate would perform as a TBI in the bulkhead thickness range tested. The optimum TBI is about 0.060 inches thick, and steel bulkheads seem to be more structurally sound than those made of Inconel. That is, cross section views of the Inconel bulkheads showed it to be more prone to stress cracking than was the 304 stainless steel. Both PETN and BNCP showed good performance when tested at {minus}65 F following thermal cycling of {minus}65 F to +165 F. Analysis of the TBI function times showed that BNCP acceptor explosives were undergoing the classical deflagration to detonation process. The PETN acceptors were undergoing prompt detonation.

  5. Initial blood storage experiment

    NASA Technical Reports Server (NTRS)

    Surgenor, Douglas MACN.

    1988-01-01

    The design of the Initial Blood Storage Experiment (IBSE) was based upon a carefully controlled comparison between identical sets of human blood cell suspensions - red cells, white cell, and platelets - one set of which was transported aboard the Columbia on a 6 day 11 hour mission, and the other held on the ground. Both sets were carried inside stainless steel dewars within specially fabricated flight hardware. Individual bags of cell suspensions were randomly assigned with respect to ground vs orbit status, dewar chamber, and specific location within the dewar. To foster optimal preservation, each cell type was held under specific optimal conditions of pH, ionic strength, solute concentration, gas tension, and temperature. An added variable in this initial experiment was provided by the use of three different polymer/plasticizer formulations for the sealed bags which held the blood cells. At termination of the experiment, aliquots of the suspensions, identified only by code, were distributed to be assayed. Assays were selected to constitute a broad survey of cellular properties and thereby maximize the chances of detection of gravitational effects. A total of 74 different outcome measurements were reported for statistical analysis. When the measurements were completed, the results were entered into the IBSE data base, at which time the data were matched with the original blood bag numbers to determine their status with respect to polymer/plasticizer type, orbit status (orbit or ground), and storage position within the experimental hardware. The data were studied by analysis of variance. Initially, type of bag and orbital status were main factors; later more detailed analyses were made on specific issues such as position in the hardware and specific plastic. If the analysis of variance indicated a statistical significance at the 5 percent level the corresponding p-value was reported.

  6. Stirling to Flight Initiative

    NASA Technical Reports Server (NTRS)

    Hibbard, Kenneth E.; Mason, Lee S.; Ndu, Obi; Smith, Clayton; Withrow, James P.

    2016-01-01

    Flight (S2F) initiative with the objective of developing a 100-500 We Stirling generator system. Additionally, a different approach is being devised for this initiative to avoid pitfalls of the past, and apply lessons learned from the recent ASRG experience. Two key aspects of this initiative are a Stirling System Technology Maturation Effort, and a Surrogate Mission Team (SMT) intended to provide clear mission pull and requirements context. The S2F project seeks to lead directly into a DOE flight system development of a new SRG. This paper will detail the proposed S2F initiative, and provide specifics on the key efforts designed to pave a forward path for bringing Stirling technology to flight.

  7. UNLV Nuclear Hydrogen Initiative

    SciTech Connect

    Hechanova, Anthony E.; Johnson, Allen; O'Toole, Brendan; Trabia, Mohamed; Peterson, Per

    2012-10-25

    Evaluation of the Crack growth rate (CGR) of Alloy 617 and Alloy 276 under constant K at ambient temperature has been completed. Creep deformation of Alloy 230 at different temperature range and load level has been completed and heat to heat variation has been noticed. Creep deformation study of Alloy 276 has been completed under an applied initial stress level of 10% of yield stress at 950ºC. The grain size evaluation of the tested creep specimens of Alloy 276 has been completed.

  8. Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    1990-01-01

    An overview of President Bush's Space Exploration Initiative (SEI) and it's three main components, Space Station Freedom, a Permanent Lunar Base, and a Manned Mission to Mars is provided. Computer simulations of the Space Station Freedom and Permanent Lunar Base are shown, and an animated sequence describes a Mars mission where heavy lift vehicle will bring components of a Mars Spacecraft into orbit, where it will be put together by astronauts using a robotic arm. The Mars spacecraft is shown orbiting Mars and discharging a lander to the surface, carrying human explorers. The video also details the SEI's Outreach Program, designed to garner interest in and ideas for Space Exploration.

  9. Initiation of slug flow

    SciTech Connect

    Hanratty, T.J.; Woods, B.D.

    1995-12-31

    The initiation of slug flow in a horizontal pipe can be predicted either by considering the stability of a slug or by considering the stability of a stratified flow. Measurements of the shedding rate of slugs are used to define necessary conditions for the existence of a slug. Recent results show that slugs develop from an unstable stratified flow through the evolution of small wavelength waves into large wavelength waves that have the possibility of growing to form a slug. The mechanism appears to be quite different for fluids with viscosities close to water than for fluids with large viscosities (20 centipoise).

  10. Human Research Initiative (HRI)

    NASA Technical Reports Server (NTRS)

    Motil, Brian

    2003-01-01

    A code U initiative starting in the FY04 budget includes specific funding for 'Phase Change' and 'Multiphase Flow Research' on the ISS. NASA GRC developed a concept for two facilities based on funding/schedule constraints: 1) Two Phase Flow Facility (TphiFFy) which assumes integrating into FIR; 2) Contact Line Dynamics Experiment Facility (CLiDE) which assumes integration into MSG. Each facility will accommodate multiple experiments conducted by NRA selected PIs with an overall goal of enabling specific NASA strategic objectives. There may also be a significant ground-based component.

  11. Feedback stabilization initiative

    SciTech Connect

    1997-06-01

    Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes.

  12. Advanced Monitoring systems initiative

    SciTech Connect

    R.J. Venedam; E.O. Hohman; C.F. Lohrstorfer; S.J. Weeks; J.B. Jones; W.J. Haas

    2004-09-30

    The Advanced Monitoring Systems Initiative (AMSI) actively searches for promising technologies and aggressively moves them from the research bench into DOE/NNSA end-user applications. There is a large unfulfilled need for an active element that reaches out to identify and recruit emerging sensor technologies into the test and evaluation function. Sensor research is ubiquitous, with the seeds of many novel concepts originating in the university systems, but at present these novel concepts do not move quickly and efficiently into real test environments. AMSI is a widely recognized, self-sustaining ''business'' accelerating the selection, development, testing, evaluation, and deployment of advanced monitoring systems and components.

  13. Contemporary management of cancer of the oral cavity

    PubMed Central

    Genden, Eric M.; Silver, Carl E.; Takes, Robert P.; Suárez, Carlos; Owen, Randall P.; Haigentz, Missak; Stoeckli, Sandro J.; Shaha, Ashok R.; Rapidis, Alexander D.; Rodrigo, Juan Pablo; Rinaldo, Alessandra

    2010-01-01

    Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers. PMID:20155361

  14. Initiation of the Madden-Julian Oscillation

    ScienceCinema

    None

    2016-07-12

    Many storms around the world have roots in the Indian Ocean, where they are churned up by the atmospheric process called the Madden-Julian Oscillation (MJO). PNNL is working to unlock the secrets of the MJO, particularly how it initiates in the Indian Ocean every 30-60 days. Better prediction of the MJO will help resource managers, weather forecasters and people worldwide better prepare for its effects.

  15. Initiation of the Madden-Julian Oscillation

    SciTech Connect

    2015-12-14

    Many storms around the world have roots in the Indian Ocean, where they are churned up by the atmospheric process called the Madden-Julian Oscillation (MJO). PNNL is working to unlock the secrets of the MJO, particularly how it initiates in the Indian Ocean every 30-60 days. Better prediction of the MJO will help resource managers, weather forecasters and people worldwide better prepare for its effects.

  16. NASA Gulf of Mexico Initiative Hypoxia Research

    NASA Technical Reports Server (NTRS)

    Armstrong, Curtis D.

    2012-01-01

    The Applied Science & Technology Project Office at Stennis Space Center (SSC) manages NASA's Gulf of Mexico Initiative (GOMI). Addressing short-term crises and long-term issues, GOMI participants seek to understand the environment using remote sensing, in-situ observations, laboratory analyses, field observations and computational models. New capabilities are transferred to end-users to help them make informed decisions. Some GOMI activities of interest to the hypoxia research community are highlighted.

  17. Managing Mandated Educational Change

    ERIC Educational Resources Information Center

    Clement, Jennifer

    2014-01-01

    This paper explores teachers' perspectives on the management of mandated educational change in order to understand how it may be managed more effectively. A case study of teachers' responses to the introduction of a quality teaching initiative in two New South Wales schools found that while some teachers described the strong negative impact of…

  18. Development and Initial Evaluation of the Web-Based Self-Management Program “Partner in Balance” for Family Caregivers of People With Early Stage Dementia: An Exploratory Mixed-Methods Study

    PubMed Central

    de Vugt, Marjolein E; Withagen, Hanneke EJ; Kempen, Gertrudis IJM; Verhey, Frans RJ

    2016-01-01

    Background People with dementia increasingly depend on informal caregivers. Internet-based self-management interventions hold considerable promise for meeting the educational and support needs of early stage dementia caregivers (EDCs) at a reduced cost. Objective This study aimed to (1) develop an online self-management program for EDC to increase self-efficacy and goal attainment, and (2) evaluate the program’s feasibility and report preliminary data on effectiveness. Methods Based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, a stepwise approach was adopted to explore potential user needs and develop and validate the content by means of (1) focus group discussions with dementia caregivers (N=28), (2) interviews with dementia care professionals (N=11), and (3) individual think-aloud usability tests with EDC (N=2) and experts (N=2). A pilot evaluation was conducted with EDC (N=17) to test the feasibility and establish preliminary effects. Self-report measures of feasibility were completed after the completion of intervention. Self-efficacy and goal attainment were evaluated before and after the intervention. Results The different steps provided useful information about the needs of potential users regarding the content and delivery of the program. This resulted in the newly developed “Partner in Balance” program. At the start, system failures resulted in a high noncompleter rate (7/17, 41%), but at the end, an acceptable feasibility score of 209 (range 54-234) was found. The convenience of completing the program at home, the tailored content, and the guidance (face-to-face and online) were appraised positively. Preliminary effects on caregiver self-efficacy (P<.05) and goal attainment (T>50) were promising. Conclusions Adaptations were made to the program to limit the amount of system failures and prevent high noncompleter rates. As recommended by the MRC framework, confirming the feasibility and

  19. Two Phase Technology Development Initiatives

    NASA Technical Reports Server (NTRS)

    Didion, Jeffrey R.

    1999-01-01

    Three promising thermal technology development initiatives, vapor compression thermal control system, electronics cooling, and electrohydrodynamics applications are outlined herein. These technologies will provide thermal engineers with additional tools to meet the thermal challenges presented by increased power densities and reduced architectural options that will be available in future spacecraft. Goddard Space Flight Center and the University of Maryland are fabricating and testing a 'proto- flight' vapor compression based thermal control system for the Ultra Long Duration Balloon (ULDB) Program. The vapor compression system will be capable of transporting approximately 400 W of heat while providing a temperature lift of 60C. The system is constructed of 'commercial off-the-shelf' hardware that is modified to meet the unique environmental requirements of the ULDB. A demonstration flight is planned for 1999 or early 2000. Goddard Space Flight Center has embarked upon a multi-discipline effort to address a number of design issues regarding spacecraft electronics. The program addressed the high priority design issues concerning the total mass of standard spacecraft electronics enclosures and the impact of design changes on thermal performance. This presentation reviews the pertinent results of the Lightweight Electronics Enclosure Program. Electronics cooling is a growing challenge to thermal engineers due to increasing power densities and spacecraft architecture. The space-flight qualification program and preliminary results of thermal performance tests of copper-water heat pipes are presented. Electrohydrodynamics (EHD) is an emerging technology that uses the secondary forces that result from the application of an electric field to a flowing fluid to enhance heat transfer and manage fluid flow. A brief review of current EHD capabilities regarding heat transfer enhancement of commercial heat exchangers and capillary pumped loops is presented. Goddard Space Flight

  20. Brazilian Nanotechnology Initiative

    NASA Astrophysics Data System (ADS)

    Fazzio, Adalberto

    2015-03-01

    In Brazil there is intense research activity in nanotechnology, most of these developed in universities and research institutes. The Brazilian Nanotechnology Initiative (BNI) aims to integrate government actions to promote the competitiveness of the Brazilian industry. This initiative is founded on support for research and development in the laboratories of the National Laboratories for Nanotechnology (SisNANO), starting from an improvement in infrastructure and opening of laboratories for users of academia and business, promoting interaction and transfer knowledge between academia and business. Country currently has 26 thematic networks of nanotechnology, 16 -Virtual-National Institutes of Technology, seven National- Laboratories and 18 Associate Laboratories, which comprise the SisNANO. Seeking to expand and share governance with other government actors, the Interministries Committee for Nanotechnology was set up, composed of 10 ministries, and has the task of coordinating the entire program of the Federal Government Nanotechnology.Cooperation activities are an important part of BNI. Currently Brazil has cooperation programs with U.S., China, Canada and European Union among others. Recently, Brazil decided to join the European NanoReg program where 60 research groups are joining efforts to provide protocols and standards that can help regulatory agencies and governments.

  1. Initiatives for proliferation prevention

    SciTech Connect

    1997-04-01

    Preventing the proliferation of weapons of mass destruction is a central part of US national security policy. A principal instrument of the Department of Energy`s (DOE`s) program for securing weapons of mass destruction technology and expertise and removing incentives for scientists, engineers and technicians in the newly independent states (NIS) of the former Soviet Union to go to rogue countries or assist terrorist groups is the Initiatives for Proliferation Prevention (IPP). IPP was initiated pursuant to the 1994 Foreign Operations Appropriations Act. IPP is a nonproliferation program with a commercialization strategy. IPP seeks to enhance US national security and to achieve nonproliferation objectives by engaging scientists, engineers and technicians from former NIS weapons institutes; redirecting their activities in cooperatively-developed, commercially viable non-weapons related projects. These projects lead to commercial and economic benefits for both the NIS and the US IPP projects are funded in Russian, Ukraine, Kazakhstan and Belarus. This booklet offers an overview of the IPP program as well as a sampling of some of the projects which are currently underway.

  2. Precision flyer initiator

    DOEpatents

    Frank, A.M.; Lee, R.S.

    1998-05-26

    A precision flyer initiator forms a substantially spherical detonation wave in a high explosive (HE) pellet. An explosive driver, such as a detonating cord, a wire bridge circuit or a small explosive, is detonated. A flyer material is sandwiched between the explosive driver and an end of a barrel that contains an inner channel. A projectile or ``flyer`` is sheared from the flyer material by the force of the explosive driver and projected through the inner channel. The flyer than strikes the HE pellet, which is supported above a second end of the barrel by a spacer ring. A gap or shock decoupling material delays the shock wave in the barrel from predetonating the HE pellet before the flyer. A spherical detonation wave is formed in the HE pellet. Thus, a shock wave traveling through the barrel fails to reach the HE pellet before the flyer strikes the HE pellet. The precision flyer initiator can be used in mining devices, well-drilling devices and anti-tank devices. 10 figs.

  3. Precision flyer initiator

    DOEpatents

    Frank, Alan M.; Lee, Ronald S.

    1998-01-01

    A precision flyer initiator forms a substantially spherical detonation wave in a high explosive (HE) pellet. An explosive driver, such as a detonating cord, a wire bridge circuit or a small explosive, is detonated. A flyer material is sandwiched between the explosive driver and an end of a barrel that contains an inner channel. A projectile or "flyer" is sheared from the flyer material by the force of the explosive driver and projected through the inner channel. The flyer than strikes the HE pellet, which is supported above a second end of the barrel by a spacer ring. A gap or shock decoupling material delays the shock wave in the barrel from predetonating the HE pellet before the flyer. A spherical detonation wave is formed in the HE pellet. Thus, a shock wave traveling through the barrel fails to reach the HE pellet before the flyer strikes the HE pellet. The precision flyer initiator can be used in mining devices, well-drilling devices and anti-tank devices.

  4. Big Earth Data Initiative: Metadata Improvement: Case Studies

    NASA Technical Reports Server (NTRS)

    Kozimor, John; Habermann, Ted; Farley, John

    2016-01-01

    Big Earth Data Initiative (BEDI) The Big Earth Data Initiative (BEDI) invests in standardizing and optimizing the collection, management and delivery of U.S. Government's civil Earth observation data to improve discovery, access use, and understanding of Earth observations by the broader user community. Complete and consistent standard metadata helps address all three goals.

  5. 5 CFR 9701.605 - Initial service period.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Initial service period. 9701.605 Section... RESOURCES MANAGEMENT SYSTEM Adverse Actions General § 9701.605 Initial service period. (a) DHS may establish... in such occupations to demonstrate appropriate competencies. DHS will establish standard policies...

  6. 5 CFR 9701.605 - Initial service period.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Initial service period. 9701.605 Section... RESOURCES MANAGEMENT SYSTEM Adverse Actions General § 9701.605 Initial service period. (a) DHS may establish... in such occupations to demonstrate appropriate competencies. DHS will establish standard policies...

  7. 5 CFR 9701.605 - Initial service period.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Initial service period. 9701.605 Section... RESOURCES MANAGEMENT SYSTEM Adverse Actions General § 9701.605 Initial service period. (a) DHS may establish... in such occupations to demonstrate appropriate competencies. DHS will establish standard policies...

  8. Provincially and Locally Initiated Curriculum Program Assessment, Final Report.

    ERIC Educational Resources Information Center

    1999

    This report is an independent assessment of the Provincially Initiated Curriculum (PIC) and Locally Initiated Curriculum (LIC) for British Columbia's Centre for Curriculum, Transfer and Technology (C2T2), which manages both PIC and LIC projects. The report makes four recommendations for C2T2's consideration: (1) a renewed emphasis on communication…

  9. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Initiation of research programs. 470.205... PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Research Programs § 470.205 Initiation of research programs. OPM will announce opportunities for...

  10. Benthic habitat map of the U.S. Coral Reef Task Force Watershed Partnership Initiative Kā'anapali priority study area and the State of Hawai'i Kahekili Herbivore Fisheries Management Area, west-central Maui, Hawai'i

    USGS Publications Warehouse

    Cochran, Susan A.; Gibbs, Ann E.; White, Darla J.

    2014-01-01

    Nearshore areas off of west-central Maui, Hawai‘i, once dominated by abundant coral coverage, now are characterized by an increased abundance of turf algae and macroalgae. In an effort to improve the health and resilience of the coral reef system, the Kahekili Herbivore Fisheries Management Area was established by the State of Hawai‘i, and the U.S. Coral Reef Task Force selected the Kā‘anapali region as a priority study area. To support these efforts, the U.S. Geological survey mapped nearly 5 km2 of sea floor from the shoreline to water depths of about 30 m. Unconsolidated sediment (predominantly sand) constitutes 65 percent of the sea floor in the mapped area. Reef and other hardbottom potentially available for coral recruitments constitutes 35 percent of the mapped area. Of this potentially available hardbottom, only 51 percent is covered with a minimum of 10 percent coral, and most is found between 5 and 10 m water depth.

  11. Breckinridge Project, initial effort

    SciTech Connect

    1982-01-01

    Report V, Volume 4 provides descriptions, data, and drawings pertaining to Instrument and Plant Air Systems (Plant 36), Telecommunication Systems (Plant 37), Inert Gas Systems (Plant 38), Purge and Flush Oil Systems (Plant 39), Site Development and Roads (Plant 40), Buildings (Plant 41), Solid Waste Management (Plant 42), and Landfill (Plant 44). Instrument and Plant Air Systems (Plant 36) includes all equipment and piping necessary to supply instrument and utility air to the process plants and offsite facilities. Telecommunication Systems (Plant 37) includes the equipment and wiring for: communication throughout the facility; communication between plant data processing systems and offsite computing facilities; and communication with transportation carriers. Inert Gas Systems (Plant 38) provides high purity and low purity nitrogen streams for plant startup and normal operation. Purge and Flush Oil Systems (Plant 39) provides purge and flush oils to various plants. Site Development and Roads (Plant 40) provides site leveling, the addition of roads, fencing, and drainage, and the placement of fills, pilings, footings, and foundations for plants. Buildings (Plant 41) provides buildings for equipment and for personnel, including utilities, lighting, sanitary facilities, heating, air conditioning, and ventilation. Solid Waste Management (Plant 42) identifies, characterizes, segregates, and transports the various types of solid wastes to either Landfill (Plant 44) or outside disposal sites. Landfill (Plant 44) provides disposal of both nonhazardous and hazardous solid wastes. Information is included (as applicable) for each of the eight plants described.

  12. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions § 9701.372...

  13. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions § 9701.372...

  14. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions § 9701.372...

  15. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions § 9701.372...

  16. 5 CFR 9701.372 - Creating initial pay ranges.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Creating initial pay ranges. 9701.372 Section 9701.372 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Transitional Provisions § 9701.372...

  17. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  18. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  19. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  20. 5 CFR 470.205 - Initiation of research programs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Initiation of research programs. 470.205 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  1. Instrumented Pipeline Initiative

    SciTech Connect

    Thomas Piro; Michael Ream

    2010-07-31

    This report summarizes technical progress achieved during the cooperative agreement between Concurrent Technologies Corporation (CTC) and U.S. Department of Energy to address the need for a for low-cost monitoring and inspection sensor system as identified in the Department of Energy (DOE) National Gas Infrastructure Research & Development (R&D) Delivery Reliability Program Roadmap.. The Instrumented Pipeline Initiative (IPI) achieved the objective by researching technologies for the monitoring of pipeline delivery integrity, through a ubiquitous network of sensors and controllers to detect and diagnose incipient defects, leaks, and failures. This report is organized by tasks as detailed in the Statement of Project Objectives (SOPO). The sections all state the objective and approach before detailing results of work.

  2. [Advanced Composites Technology Initiatives

    NASA Technical Reports Server (NTRS)

    Julian, Mark R.

    2002-01-01

    This final report closes out the W02 NASA Grant #NCC5-646. The FY02 grant for advanced technology initiatives through the Advanced Composites Technology Institute in Bridgeport, WV, at the Robert C. Byrd Institute (RCBI) Bridgeport Manufacturing Technology Center, is complete; all funding has been expended. RCBI continued to expand access to technology; develop and implement a workforce-training curriculum; improve material development; and provide prototyping and demonstrations of new and advanced composites technologies for West Virginia composites firms. The FY 02 efforts supported workforce development, technical training and the HST development effort of a super-lightweight composite carrier prototype and expanded the existing technical capabilities of the growing aerospace industry across West Virginia to provide additional support for NASA missions. Additionally, the Composites Technology and Training Center was awarded IS0 9001 - 2000 certification and Cleanroom Class 1000 certification during this report period.

  3. Breckinridge Project, initial effort

    SciTech Connect

    None, None

    1982-09-01

    Report III, Volume 1 contains those specifications numbered A through J, as follows: General Specifications (A); Specifications for Pressure Vessels (C); Specifications for Tanks (D); Specifications for Exchangers (E); Specifications for Fired Heaters (F); Specifications for Pumps and Drivers (G); and Specifications for Instrumentation (J). The standard specifications of Bechtel Petroleum Incorporated have been amended as necessary to reflect the specific requirements of the Breckinridge Project, and the more stringent specifications of Ashland Synthetic Fuels, Inc. These standard specifications are available to the Initial Effort (Phase Zero) work performed by all contractors and subcontractors. Report III, Volume 1 also contains the unique specifications prepared for Plants 8, 15, and 27. These specifications will be substantially reviewed during Phase I of the project, and modified as necessary for use during the engineering, procurement, and construction of this project.

  4. [Dementia: management and prevention].

    PubMed

    Daher, Oscar; Nguyen, Sylvain; Smith, Cindi; Büla, Christophe; Démonet, Jean-François

    2016-04-20

    Dementia represents a great challenge for health care providers. Detection of cognitive impairment is critical for early diagnosis of dementia. Early diagnosis allows to initiate individualized management that focuses on maintaining patient's autonomy and supporting their caregivers. Proposed multimodal interventions include physical activity, cognitive training, mediterranean diet, and management of cardiovascular risk factors. Before the initiation of pro-cognitive therapy, medication review is essential to evaluate current treament and determine specific therapeutic objectives, based on patient's overall health and preferences. Overall risk reduction for dementia revolves around similar measures that target physical activity, cognition, diet and management of cardiovascular risk factors.

  5. MONTANA PALLADIUM RESEARCH INITIATIVE

    SciTech Connect

    Peters, John; McCloskey, Jay; Douglas, Trevor; Young, Mark; Snyder, Stuart; Gurney, Brian

    2012-05-09

    Project Objective: The overarching objective of the Montana Palladium Research Initiative is to perform scientific research on the properties and uses of palladium in the context of the U.S. Department of Energy's Hydrogen, Fuel Cells and Infrastructure Technologies Program. The purpose of the research will be to explore possible palladium as an alternative to platinum in hydrogen-economy applications. To achieve this objective, the Initiatives activities will focus on several cutting-edge research approaches across a range of disciplines, including metallurgy, biomimetics, instrumentation development, and systems analysis. Background: Platinum-group elements (PGEs) play significant roles in processing hydrogen, an element that shows high potential to address this need in the U.S. and the world for inexpensive, reliable, clean energy. Platinum, however, is a very expensive component of current and planned systems, so less-expensive alternatives that have similar physical properties are being sought. To this end, several tasks have been defined under the rubric of the Montana Palladium Research Iniative. This broad swath of activities will allow progress on several fronts. The membrane-related activities of Task 1 employs state-of-the-art and leading-edge technologies to develop new, ceramic-substrate metallic membranes for the production of high-purity hydrogen, and develop techniques for the production of thin, defect-free platinum group element catalytic membranes for energy production and pollution control. The biomimetic work in Task 2 explores the use of substrate-attached hydrogen-producing enzymes and the encapsulation of palladium in virion-based protein coats to determine their utility for distributed hydrogen production. Task 3 work involves developing laser-induced breakdown spectroscopy (LIBS) as a real-time, in situ diagnostic technique to characterize PGEs nanoparticles for process monitoring and control. The systems engineering work in task 4 will

  6. Green Power Initiative

    SciTech Connect

    Butler, Patrick Barry

    2013-01-28

    National energy policy supports the gathering of more detailed and authoritative data on the introduction of renewable bio-based fuels into new and existing district energy systems via the application of biomass gasification. The University of Iowa developed a biomass-fueled, university-scale steam generation system based on biomass gasification technologies. The system serves as a state-of-the-art research and educational facility in the emerging application of gasification in steam generation. The facility, which includes a smaller down-draft gasifier and a larger multi-stage biomass boiler, was designed to operate primarily on wood-based fuels, but has provisions for testing other biomass fuel sources produced within a 100-mile radius, providing enough flexibility to meet the fluctuating local supply of biomass from industry and Midwest agriculture. The equipment was installed in an existing, staffed facility. The down-draft gasifier unit is operated by College of Engineering staff and students, under the direct technical supervision of qualified Utilities plant staff. The Green Power Initiative also includes a substantial, innovative educational component. In addition to an onsite, graduate-level research program in biomass fuels, the investigators have integrated undergraduate and graduate level teaching – through classroom studies and experiential learning – and applied research into a biomass-based, university-scale, functioning power plant. University of Iowa is unique in that it currently has multiple renewable energy technologies deployed, including significant biomass combustion (oat hulls) at its Main Power Plant and a new reciprocating engine based renewable district energy system. This project complements and supports the national energy policy and State of Iowa initiatives in ethanol and biodiesel. Byproducts of ethanol and biodiesel processes (distiller grains) as well as industry residues (oat hulls, wood chips, construction and demolition

  7. Process Engineering Technology Center Initiative

    NASA Technical Reports Server (NTRS)

    Centeno, Martha A.

    2001-01-01

    NASA's Kennedy Space Center (KSC) is developing as a world-class Spaceport Technology Center (STC). From a process engineering (PE) perspective, the facilities used for flight hardware processing at KSC are NASA's premier factories. The products of these factories are safe, successful shuttle and expendable vehicle launches carrying state-of-the-art payloads. PE is devoted to process design, process management, and process improvement, rather than product design. PE also emphasizes the relationships of workers with systems and processes. Thus, it is difficult to speak of having a laboratory for PE at KSC because the entire facility is practically a laboratory when observed from a macro level perspective. However, it becomes necessary, at times, to show and display how KSC has benefited from PE and how KSC has contributed to the development of PE; hence, it has been proposed that a Process Engineering Technology Center (PETC) be developed to offer a place with a centralized focus on PE projects, and a place where KSC's PE capabilities can be showcased, and a venue where new Process Engineering technologies can be investigated and tested. Graphics for showcasing PE capabilities have been designed, and two initial test beds for PE technology research have been identified. Specifically, one test bed will look into the use of wearable computers with head mounted displays to deliver work instructions; the other test bed will look into developing simulation models that can be assembled into one to create a hierarchical model.

  8. Simulation of Initiation in Hexanitrostilbene

    NASA Astrophysics Data System (ADS)

    Thompson, Aidan; Shan, Tzu-Ray; Yarrington, Cole; Wixom, Ryan

    We report on the effect of isolated voids and pairs of nearby voids on hot spot formation, growth and chemical reaction initiation in hexanitrostilbene (HNS) crystals subjected to shock loading. Large-scale, reactive molecular dynamics simulations are performed using the reactive force field (ReaxFF) as implemented in the LAMMPS software. The ReaxFF force field description for HNS has been validated previously by comparing the isothermal equation of state to available diamond anvil cell (DAC) measurements and density function theory (DFT) calculations. Micron-scale molecular dynamics simulations of a supported shockwave propagating in HNS crystal along the [010] orientation are performed (up = 1.25 km/s, Us =4.0 km/s, P = 11GPa.) We compare the effect on hot spot formation and growth rate of isolated cylindrical voids up to 0.1 µm in size with that of two 50nm voids set 100nm apart. Results from the micron-scale atomistic simulations are compared with hydrodynamics simulations. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lock- heed Martin Corporation, for the U.S. DOE National Nuclear Security Administration under Contract DE-AC04-94AL85000.

  9. 14 CFR 121.421 - Flight attendants: Initial and transition ground training.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...) Approved crew resource management initial training. (2) For each airplane type— (i) A general description... equipment and the controls for cabin heat and ventilation. (b) Initial and transition ground training...

  10. TFTR initial operations

    SciTech Connect

    Young, K.M.; Bell, M.; Blanchard, W.R.; Bretz, N.; Cecchi, J.; Coonrod, J.; Davis, S.; Dylla, H.F.; Efthimion, P.C.; Fonck, R.

    1983-11-01

    The Tokamak Fusion Test Reactor (TFTR) has operated since December 1982 with ohmically heated plasmas. Routine operation with feedback control of plasma current, position, and density has been obtained for plasmas with I/sub p/ approx. = 800 kA, a = 68 cm, R = 250 cm, and B/sub t/ = 27 kG. A maximum plasma current of 1 MA was achieved with q approx. = 2.5. Energy confinement times of approx. 150 msec were measured for hydrogen and deuterium plasmas with anti n/sub e/ approx. = 2 x 10/sup 13/ cm/sup -3/, T/sub e/ (0) approx. = 1.5 keV, T/sub i/ (0) approx. = 1.5 keV, and Z/sub eff/ approx. = 3. The preliminary results suggest a size-cubed scaling from PLT and are consistent with Alcator C scaling where tau approx. nR/sup 2/a. Initial measurements of plasma disruption characteristics indicate current decay rates of approx. 800 kA in 8 ms which is within the TFTR design requirement of 3 MA in 3 ms.

  11. ALOS-2 initial results

    NASA Astrophysics Data System (ADS)

    Kankaku, Yukihiro; Suzuki, Shinichi; Shimada, Masanobu

    2015-10-01

    The Advanced Land Observing Satellite-2 (ALOS-2) was launched from Tanegashima Space Center by H-IIA rocket successfully on 24th May 2014. ALOS-2 carries the Phased Array type L-band Synthetic Aperture Radar-2 (PALSAR-2) as the state-of-the-art L-band SAR system which succeeds to PALSAR onboard ALOS. PALSAR-2 uses almost whole bandwidth allocated for L-band active sensor of Earth Exploration Satellites Service specified by the Radio Regulation in order to realize the high resolution observation, and also, it transmits more than 6 kW power for lower Noise Equivalent Sigma Zero using 180 TRMs driven by Gallium Nitride (GaN) amplifier which is the first use in space. Furthermore, because ALOS-2 carries the SAR system only, PALSAR-2 antenna can be mounted under the satellite body. It enables to observe right-/left-looking observation by satellite maneuvering. And the high accuracy orbit control to maintain the satellite within 500 m radius tube against the reference orbit enables high coherence for the InSAR processing. Using these new technologies, ALOS-2 has been operating to fulfill the mission requirements such as disaster monitoring and so on. This document introduces the initial result of ALOS-2 from the first year operation.

  12. Scientific Component Technology Initiative

    SciTech Connect

    Kohn, S; Bosl, B; Dahlgren, T; Kumfert, G; Smith, S

    2003-02-07

    The laboratory has invested a significant amount of resources towards the development of high-performance scientific simulation software, including numerical libraries, visualization, steering, software frameworks, and physics packages. Unfortunately, because this software was not designed for interoperability and re-use, it is often difficult to share these sophisticated software packages among applications due to differences in implementation language, programming style, or calling interfaces. This LDRD Strategic Initiative investigated and developed software component technology for high-performance parallel scientific computing to address problems of complexity, re-use, and interoperability for laboratory software. Component technology is an extension of scripting and object-oriented software development techniques that specifically focuses on the needs of software interoperability. Component approaches based on CORBA, COM, and Java technologies are widely used in industry; however, they do not support massively parallel applications in science and engineering. Our research focused on the unique requirements of scientific computing on ASCI-class machines, such as fast in-process connections among components, language interoperability for scientific languages, and data distribution support for massively parallel SPMD components.

  13. Urban Environment Initiative

    NASA Technical Reports Server (NTRS)

    1998-01-01

    The Urban Environment Initiative (UEI), has been established as part of a Cooperative Agreement with the National Aeronautics and Space Administration (NASA). The UEI is part of NASA's overall High Performance Computing and Communications (HPCC) and the Information Infrastructure Technology Applications (IITA) programs. The goal of the UEI is to provide public access to Earth Science information and promote its use with a focus on the environment of urban areas. This goal will be accomplished through collaborative efforts of the UEI team with both community-based and local/regional governmental organizations. The UEI team is comprised of four organizations representing private industry, NASA, and universities: Prime Technologies Service Corporation, NASA's Minority University Space Interdisciplinary Network (MU-SPIN) California State University, at Los Angeles, and Central State University (Wilberforce, OH). "Urban Environment" refers to the web of environmental, economic, and social factors that combine to create the urban world in which we live. Examples of these factors are population distribution, neighborhood demographic profiles, economic resources, business activities, location and concentration of environmental hazards and various pollutants, proximity and level of urban services, which form the basis of the urban environment and ultimately affect our lives and experiences. The use of Geographic Information Systems (GIS) and remote sensing allows data to be visualized in the forms of maps and spatial images. The use of these tools allow analysis of information about urban environments. Also included are descriptions of the four query types which will assist in understanding the maps.

  14. Information resource management concepts for records managers

    SciTech Connect

    Seesing, P.R.

    1992-10-01

    Information Resource Management (ERM) is the label given to the various approaches used to foster greater accountability for the use of computing resources. It is a corporate philosophy that treats information as it would its other resources. There is a reorientation from simply expenditures to considering the value of the data stored on that hardware. Accountability for computing resources is expanding beyond just the data processing (DP) or management information systems (MIS) manager to include senior organization management and user management. Management`s goal for office automation is being refocused from saving money to improving productivity. A model developed by Richard Nolan (1982) illustrates the basic evolution of computer use in organizations. Computer Era: (1) Initiation (computer acquisition), (2) Contagion (intense system development), (3) Control (proliferation of management controls). Data Resource Era: (4) Integration (user service orientation), (5) Data Administration (corporate value of information), (6) Maturity (strategic approach to information technology). The first three stages mark the growth of traditional data processing and management information systems departments. The development of the IRM philosophy in an organization involves the restructuring of the DP organization and new management techniques. The three stages of the Data Resource Era represent the evolution of IRM. This paper examines each of them in greater detail.

  15. Breckinridge Project, initial effort

    SciTech Connect

    1982-01-01

    This report presents an overview of the Breckinridge Project and summarizes the results achieved during the development phase of the project performed under a Cooperative Agreement with the United States Department of Energy. The Breckinridge Project provides for the design, construction and operation of a 50,000 barrel per day coal liquefaction facility in Breckinridge County, Kentucky. The development of the basic technology used in the Breckinridge Project dates back to the late 1950's and the invention by Hydrocarbon Research, Inc., (HRI) of the ebullated-bed reactor and the H-OIL process. The H-COAL process is based on the H-OIL technology. This coal liquefaction process produces clean low-sulfur petroleum substitutes suitable for most types of hydrocarbon-based fuel and chemical uses regardless of the sulfur content of the coal. A large H-COAL Pilot Plant in operation at Catlettsburg, Kentucky, is converting 220 tons of coal per day into 600 barrels of distillate products by catalytic hydrogenation. The estimated capital cost of the commercial facility is $3.17 billion, and the associated out-of-pocket operating cost is $18 per barrel, both in January 1981 dollars. Financial analysis shows the project to be an attractive investment under certain leveraged conditions which are possible through the assistance of the Synthetic Fuels Corporation. Ashland Synthetic Fuels, Inc. is currently working with the Synthetic Fuels Corporation and potential partners to develop financing for the commercial venture. Critical permits are being obtained and an Environmental Impact Statement is being prepared pursuant to initiating site preparation in early 1983. Commercial operations are expected to start up in early 1988.

  16. Glennan Microsystems Initiative

    NASA Technical Reports Server (NTRS)

    Brillson, Leonard J.

    2002-01-01

    During the 2001-2002 award period, we performed research on Pt/Ti/bare 6H-SiC and bare 4H-SiC interfaces in order to identify their electronic properties as a function of surface preparation. The overall aim of this work is to optimize the electronic properties of metal contacts to SiC as well as the active SiC material itself as a function of surface preparation and subsequent processing. Initially, this work has involved identifying bare surface, subsurface, and metal induced gap states at the metal-SiC contact and correlating energies and densities of deep levels with Schottky barrier heights. We used low energy electron-excited nanoluminescence (LEEN) spectroscopy, X-ray photoemission spectroscopy (XPS), and Secondary Ion Mass Spectrometry (SIMS) in order to correlate electronic states and energy bands with chemical composition, bonding, and crystal structure. A major development has been the discovery of polytype transformations that occur in 4H-SiC under standard microelectronic process conditions used to fabricate SiC devices. Our results are consistent with the stacking fault generation, defect formation, and consequent degradation of SiC recently reported for state-of-the-art ABB commercial diodes under localized electrical stress. Our results highlight the importance of -optimizing process conditions and material properties - anneal times, temperatures and doping to control such structural changes within epitaxial SiC layers. Thus far, we have established threshold times and temperatures beyond which 4H-SiC exhibits 3C-SiC transformation bands for a subset of dopant concentrations and process conditions. On the basis of this temperature time behavior, we have been able to establish an activation energy of approximately 2.5 eV for polytype transformation and dislocation motion. Work continues to establish the fundamental mechanisms underlying the polytype changes and its dependence on material parameters.

  17. Initial Radionuclide Inventories

    SciTech Connect

    H. Miller

    2004-09-19

    The purpose of this analysis is to provide an initial radionuclide inventory (in grams per waste package) and associated uncertainty distributions for use in the Total System Performance Assessment for the License Application (TSPA-LA) in support of the license application for the repository at Yucca Mountain, Nevada. This document is intended for use in postclosure analysis only. Bounding waste stream information and data were collected that capture probable limits. For commercially generated waste, this analysis considers alternative waste stream projections to bound the characteristics of wastes likely to be encountered using arrival scenarios that potentially impact the commercial spent nuclear fuel (CSNF) waste stream. For TSPA-LA, this radionuclide inventory analysis considers U.S. Department of Energy (DOE) high-level radioactive waste (DHLW) glass and two types of spent nuclear fuel (SNF): CSNF and DOE-owned (DSNF). These wastes are placed in two groups of waste packages: the CSNF waste package and the codisposal waste package (CDSP), which are designated to contain DHLW glass and DSNF, or DHLW glass only. The radionuclide inventory for naval SNF is provided separately in the classified ''Naval Nuclear Propulsion Program Technical Support Document'' for the License Application. As noted previously, the radionuclide inventory data presented here is intended only for TSPA-LA postclosure calculations. It is not applicable to preclosure safety calculations. Safe storage, transportation, and ultimate disposal of these wastes require safety analyses to support the design and licensing of repository equipment and facilities. These analyses will require radionuclide inventories to represent the radioactive source term that must be accommodated during handling, storage and disposition of these wastes. This analysis uses the best available information to identify the radionuclide inventory that is expected at the last year of last emplacement, currently identified as

  18. Weed Management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adaptive management can complement integrated programs to manage weeds in forage production systems. This approach requires establishing management goals, developing and implementing management programs based on the goals, monitoring and assessing impacts of management efforts, and modifying goals a...

  19. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative

    PubMed Central

    Visser, K; Katchamart, W; Loza, E; Martinez-Lopez, J A; Salliot, C; Trudeau, J; Bombardier, C; Carmona, L; van der Heijde, D; Bijlsma, J W J; Boumpas, D T; Canhao, H; Edwards, C J; Hamuryudan, V; Kvien, T K; Leeb, B F; Martín-Mola, E M; Mielants, H; Müller-Ladner, U; Murphy, G; Østergaard, M; Pereira, I A; Ramos-Remus, C; Valentini, G; Zochling, J; Dougados, M

    2009-01-01

    Objectives: To develop evidence-based recommendations for the use of methotrexate in daily clinical practice in rheumatic disorders. Methods: 751 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2007–8 consisting of three separate rounds of discussions and Delphi votes. Ten clinical questions concerning the use of methotrexate in rheumatic disorders were formulated. A systematic literature search in Medline, Embase, Cochrane Library and 2005–7 American College of Rheumatology/European League Against Rheumatism meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford levels of evidence. Each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. Results: A total of 16 979 references was identified, of which 304 articles were included in the systematic reviews. Ten multinational key recommendations on the use of methotrexate were formulated. Nine recommendations were specific for rheumatoid arthritis (RA), including the work-up before initiating methotrexate, optimal dosage and route, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy and management in the perioperative period and before/during pregnancy. One recommendation concerned methotrexate as a steroid-sparing agent in other rheumatic diseases. Conclusions: Ten recommendations for the use of methotrexate in daily clinical practice focussed on RA were developed, which are evidence based and supported by a large panel of rheumatologists, enhancing their validity and practical use. PMID:19033291

  20. A Coordinated Initialization Process for the Distributed Space Exploration Simulation

    NASA Technical Reports Server (NTRS)

    Crues, Edwin Z.; Phillips, Robert G.; Dexter, Dan; Hasan, David

    2007-01-01

    A viewgraph presentation on the federate initialization process for the Distributed Space Exploration Simulation (DSES) is described. The topics include: 1) Background: DSES; 2) Simulation requirements; 3) Nine Step Initialization; 4) Step 1: Create the Federation; 5) Step 2: Publish and Subscribe; 6) Step 3: Create Object Instances; 7) Step 4: Confirm All Federates Have Joined; 8) Step 5: Achieve initialize Synchronization Point; 9) Step 6: Update Object Instances With Initial Data; 10) Step 7: Wait for Object Reflections; 11) Step 8: Set Up Time Management; 12) Step 9: Achieve startup Synchronization Point; and 13) Conclusions

  1. The national geomagnetic initiative

    NASA Technical Reports Server (NTRS)

    1993-01-01

    The Earth's magnetic field, through its variability over a spectrum of spatial and temporal scales, contains fundamental information on the solid Earth and geospace environment (the latter comprising the atmosphere, ionosphere, and magnetosphere). Integrated studies of the geomagnetic field have the potential to address a wide range of important processes in the deep mantle and core, asthenosphere, lithosphere, oceans, and the solar-terrestrial environment. These studies have direct applications to important societal problems, including resource assessment and exploration, natural hazard mitigation, safe navigation, and the maintenance and survivability of communications and power systems on the ground and in space. Studies of the Earth's magnetic field are supported by a variety of federal and state agencies as well as by private industry. Both basic and applied research is presently supported by several federal agencies, including the National Science Foundation (NSF), U.S. Geological Survey (USGS), U.S. Department of Energy (DOE), National Oceanic and Atmospheric Administration (NOAA), National Aeronautics and Space Administration (NASA), and U.S. Department of Defense (DOD) (through the Navy, Air Force, and Defense Mapping Agency). Although each agency has a unique, well-defined mission in geomagnetic studies, many areas of interest overlap. For example, NASA, the Navy, and USGS collaborate closely in the development of main field reference models. NASA, NSF, and the Air Force collaborate in space physics. These interagency linkages need to be strengthened. Over the past decade, new opportunities for fundamental advances in geomagnetic research have emerged as a result of three factors: well-posed, first-order scientific questions; increased interrelation of research activities dealing with geomagnetic phenomena; and recent developments in technology. These new opportunities can be exploited through a national geomagnetic initiative to define objectives and

  2. Process Engineering Technology Center Initiative

    NASA Technical Reports Server (NTRS)

    Centeno, Martha A.

    2002-01-01

    NASA's Kennedy Space Center (KSC) is developing as a world-class Spaceport Technology Center (STC). From a process engineering (PE) perspective, the facilities used for flight hardware processing at KSC are NASA's premier factories. The products of these factories are safe, successful shuttle and expendable vehicle launches carrying state-of-the-art payloads. PE is devoted to process design, process management, and process improvement, rather than product design. PE also emphasizes the relationships of workers with systems and processes. Thus, it is difficult to speak of having a laboratory for PE at K.S.C. because the entire facility is practically a laboratory when observed from a macro level perspective. However, it becomes necessary, at times, to show and display how K.S.C. has benefited from PE and how K.S.C. has contributed to the development of PE; hence, it has been proposed that a Process Engineering Technology Center (PETC) be developed to offer a place with a centralized focus on PE projects, and a place where K.S.C.'s PE capabilities can be showcased, and a venue where new Process Engineering technologies can be investigated and tested. Graphics for showcasing PE capabilities have been designed, and two initial test beds for PE technology research have been identified. Specifically, one test bed will look into the use of wearable computers with head mounted displays to deliver work instructions; the other test bed will look into developing simulation models that can be assembled into one to create a hierarchical model.

  3. Clean Energy Infrastructure Educational Initiative

    SciTech Connect

    Hallinan, Kevin; Menart, James; Gilbert, Robert

    2012-08-31

    The Clean Energy Infrastructure Educational Initiative represents a collaborative effort by the University of Dayton, Wright State University and Sinclair Community College. This effort above all aimed to establish energy related programs at each of the universities while also providing outreach to the local, state-wide, and national communities. At the University of Dayton, the grant has aimed at: solidfying a newly created Master's program in Renewable and Clean Energy; helping to establish and staff a regional sustainability organization for SW Ohio. As well, as the prime grantee, the University of Dayton was responsible for insuring curricular sharing between WSU and the University of Dayton. Finally, the grant, through its support of graduate students, and through cooperation with the largest utilities in SW Ohio enabled a region-wide evaluation of over 10,000 commercial building buildings in order to identify the priority buildings in the region for energy reduction. In each, the grant has achieved success. The main focus of Wright State was to continue the development of graduate education in renewable and clean energy. Wright State has done this in a number of ways. First and foremost this was done by continuing the development of the new Renewable and Clean Energy Master's Degree program at Wright State . Development tasks included: continuing development of courses for the Renewable and Clean Energy Master's Degree, increasing the student enrollment, and increasing renewable and clean energy research work. The grant has enabled development and/or improvement of 7 courses. Collectively, the University of Dayton and WSU offer perhaps the most comprehensive list of courses in the renewable and clean energy area in the country. Because of this development, enrollment at WSU has increased from 4 students to 23. Secondly, the grant has helped to support student research aimed in the renewable and clean energy program. The grant helped to solidify new research

  4. Information resource management concepts for records managers

    SciTech Connect

    Seesing, P.R.

    1992-10-01

    Information Resource Management (ERM) is the label given to the various approaches used to foster greater accountability for the use of computing resources. It is a corporate philosophy that treats information as it would its other resources. There is a reorientation from simply expenditures to considering the value of the data stored on that hardware. Accountability for computing resources is expanding beyond just the data processing (DP) or management information systems (MIS) manager to include senior organization management and user management. Management's goal for office automation is being refocused from saving money to improving productivity. A model developed by Richard Nolan (1982) illustrates the basic evolution of computer use in organizations. Computer Era: (1) Initiation (computer acquisition), (2) Contagion (intense system development), (3) Control (proliferation of management controls). Data Resource Era: (4) Integration (user service orientation), (5) Data Administration (corporate value of information), (6) Maturity (strategic approach to information technology). The first three stages mark the growth of traditional data processing and management information systems departments. The development of the IRM philosophy in an organization involves the restructuring of the DP organization and new management techniques. The three stages of the Data Resource Era represent the evolution of IRM. This paper examines each of them in greater detail.

  5. Florida Hydrogen Initiative

    SciTech Connect

    Block, David L

    2013-06-30

    The Florida Hydrogen Initiative (FHI) was a research, development and demonstration hydrogen and fuel cell program. The FHI program objectives were to develop Florida?s hydrogen and fuel cell infrastructure and to assist DOE in its hydrogen and fuel cell activities The FHI program funded 12 RD&D projects as follows: Hydrogen Refueling Infrastructure and Rental Car Strategies -- L. Lines, Rollins College This project analyzes strategies for Florida's early stage adaptation of hydrogen-powered public transportation. In particular, the report investigates urban and statewide network of refueling stations and the feasibility of establishing a hydrogen rental-car fleet based in Orlando. Methanol Fuel Cell Vehicle Charging Station at Florida Atlantic University ? M. Fuchs, EnerFuel, Inc. The project objectives were to design, and demonstrate a 10 kWnet proton exchange membrane fuel cell stationary power plant operating on methanol, to achieve an electrical energy efficiency of 32% and to demonstrate transient response time of less than 3 milliseconds. Assessment of Public Understanding of the Hydrogen Economy Through Science Center Exhibits, J. Newman, Orlando Science Center The project objective was to design and build an interactive Science Center exhibit called: ?H2Now: the Great Hydrogen Xchange?. On-site Reformation of Diesel Fuel for Hydrogen Fueling Station Applications ? A. Raissi, Florida Solar Energy Center This project developed an on-demand forecourt hydrogen production technology by catalytically converting high-sulfur hydrocarbon fuels to an essentially sulfur-free gas. The removal of sulfur from reformate is critical since most catalysts used for the steam reformation have limited sulfur tolerance. Chemochromic Hydrogen Leak Detectors for Safety Monitoring ? N. Mohajeri and N. Muradov, Florida Solar Energy Center This project developed and demonstrated a cost-effective and highly selective chemochromic (visual) hydrogen leak detector for safety monitoring

  6. [Initial medical management in radiological accidents and nuclear disaster].

    PubMed

    Tanigawa, Koichi

    2012-03-01

    Major radiological emergencies include criticality in nuclear power plants or terrorist attacks using dirty bombs or nuclear device detonation. Because irradiation itself does not cause any immediate death of the victims, and there is a minimum risk of secondary irradiation to medical personnel during decontamination procedures, lifesaving treatments should be prioritized. When a major radiological accident occurs, information is scarce and/or becomes intricate. We might face with significant difficulties in determining the exact culprits of the event, i.e., radiological or chemical or others. Therefore, it is strongly recommended for the national and local governments, related organizations and hospitals to develop comprehensive systems to cope with all hazards(chemical, biological, radiation, nuclear, and explosion) under the common incident command system.

  7. Managing Operational Transitions: A Key to Maintaining the Initiative

    DTIC Science & Technology

    2007-11-02

    Linear Dynamics of War, available online at http://www.calresco.org/beckerman/nonlindy.htm. 24 Ludwig von Bertalanffy , a biologist by trade, is... Ludwig von . General System Theory: Foundation, Development, Application. New York: George Braziller, 1968. Cole, Ronald H. Operation Just Cause: The...Publishing, 1977. Beer, Michael. Organization Change and Development: A Systems View. Glenview, Illinois. Scott, Foresman and Company, 1980. Bertalanffy

  8. Approaches to the initial respiratory management of preterm neonates.

    PubMed

    Dunn, Michael S; Reilly, Maureen Charlotte

    2003-03-01

    Newly born preterm infants often require respiratory support. Various approaches have been taken to provide this support, including elective intubation and ventilation, prophylactic surfactant and continuous positive airway pressure (CPAP). Elective intubation and ventilation allow the clinician to take control of the baby's airway and reduce the support as tolerated. Surfactant can be administered prophylactically to prevent lung injury and respiratory complications. Many neonatologists, however, advocate a less aggressive approach to the provision of support, which includes the application of early nasal CPAP with intubation and ventilation only if necessary. Avoiding intubation may be effective in minimising ventilator-induced lung injury, but withholding surfactant may be detrimental to the infant. In this paper, we examine the advantages and disadvantages of the different approaches that can be taken in providing respiratory support to preterm neonates shortly after birth and examine some strategies that integrate them.

  9. Multimedia environmental management

    SciTech Connect

    Soesilo, J.A.; Wiley, W.D.

    1999-09-01

    This book explores and supports the argument that effective environmental management must be based on a multimedia approach, which focuses simultaneously on air, water, and waste and enables managers to assess the resulting financial, operation, and management benefits. The multimedia approach, which can be used to design an effective compliance program, includes proper waste and material handling management, systematic monitoring, and record keeping requirements. This approach integrates a wide array of environmental requirements and decision processes, which the authors examine in sixteen chapters, organized into four parts: the role of environmental management; environmental aspects of business operation, environmental processes; and environmental management trends. Within these parts, the authors highlight the development of modern environmental management and provide an overview of federal laws pertinent to multimedia environmental management. They examine such issues as chemical storage and transportation, tank system operations and requirements, waste determination, spill response procedures, and employee training. Environmental processes addressed in the book include the management of solid and hazardous waste, wastewater treatment systems, stormwater management, air emission control, and site remediation. The authors also briefly discuss significant initiatives in US environmental management and look toward corporate sustainable development.

  10. Canadian Disasters Initiatives Using Envisat and RADARSAT-2

    NASA Astrophysics Data System (ADS)

    Aube, Guy

    2010-12-01

    Over the last decade, the Canadian Space Agency (CSA) has been involved in the support of scientific initiatives, demonstration projects and operational activities related to disasters monitoring and management. Through the Government Related Initiatives Program (GRIP) and the Earth Observation Application Development Program (EOADP), the CSA and its public and private sector partners have fostered the development of Earth Observation (EO) information and services to monitor, understand and manage geohazards, forest fires, floods, oil spills, ice jam, hurricanes, food security, etc. The CSA understands the tremendous role and value that space-based EO systems and information have regarding disasters and security management and its environmental and socio-economic impacts and benefits. The proposed presentation will provide a brief description of the Canadian EO initiatives and activities affecting natural and technological disasters at the local, regional and national scales, focusing on existing EO programs, coordinated activities and assets.

  11. Neurologic Itch Management.

    PubMed

    Şavk, Ekin

    2016-01-01

    Neurologic itch is defined as pruritus resulting from any dysfunction of the nervous system. Itch arising due to a neuroanatomic pathology is seen to be neuropathic. Causes of neuropathic itch range from localized entrapment of a peripheral nerve to generalized degeneration of small nerve fibers. Antipruritic medications commonly used for other types of itch such as antihistamines and corticosteroids lack efficacy in neuropathic itch. Currently there are no therapeutic options that offer relief in all types of neuropathic pruritus, and treatment strategies vary according to etiology. It is best to decide on the appropriate tests and procedures in collaboration with a neurologist during the initial work-up. Treatment of neuropathic itch includes general antipruritic measures, local or systemic pharmacotherapy, various physical modalities, and surgery. Surgical intervention is the obvious choice of therapy in cases of spinal or cerebral mass, abscess, or hemorrhagic stroke, and may provide decompression in entrapment neuropathies. Symptomatic treatment is needed in the vast majority of patients. General antipruritic measures should be encouraged. Local treatment agents with at least some antipruritic effect include capsaicin, local anesthetics, doxepin, tacrolimus, and botulinum toxin A. Current systemic therapy relies on anticonvulsants such as gabapentin and pregabalin. Phototherapy, transcutaneous electrical nerve stimulation, and physical therapy have also been of value in selected cases. Among the avenues to be explored are transcranial magnetic stimulation of the brain, new topical cannabinoid receptor agonists, various modes of acupuncture, a holistic approach with healing touch, and cell transplantation to the spinal cord.

  12. Managing Fault Management Development

    NASA Technical Reports Server (NTRS)

    McDougal, John M.

    2010-01-01

    As the complexity of space missions grows, development of Fault Management (FM) capabilities is an increasingly common driver for significant cost overruns late in the development cycle. FM issues and the resulting cost overruns are rarely caused by a lack of technology, but rather by a lack of planning and emphasis by project management. A recent NASA FM Workshop brought together FM practitioners from a broad spectrum of institutions, mission types, and functional roles to identify the drivers underlying FM overruns and recommend solutions. They identified a number of areas in which increased program and project management focus can be used to control FM development cost growth. These include up-front planning for FM as a distinct engineering discipline; managing different, conflicting, and changing institutional goals and risk postures; ensuring the necessary resources for a disciplined, coordinated approach to end-to-end fault management engineering; and monitoring FM coordination across all mission systems.

  13. Initiation into Adolescent Marijuana Use.

    ERIC Educational Resources Information Center

    Brook, Judith S.; And Others

    1980-01-01

    This longitudinal study examined the relationship of three domains (personality/attitudinal orientations, peer relationships, and family socialization factors) with initiation into adolescent marihuana use. (Author/DB)

  14. Congenital Hypothyroidism: Optimal Initial Dosage and Time of Initiation of Treatment: A Systematic Review

    PubMed Central

    Rahmani, Khaled; Yarahmadi, Shahin; Etemad, Koorosh; Koosha, Ahmad; Mehrabi, Yadollah; Aghang, Nasrin; Soori, Hamid

    2016-01-01

    Context Appropriate management of neonates, tested positive for congenital hypothyroidism (CH), in particular, the initial dosage of levothyroxine and the time of initiation of treatment is a critical issue. The aim of this study was to assess all current evidence available on the subject to ascertain the optimal initial dose and optimal initiation time of treatment for children with CH. Evidence Acquisition In this study, all published research related to the initiation treatment dose and the onset time of treatment in congenital hypothyroidism were reviewed. The searched electronic databases included Medline, Science direct, Scopus EMBASE, PsycINFO, Cochrane, BIOSIS and ISI Web of Knowledge. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major thyroid and pediatrics journals published within the past 35 years. Studies were included if they were written in English and investigated levothyroxine dose or timing of treatment or both, used for the treatment of children with congenital hypothyroidism. Results Two thousand three hundred and seventy-four articles (excluding duplicates) were retrieved from the primary search. After reviewing the titles, abstracts and full-texts of studies, eventually, 22 studies were found that met our inclusion criteria. Amongst these, 17 and 12 evaluated outcomes of different treatment doses and treatment timing, respectively. Overall, the majority of these studies emphasized the initial high dose of levothyroxine and early treatment of newborns with hypothyroidism. There were, however, some studies that disagreed with increasing levothyroxine dose at initiation of treatment. Conclusions Considering the results of this review, apparently there is no difference in opinion regarding the early initiation of treatment, whereas determining the optimal dose of levothyroxine for start of treatment in CH patients still remains a controversial issue, demonstrating the need for

  15. 75 FR 39971 - Notice of Reestablishment of the North Slope Science Initiative Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-13

    ... Bureau of Land Management Notice of Reestablishment of the North Slope Science Initiative Science... the Bureau of Land Management's (BLM) North Slope Science Initiative (NSSI) Science Technical Advisory... Group on the inventory, monitoring, and research needed on the North Slope of Alaska, including the...

  16. Management of gastrointestinal hemorrhage.

    PubMed Central

    Hilsden, R. J.; Shaffer, E. A.

    1995-01-01

    Acute gastrointestinal hemorrhage is a common problem that requires prompt recognition and management to prevent serious morbidity and mortality. Management goals are stabilization of the patient with vigorous fluid resuscitation followed by investigation and definitive treatment of the bleeding source. Endoscopy is often the initial diagnostic test and allows therapeutic measures to be performed at the same time. Images Figure 1 Figure 2 PMID:8563510

  17. Adaptive Management

    EPA Science Inventory

    Adaptive management is an approach to natural resource management that emphasizes learning through management where knowledge is incomplete, and when, despite inherent uncertainty, managers and policymakers must act. Unlike a traditional trial and error approach, adaptive managem...

  18. The NOAA IOOS Data Integration Framework: Initial Implementation Report

    DTIC Science & Technology

    2008-09-01

    The NOAA IOOS Data Integration Framework: Initial Implementation Report Jeff de La Beaujardière National Oceanic and Atmospheric Administration...Administration ( NOAA ) Integrated Ocean Observing System (IOOS) program office has begun the implementation of a Data Integration Framework (DIF) to...improve management and delivery of an initial subset of ocean observations. The DIF establishes a web service layer atop key NOAA data providers

  19. Cost-effectiveness of initial stress cardiovascular MR, stress SPECT or stress echocardiography as a gate-keeper test, compared with upfront invasive coronary angiography in the investigation and management of patients with stable chest pain: mid-term outcomes from the CECaT randomised controlled trial

    PubMed Central

    Thom, Howard; West, Nicholas E J; Hughes, Vikki; Dyer, Matthew; Buxton, Martin; Sharples, Linda D; Jackson, Christopher H; Crean, Andrew M

    2014-01-01

    Objectives To compare outcomes and cost-effectiveness of various initial imaging strategies in the management of stable chest pain in a long-term prospective randomised trial. Setting Regional cardiothoracic referral centre in the east of England. Participants 898 patients (69% man) entered the study with 869 alive at 2 years of follow-up. Patients were included if they presented for assessment of stable chest pain with a positive exercise test and no prior history of ischaemic heart disease. Exclusion criteria were recent infarction, unstable symptoms or any contraindication to stress MRI. Primary outcome measures The primary outcomes of this follow-up study were survival up to a minimum of 2 years post-treatment, quality-adjusted survival and cost-utility of each strategy. Results 898 patients were randomised. Compared with angiography, mortality was marginally higher in the groups randomised to cardiac MR (HR 2.6, 95% CI 1.1 to 6.2), but similar in the single photon emission CT-methoxyisobutylisonitrile (SPECT-MIBI; HR 1.0, 95% CI 0.4 to 2.9) and ECHO groups (HR 1.6, 95% CI 0.6 to 4.0). Although SPECT-MIBI was marginally superior to other non-invasive tests there were no other significant differences between the groups in mortality, quality-adjusted survival or costs. Conclusions Non-invasive cardiac imaging can be used safely as the initial diagnostic test to diagnose coronary artery disease without adverse effects on patient outcomes or increased costs, relative to angiography. These results should be interpreted in the context of recent advances in imaging technology. Trial registration ISRCTN 47108462, UKCRN 3696. PMID:24508847

  20. Information management

    NASA Technical Reports Server (NTRS)

    Ricks, Wendell; Corker, Kevin

    1990-01-01

    Primary Flight Display (PFD) information management and cockpit display of information management research is presented in viewgraph form. The information management problem in the cockpit, information management burdens, the key characteristics of an information manager, the interface management system handling the flow of information and the dialogs between the system and the pilot, and overall system architecture are covered.

  1. Washington State's Student Achievement Initiative

    ERIC Educational Resources Information Center

    Pettitt, Maureen; Prince, David

    2010-01-01

    This article describes Washington State's Student Achievement Initiative, an accountability system implemented in 2005-06 that measures students' gains in college readiness, college credits earned, and degree or certificate completion. The goal of the initiative is to increase educational attainment by focusing on the critical momentum points…

  2. Maine: Early Head Start Initiatives

    ERIC Educational Resources Information Center

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    Maine has two initiatives that build on Early Head Start (EHS). The first initiative, Fund for a Healthy Maine, has since 2001 provided tobacco settlement money to existing Head Start and EHS programs to expand the number of children who receive full-day, full-year services. Local programs have the option of using these funds for EHS, depending on…

  3. Career Technical Education Pathways Initiative

    ERIC Educational Resources Information Center

    California Community Colleges, Chancellor's Office, 2013

    2013-01-01

    California's education system--the largest in the United States--is an essential resource for ensuring strong economic growth in the state. The Career Technical Education Pathways Initiative (referred to as the Initiative in this report), which became law in 2005, brings together community colleges, K-12 school districts, employers, organized…

  4. Two black hole initial data

    SciTech Connect

    Leski, Szymon

    2005-06-15

    The Misner initial data are a standard example of time-symmetric initial data with two apparent horizons. Compact formulae describing such data are presented in the cases of equal or nonequal masses (i.e. isometric or nonisometric horizons). The interaction energy in the 'Schwarzschild + test-particle' limit of the Misner data is analyzed.

  5. The Internet 2 Middleware Initiative.

    ERIC Educational Resources Information Center

    Simco, Greg

    2001-01-01

    Discussion of middleware focuses on the Internet 2 Middleware Initiative. Topics include a description of middleware as a layer of software in a distributed system; middleware characteristics, including transparency, portability, reliability, scalability, and interoperability; and the Internet 2 Middleware Initiative which is focused on research…

  6. Management of Intracranial Hypertension

    PubMed Central

    Rangel-Castillo, Leonardo; Gopinath, Shankar; Robertson, Claudia S.

    2008-01-01

    Effective management of intracranial hypertension involves meticulous avoidance of factors that precipitate or aggravate increased intracranial pressure. When intracranial pressure becomes elevated, it is important to rule out new mass lesions that should be surgically evacuated. Medical management of increased intracranial pressure should include sedation, drainage of cerebrospinal fluid, and osmotherapy with either mannitol or hypertonic saline. For intracranial hypertension refractory to initial medical management, barbiturate coma, hypothermia, or decompressive craniectomy should be considered. Steroids are not indicated and may be harmful in the treatment of intracranial hypertension resulting from traumatic brain injury. PMID:18514825

  7. 75 FR 52370 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-25

    ....DB0000 LXSINSSI0000] Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative, Interior... Slope Science Initiative (NSSI)- Science Technical Advisory Panel (STAP) will meet as indicated:...

  8. 75 FR 159 - Notice of Public Meeting, North Slope Science Initiative, Science Technical Advisory Panel, Alaska

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-04

    ... LXSINSSI0000] Notice of Public Meeting, North Slope Science Initiative, Science Technical Advisory Panel, Alaska AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science Initiative, Interior... Slope Science Initiative (NSSI)-- Science Technical Advisory Panel (STAP) will meet as indicated...

  9. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Pilots: Initial, transition, and upgrade... RULES Fractional Ownership Operations Program Management § 91.1101 Pilots: Initial, transition, and upgrade ground training. Initial, transition, and upgrade ground training for pilots must...

  10. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Pilots: Initial, transition, and upgrade... RULES Fractional Ownership Operations Program Management § 91.1101 Pilots: Initial, transition, and upgrade ground training. Initial, transition, and upgrade ground training for pilots must...

  11. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Pilots: Initial, transition, and upgrade... RULES Fractional Ownership Operations Program Management § 91.1101 Pilots: Initial, transition, and upgrade ground training. Initial, transition, and upgrade ground training for pilots must...

  12. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Pilots: Initial, transition, and upgrade... RULES Fractional Ownership Operations Program Management § 91.1101 Pilots: Initial, transition, and upgrade ground training. Initial, transition, and upgrade ground training for pilots must...

  13. 14 CFR 91.1101 - Pilots: Initial, transition, and upgrade ground training.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Pilots: Initial, transition, and upgrade... RULES Fractional Ownership Operations Program Management § 91.1101 Pilots: Initial, transition, and upgrade ground training. Initial, transition, and upgrade ground training for pilots must...

  14. Adrenal myelolipoma: Controversies in its management

    PubMed Central

    Shenoy, Vasanth G.; Thota, Anuroop; Shankar, Ravi; Desai, Mallikarjun G.

    2015-01-01

    Adrenal myelolipomas (AMLs) are rare, benign neoplasms of the adrenal gland with varied clinical presentations. The rarity of these tumors precludes any case-controlled or randomized study into their management. The available literature is limited to case reports and short series from referral centers. This review is an effort to put the available literature into perspective such that clinical decision making can be done with some clarity. The PubMed and Cochrane databases were searched with key words Adrenal Myelolipoma, Adrenal Incidentaloma (AI) and Adrenal Collision Tumor (ACT). From over 1300 search results, 547 relevant publications dating from 1954 to 2014 were reviewed. Details of about 1231 AMLs in the indexed literature were analyzed. Increasing usage of imaging studies has significantly increased the discovery of AMLs. Although AMLs are benign tumors, those measuring larger than 6 cm are prone to rupture and hemorrhage. Thorough endocrine work-up may benefit a selected group of patients, especially those who are hypertensive, diabetic/pre-diabetic, young patients (<50 years) and those with bilateral AML. Regular observation is needed for AML patients who are being treated non-operatively, as many of them may require surgery during follow-up. Although the AACE/AAES guidelines for AI (2009) exclude AML from mandatory metabolic work-up for a newly discovered AI, we feel that a significant number of patients with AML would benefit from metabolic work-up. In the literature, endocrine dysfunction in AML is 7% as compared with 11% in AI. Endocrine dysfunction in AML is probably underdiagnosed. PMID:25878407

  15. Initial evaluation of the "Trauma surgery course"

    PubMed Central

    Tugnoli, Gregorio; Ribaldi, Sergio; Casali, Marco; Calderale, Stefano M; Coletti, Massimo; Alifano, Marco; Parri, Sergio N Forti; Villani, Silvia; Biscardi, Andrea; Giordano, M Chiara; Baldoni, Franco

    2006-01-01

    Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses. PMID:16759403

  16. Population management takes disease management to the next level.

    PubMed

    Ketner, L

    1999-08-01

    The increased development and implementation of disease management programs reflect attempts by a growing number of health plans to reduce costs while providing patients with high-quality care. Unfortunately, few of these programs are generating optimal cost savings. Instituting initiatives for a select group of plan members afflicted with a disease will not produce the positive results that a comprehensive population management program can. Through the integration, coordination, and management of all of a population's healthcare needs, diabetes population management programs are producing significantly greater cost savings than are other disease management programs, including those for diabetes.

  17. Thin-film optical initiator

    DOEpatents

    Erickson, Kenneth L.

    2001-01-01

    A thin-film optical initiator having an inert, transparent substrate, a reactive thin film, which can be either an explosive or a pyrotechnic, and a reflective thin film. The resultant thin-film optical initiator system also comprises a fiber-optic cable connected to a low-energy laser source, an output charge, and an initiator housing. The reactive thin film, which may contain very thin embedded layers or be a co-deposit of a light-absorbing material such as carbon, absorbs the incident laser light, is volumetrically heated, and explodes against the output charge, imparting about 5 to 20 times more energy than in the incident laser pulse.

  18. Distributed Information Management.

    ERIC Educational Resources Information Center

    Pottenger, William M.; Callahan, Miranda R.; Padgett, Michael A.

    2001-01-01

    Reviews the scope and effects of distributed information management. Discusses cultural and social influences, including library and Internet culture, information and knowledge, electronic libraries, and social aspects of libraries; digital collections; indexing; permanent link systems; metadata; the Open Archives initiative; digital object…

  19. Green Power Partnership Program Initiatives

    EPA Pesticide Factsheets

    EPA's Green Power Partnership has a number of initiatives that focus on the collective green power efforts within specific sectors and renewable energy procurement strategies, which provide recognition opportunities for Partners and increase awareness.

  20. Discovery Performs Terminal Initiation Burn

    NASA Video Gallery

    The terminal initiation burn, a left Orbital Maneuvering System engine firing that gave Discovery one last big push toward the space station, took place Feb. 26, 2011 at 10:33 a.m. The burn lasted ...