Science.gov

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. Osteoblastoma of the lateral skull base: work-up, surgical management, and a review of the literature".

    PubMed

    Miller, Craig; Khan, Rihan; Lemole, G Michael; Jacob, Abraham

    2013-06-01

    Objectives To describe the work-up and surgical management of an osteoblastoma involving the lateral skull base. Typically occurring in the spine or long bones, osteoblastomas of the craniofacial skeleton are exceedingly rare and infrequently reported. A review of the current literature regarding temporal bone osteoblastoma, diagnosis, and treatment is described. Methods This case report describes the clinical presentation, radiographic studies, surgical management, histology, and postoperative follow-up of a young man presenting to a tertiary care neurotology practice with osteoblastoma involving the lateral skull base. A review of the current literature regarding osteoblastoma of the skull base, work-up, and treatment is described. Results A 15-year-old adolescent boy with a greater than 1-year history of right-sided retroauricular pain, a palpable postauricular mass, and chronic headaches presented for evaluation/management. Microscope examination of the ears, hearing, and cranial nerve function were normal. High-resolution temporal bone computed tomography and magnetic resonance imaging scans were obtained, which revealed an expansile mass involving the junction of the temporal and occipital bones. The patient underwent a combined retrosigmoid/retrolabyrinthine resection of this extradural tumor. Histology revealed a benign bone neoplasm consistent with osteoblastoma. Complete surgical resection was achieved, and the patient's symptoms fully resolved. Follow-up imaging studies found no evidence of recurrence. The scientific literature relevant to work-up and management of osteoblastoma is reviewed. Discussion Osteoblastomas of the lateral skull base are rare, histologically benign tumors that can present with radiographic features suggestive of malignancy. An en bloc resection is important for both diagnosis and definitive treatment of these neoplasms. The differential diagnosis on imaging and histology is discussed. PMID:23943719

  3. [Diagnostic work-up of pulmonary nodules : Management of pulmonary nodules detected with low‑dose CT screening].

    PubMed

    Wormanns, D

    2016-09-01

    Pulmonary nodules are the most frequent pathological finding in low-dose computed tomography (CT) scanning for early detection of lung cancer. Early stages of lung cancer are often manifested as pulmonary nodules; however, the very commonly occurring small nodules are predominantly benign. These benign nodules are responsible for the high percentage of false positive test results in screening studies. Appropriate diagnostic algorithms are necessary to reduce false positive screening results and to improve the specificity of lung cancer screening. Such algorithms are based on some of the basic principles comprehensively described in this article. Firstly, the diameter of nodules allows a differentiation between large (>8 mm) probably malignant and small (<8 mm) probably benign nodules. Secondly, some morphological features of pulmonary nodules in CT can prove their benign nature. Thirdly, growth of small nodules is the best non-invasive predictor of malignancy and is utilized as a trigger for further diagnostic work-up. Non-invasive testing using positron emission tomography (PET) and contrast enhancement as well as invasive diagnostic tests (e.g. various procedures for cytological and histological diagnostics) are briefly described in this article. Different nodule morphology using CT (e.g. solid and semisolid nodules) is associated with different biological behavior and different algorithms for follow-up are required. Currently, no obligatory algorithm is available in German-speaking countries for the management of pulmonary nodules, which reflects the current state of knowledge. The main features of some international and American recommendations are briefly presented in this article from which conclusions for the daily clinical use are derived. PMID:27495787

  4. Recurrent urinary tract infections in otherwise healthy adult women. Rational strategies for work-up and management.

    PubMed

    Leiner, S

    1995-02-01

    Recurrent urinary tract infections (UTIs) are common, but clinicians unfamiliar with the natural history or pathogenesis may order unnecessarily expensive tests and provide unsubstantiated advice to their patients. A large body of literature indicates that recurrent UTIs do not progress to permanent kidney damage or end-stage renal disease. The vast number of UTIs are due to the interplay between minor weaknesses in host defenses and bacterial virulence factors. Sexual intercourse and diaphragm/spermicide use are the two behavioral factors most consistently associated with UTIs. Basic history, physical exam, and urinalysis are able to identify the few patients likely to benefit from invasive urologic workups, which usually have a very low yield when ordered routinely. Effective management options include daily or post-coital antimicrobial prophylaxis, or patient-initiated treatment. Patients can be reassured of an excellent prognosis. There is no evidence validating proscription of personal preferences, such as soda pop, tight clothing, or direction of perineal cleansing after defecation.

  5. Incidentalomas: initial management.

    PubMed

    Hitzeman, Nathan; Cotton, Erin

    2014-12-01

    Incidentalomas are increasingly common findings on radiologic studies, causing worry for physicians and patients. Physicians should consider the risk of discovering incidentalomas when contemplating imaging. Patients may assume that incidentalomas are cancer, and may not be aware of the radiation risks associated with repeat imaging. Once incidentalomas are detected, appropriate management is dependent on an informed patient's wishes and the clinical situation. Guidelines are provided for the initial management of eight incidentalomas (pituitary, thyroid, pulmonary, hepatic, pancreatic, adrenal, renal, and ovarian). Patients presenting with pituitary incidentalomas should undergo pituitary-specific magnetic resonance imaging if the lesion is 1 cm or larger, or if it abuts the optic chiasm. Thyroid incidentalomas are ubiquitous, but nodules larger than 1 to 2 cm are of greater concern. Worrisome pulmonary incidentalomas are those larger than 8 mm or those with irregular borders, eccentric calcifications, or low density. However, current guidelines recommend that even pulmonary incidentalomas as small as 4 mm be followed. Solid hepatic incidentalomas 5 mm or larger should be monitored closely, and multiphasic scanning is helpful. Pancreatic cystic neoplasms have malignant potential, and surgery is recommended for pancreatic cysts larger than 3 cm with suspicious features. Adrenal lesions larger than 4 cm are usually biopsied. The Bosniak classification is a well-accepted means of triaging renal incidentalomas. Lesions at category IIF or greater require serial monitoring or surgery. Benign or probably benign ovarian cysts 3 cm or smaller in premenopausal women or 1 cm or smaller in postmenopausal women do not require follow-up. Ovarian cysts with thickened walls or septa, or solid components with blood flow, should be managed closely.

  6. ABDOMINAL LYMPHOMA: IMAGING WORK UP CHALLENGES AND RECOMMENDATIONS IN RESOURCE LIMITED SETUP.

    PubMed

    Kebede, Asfaw Atnafu; Bekele, Frehiwot; Assefa, Getachew

    2014-10-01

    Lymphoma management begins with an accurate diagnosis & staging. Major advances in imaging techniques, make cross sectional imaging and nuclear medicine technique an excellent tool for patient work up. However, limited access to modern imaging modality in resource limited set up and luck of standardized imaging work up challenged patient's management. Assess the local lymphoma imaging work up and management challenges in patients with lymphoma and develop local imaging and reporting guideline. A semistructured qualitative interview to six conveniently selected physicians (hematologists, oncologists & pathologists) who primarily takes care of lymphoma patient and literature review on the role of various imaging modalities, recommendation and experience of other countries were used as a methodology Conventional and basic imaging modalities are used in the work up of patient in our set up. The imaging recommendation for these patients requires at least CT of the chest, abdomen and pelvis for initial diagnosis and FDG-PET and/or PET-CTfor follow up and recurrence. Due to the comparable diagnostic potentials of US and its wide spread availability, makes US still the primary imaging modality. Luck of required information's and inconsistency in the radiologists report found to challenge physicians in their patient management. The study concluded that US should still stay as the most important imaging modality in the initial treatment, staging and follow up patients in resource limited set up. It also recommended the general imaging work up and reporting framework. PMID:26410993

  7. Diagnostic work-up of GERD.

    PubMed

    Vela, Marcelo F

    2014-10-01

    Gastroesophageal reflux disease (GERD) is frequently diagnosed by symptoms and good response to acid suppression with proton pump inhibitors. Further work up is required when the diagnosis of GERD is uncertain, for alarm symptoms, PPI-refractoriness, and often for extraesophageal presentations. Useful tools include endoscopy for mucosal assessment and reflux monitoring (pH or impedance-pH) to quantify reflux burden. Objective documentation of pathological reflux is mandatory prior to anti-reflux surgery. In some patients, symptoms that can be attributed to GERD may have other causes; in these patients, testing that excludes GERD helps direct the diagnostic and treatment efforts to other causes. PMID:25216910

  8. Modeling lengthy work-ups in gastrointestinal bleeding.

    PubMed

    Sonnenberg, Amnon

    2015-03-01

    Multiple procedures and medical devices are being used in a complex interplay to diagnose and treat gastrointestinal bleeding. The aim of the study was to develop a mathematical model that helps in estimating the average number of procedures to be expected in the general management of gastrointestinal bleeding. The modeling process serves as an example of how mathematical analysis in general can be used to answer unresolved clinical questions, lead to a better understanding of the underlying influences in a disease process, and provide a starting point for future clinical trials. The analysis uses a Markov chain to model the transition probabilities among consecutive interventions used to find and treat a bleeding site. The results show that starting a work-up of gastrointestinal bleeding with an esophagogastroduodenoscopy will lead on average to 2.69 procedures per patient. Of these expected procedures, 1.46 will be esophagogastroduodenoscopies, 0.69 colonoscopies, 0.25 video capsule endoscopies, 0.14 double-balloon enteroscopies, and 0.14 procedures from interventional radiology. Management chains initiated with a colonoscopy result in similar outcomes. Among 10,000 simulated individual patients, the number of procedures varies between 1 and 16 consecutive procedures, with 95% of all patients undergoing 6 procedures or less. The outcomes of the model suggest that the published success rates of endoscopic and radiographic procedures are overly optimistic. The results also point to the need to generate clinical data through future studies that more reliably account for treatment failures and the interchange among various complementary diagnostic modalities. PMID:24440338

  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. Strategies for initial management of hypertension.

    PubMed

    Gupta, Rajeev; Guptha, Soneil

    2010-11-01

    High blood pressure (BP) is a major public health problem in India and its prevalence is rapidly increasing among urban and rural populations. Reducing systolic and diastolic BP can decrease cardiovascular risk and this can be achieved by non-pharmacological (lifestyle measures) as well as pharmacological means. Lifestyle changes should be the initial approach to hypertension management and include dietary interventions (reducing salt, increasing potassium, alcohol avoidance, and multifactorial diet control), weight reduction, tobacco cessation, physical exercise, and stress management. A number of pharmaceutical agents, well evidenced by large randomized clinical trials, are available for initial treatment of high BP. These include older molecules such as thiazide diuretics and beta-blocking agents and newer molecules, dihydropyridine calcium channel blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARB). In view of the recent clinical trials data, some international guidelines suggest that CCB, ACE inhibitors or ARB and not beta-blockers or diuretics should be the initial therapy in hypertension management. Comprehensive hypertension management focuses on reducing overall cardiovascular risk by lifestyle measures, BP lowering and lipid management and should be the preferred initial treatment approach.

  11. 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…

  12. 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.

  13. 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.

  14. Risk management for the Space Exploration Initiative

    NASA Technical Reports Server (NTRS)

    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.

  15. Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

    PubMed Central

    Anderson, Melissa L.; Smith, Robert A.; Carney, Patricia A.; Miglioretti, Diana L.; Monsees, Barbara S.; Sickles, Edward A.; Taplin, Stephen H.; Geller, Berta M.; Yankaskas, Bonnie C.; Onega, Tracy L.

    2014-01-01

    fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant increases in FPRfalse-positive rate (P = .011) and CDRcancer detection rate (P = .001) and a nonsignificant increase in sensitivity (P = .15). Radiologists with a lower annual volume of any work-ups had consistently lower FPRfalse-positive rate, sensitivity, and CDRcancer detection rate at all annual interpretive volumes. Conclusion These findings support the hypothesis that radiologists may improve their screening performance by performing the diagnostic work-up for their own recalled screening mammograms and directly receiving feedback afforded by means of the outcomes associated with their initial decision to recall. Arranging for radiologists to work up a minimum number of their own recalled cases could improve screening performance but would need systems to facilitate this workflow. © RSNA, 2014 Online supplemental material is available for this article. PMID:24960110

  16. Diagnostic Work-Up of Lower Urinary Tract Symptoms.

    PubMed

    Hecht, Sarah L; Hedges, Jason C

    2016-08-01

    The goal of work-up of lower urinary tract symptoms is to establish the severity and cause of lower urinary tract symptoms and to predict with certainty which patients will respond to which treatments. Clinical guidelines exist to guide urologists in decision-making. All patients need a medical history with a validated symptom score, a physical examination, and a urinalysis. Prostate-specific antigen, postvoid urine residual, and peak urine flow rate provide additional information at little cost. For more invasive testing high-level data are lacking and guidelines defer to the urologist. Even the most extensive work-up is imperfect, and thus the attempt to balance costs with benefits of invasive testing. PMID:27476123

  17. 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.

  18. Proximal myopathy: diagnostic approach and initial management.

    PubMed

    Suresh, Ernest; Wimalaratna, Sunil

    2013-08-01

    Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. There is a broad range of underlying causes including drugs, alcohol, thyroid disease, osteomalacia, idiopathic inflammatory myopathies (IIM), hereditary myopathies, malignancy, infections and sarcoidosis. Clinical assessment should aim to distinguish proximal myopathy from other conditions that can present similarly, identify patients who need prompt attention, like those with cardiac, respiratory or pharyngeal muscle involvement, and determine underlying cause of myopathy. Initial evaluation should include simple tests, like creatine kinase, thyroid function and (25)OH vitamin D levels, but further evaluation including neurophysiological studies, muscle imaging and muscle biopsy should be considered for patients in whom no toxic, metabolic or endocrine cause is found, and in those with clinical features suggestive of inflammatory or hereditary myopathy. Additionally, screening for malignancy and testing for anti-Jo1 antibody is indicated for selected patients with IIM. Management depends on underlying cause, and includes measures, such as removal of offending agent, correction of endocrine or metabolic problem, corticosteroids and immunosuppressive therapy for IIM, and physical therapy, rehabilitation and genetic counselling for muscular dystrophies.

  19. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Initial medical evaluation and management... 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)...

  20. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Initial medical evaluation and management... 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)...

  1. 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. PMID:8428070

  2. Continuous Risk Management: A NASA Program Initiative

    NASA Technical Reports Server (NTRS)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  3. 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....

  4. 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....

  5. 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....

  6. 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....

  7. 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....

  8. 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,…

  9. 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;…

  10. The DSN Asset Management/Maintenance Improvement Initiative

    NASA Astrophysics Data System (ADS)

    Wackley, J.; Dundics, D.

    2011-11-01

    This article describes the Asset Management/Maintenance Improvement (AMMI) initiative: the first focused Deep Space Network (DSN) initiative intended to improve the efficiency and efficacy of maintenance, support improvement in equipment reliability, and provide metrics for use in understanding equipment reliability and the use of maintenance resources. The initiative has resulted in the introduction of many new processes and procedures including the global use of a computerized maintenance management system (CMMS) and Reliability-Centered Maintenance (RCM) concepts. The work performed as part of the AMMI initiative represents significant changes to the DSN maintenance culture that has been in place for over 40 years.

  11. Langerhans Cell Histiocytosis (LCH): Guidelines for Diagnosis, Clinical Work-Up, and Treatment for Patients Till the Age of 18 Years

    PubMed Central

    Haupt, Riccardo; Minkov, Milen; Astigarraga, Itziar; Schäfer, Eva; Nanduri, Vasanta; Jubran, Rima; Egeler, R Maarten; Janka, Gritta; Micic, Dragan; Rodriguez-Galindo, Carlos; Van Gool, Stefaan; Visser, Johannes; Weitzman, Sheila; Donadieu, Jean

    2013-01-01

    These guidelines for the management of patients up to 18 years with Langerhans cell histiocytosis (LCH) have been set up by a group of experts involved in the Euro Histio Net project who participated in national or international studies and in peer reviewed publications. Existing guidelines were reviewed and changed where new evidence was available in the literature up to 2012. Data and publications have been ranked according to evidence based medicine and when there was a lack of published data, consensus between experts was sought. Guidelines for diagnosis, initial clinical work-up, and treatment and long-term follow-up of LCH patients are presented. PMID:23109216

  12. The CHAMPUS reform initiative and fiscal intermediary managed care.

    PubMed

    Fant, D J; Pool, C J

    1990-07-01

    Initiatives to maximize the purchasing power of DOD's health care dollars are critical to DOD's ability to function within an increasingly constrained federal budget and to provide a quality medical benefit for military family members. The CHAMPUS Reform Initiative and Fiscal Intermediary Managed Care, two leading edge programs, hold great promise in meeting this challenge. PMID:10105487

  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. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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....

  15. 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....

  16. 28 CFR 549.63 - Initial medical evaluation and management.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 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....

  17. 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…

  18. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  19. 7 CFR 4290.140 - Approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Approval of initial Management Expenses. 4290.140 Section 4290.140 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT...

  20. [Initial evaluation and management of paroxysmal supraventricular tachycardia].

    PubMed

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal; Nielsen, Jens Cosedis; Pareek, Manan

    2016-01-18

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar management strategies. The probable mechanism of paroxysmal SVT can often be diagnosed from the clinical findings and a 12-lead ECG. This review describes the initial evaluation and treatment of patients with paroxysmal SVT, including distinctive features from the most important differential diagnoses.

  1. Initial management of traumatic brain injury in the rural setting.

    PubMed

    Honeybul, Stephen; Woods, Paul

    2013-01-01

    Healthcare workers in the rural setting face unique problems when dealing with head injured patients however the basic principle of medical management are the same in any situation. The key initial elements remain aggressive early resuscitation followed by a comprehensive assessment of conscious level and either early consultation or transfer to a neurosurgical facility. What has improved considerably over recent years is the understanding of the pathophysiology of traumatic brain injury and as such some of the medical management strategies have changed. A basic understanding of some of these concepts is useful in the clinical setting and serves to emphasis the importance of effective early medical management. Thereafter consideration must be given to which patients require radiological investigations and possible discussion with or transfer to a neurosurgical facility.

  2. 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.

  3. 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.

  4. Southern Appalachian Mountains initiative: Regional partnership for air quality management

    SciTech Connect

    Brewer, P.F.

    1999-07-01

    The Southern Appalachian Mountains Initiative (SAMI) is a voluntary partnership of state and federal agencies, industry, environmental groups, academia, and interested public. SAMI was established to identify and recommend air emissions management strategies to remedy existing and prevent future adverse air quality impacts to natural resources in Southern Appalachia, with particular focus on Class I national park and wilderness areas. SAMI's integrated assessment is focusing simultaneously on ozone, visibility impairment, and acid deposition. Computer models are linking emissions, atmospheric transport, exposures, and environmental and socioeconomic effects. The assessment is considering the impacts of existing and newly enacted federal air regulatory requirements and alternative emissions management strategies that SAMI might recommend for regional, state, or community-based actions.

  5. 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.

  6. Breckinridge Project, initial effort. Report VI. Project Management Plan

    SciTech Connect

    1982-01-01

    Report VI presents a comprehensive plan for the management of the Breckinridge Project. For the purpose of this report, the project work is divided into five major project phases: Development, Engineering, Procurement, Construction, and Operations. The results of the Development Phase (Initial Effort) of the project are discussed in Section 1.0. This phase of the project was performed under a Cooperative Agreement with US Department of Energy and has produced 43 volumes of documentation. Fifteen volumes contain information of proprietary nature for patented processes and are therefore classified as Limited Access; however, twenty-eight volumes are not classified and are suitable for public dissemination. This Project Management Plan is a volume of the unclassified documentation. The other twenty-seven volumes contain comprehensive data on technical, financial, and environmental aspects of the project. Each of the four remaining project phases is presented starting with the extensive planning that will be performed and continuing through to the execution and completion of each phase. The major roles of the Operator, Ashland Synthetic Fuels, Inc. (ASFI), and the Managing Contractor are defined. Although a contract has not yet been executed with a Managing Contractor, the procedures, controls, organization and management philosophy of Bechtel Petroleum, Inc., are presented in this report as being representative of those used by contractors in the business of performing the engineering, procurement, and construction of projects of this size and complexity. The organizational structures of the Operator and the Managing Contractor are described, with designation of key project team personnel by job description and organization charts. Provisions for cost, schedule, and material control are described.

  7. [Initial surgical management of squamous carcinoma of the vulva].

    PubMed

    Salazar-Báez, Israel; Salazar-Campos, Jessica E; López-Arias, Alhely; Villavicencio-Valencia, Verónica; Coronel-Martínez, Jaime; Candelaria-Hernández, Myrna; Pérez-Montiel, Delia; Pérez-Plasencia, Carlos; Rojas-García, Aurora Elizabeth; Cantú de León, David

    2016-01-01

    Vulvar cancer accounts for approximately 4% of gynecological malignancies. At the Instituto Nacional de Cancerologia in Mexico it occupies the fourth place. The purpose of this study is to assess the management of squamous carcinoma of the vulva with initial surgical treatment. It is a descriptive retrospective, observational study, from January 1, 2002 to December 31, 2012. Twenty-seven patients, clinical stages I, II, or III, initial surgical management, with at least one year of follow-up were included. In 51.85% a partial vulvectomy was performed and in 40.74% a wide excision; 66.66% underwent inguinofemoral dissection. Recurrence occurred in 25.91% of cases and the overall survival at 10 years was 63%. It is concluded that with invasion of up to 1 mm of lymph node, affection is 0%; with invasion of 1 mm and up to 5 mm this increases to 25%; an invasion of more than 5 mm implies up to 45%. Recurrence in our study was primarily distant, necessitating long-term monitoring with emphasis on symptoms to request imaging studies when suspected. Adjuvant therapy should be offered to patients with positive nodes, close or positive margins, and tumors larger than 4 cm. PMID:27335183

  8. The European initiative for quality management in lung cancer care.

    PubMed

    Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul

    2014-05-01

    Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.

  9. 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.

  10. 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. PMID:25824071

  11. 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.

  12. 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.

  13. Initial respiratory management in preterm infants and bronchopulmonary dysplasia

    PubMed Central

    López, Ester Sanz; Rodríguez, Elena Maderuelo; Navarro, Cristina Ramos; Sánchez-Luna, Manuel

    2011-01-01

    BACKGROUND: Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes. OBJECTIVE: To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks. DESIGN/METHODS: A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours). RESULTS: Of the 329 eligible patients, a total of 49% did not need intubation, and 68.4% did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group. CONCLUSIONS: In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity = 89.5% and specificity = 67%). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients. PMID

  14. Endoscopic transnasal management of sinonasal malignancies – our initial experience

    PubMed Central

    Osuch-Wójcikiewicz, Ewa; Held-Ziółkowska, Marta; Kużmińska, Magdalena; Niemczyk, Kazimierz

    2014-01-01

    Introduction Malignant tumors of the paranasal sinuses are traditionally managed through external approaches. Advances in endoscopic transnasal surgery have allowed for the endoscopic treatment of some of these tumors. Aim To present the results of treatment of a series of patients with paranasal sinus malignancies treated with an endoscopic approach at a single institution. Material and methods The data on tumor type, operative technique, perioperative complications and postoperative course were analyzed. Results Eleven patients meeting the inclusion criteria were identified. The histopathology was as follows: malignant melanoma in 3 patients, squamous cell carcinoma in 2, adenocarcinoma in 2, poorly differentiated carcinoma in 1, hemangiopericytoma in 1, adenoid cystic carcinoma in 1 and fibrosarcoma in 1. There were no severe perioperative complications with the exception of 1 case of cerebrospinal fluid leak, which was successfully closed. The mean observation period was 13.5 months. One of the patients died of disease, another was lost to follow-up, and one was reoperated on due to recurrence. The remaining 8 patients are alive with no signs of recurrence. Conclusions Our initial experience seems to confirm results obtained by other authors indicating that in selected cases endoscopic surgery of sinonasal malignancies is similarly effective as external approach surgery. PMID:25097677

  15. 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.

  16. Limitations of stereotactic biopsy in the initial management of gliomas.

    PubMed Central

    Jackson, R. J.; Fuller, G. N.; Abi-Said, D.; Lang, F. F.; Gokaslan, Z. L.; Shi, W. M.; Wildrick, D. M.; Sawaya, R.

    2001-01-01

    Stereotactic biopsy is often performed for diagnostic purposes before treating patients whose imaging studies highly suggest glioma. Indications cited for biopsy include diagnosis and/or the "inoperability" of the tumor. This study questions the routine use of stereotactic biopsy in the initial management of gliomas. At The University of Texas M. D. Anderson Cancer Center, we retrospectively reviewed a consecutive series of 81 patients whose imaging studies suggested glioma and who underwent stereotactic biopsy followed by craniotomy/resection (within 60 days) between 1993 and 1998. All relevant clinical and imaging information was reviewed, including computerized volumetric analysis of the tumors based on pre- and postoperative MRI. Stereotactic biopsy was performed at institutions other than M. D. Anderson in 78 (96%) of 81 patients. The majority of tumors were located either in eloquent brain (36 of 81 = 44%) or near-eloquent brain (41 of 81 = 51%), and this frequently was the rationale cited for performing stereotactic biopsy. Gross total resection (>95%) was achieved in 46 (57%) of 81 patients, with a median extent of resection of 96% for this series. Diagnoses based on biopsy or resection in the same patient differed in 40 (49%) of 82 cases. This discrepancy was reduced to 30 (38%) of 80 cases when the biopsy slides were reviewed preoperatively by each of three neuropathologists at M. D. Anderson. Major neurologic complications occurred in 10 (12.3%) of 81 surgical patients and 3 (3.7%) of 81 patients undergoing biopsy. Surgical morbidity was probably higher in our series than it would be for glioma patients in general because our patients represent a highly selected subset of glioma patients whose tumors present a technical challenge to remove. Stereotactic biopsy is frequently inaccurate in providing a correct diagnosis and is associated with additional risk and cost. If stereotactic biopsy is performed, expert neuropathology consultation should be sought

  17. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management... BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval of initial Management Expenses. If you plan to obtain Leverage, you must have your Management...

  18. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... SBA approval of initial Management Expenses. A NMVC Company must have its Management Expenses...

  19. 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

  20. Self-Management of Initiations by Students Diagnosed with Autism

    ERIC Educational Resources Information Center

    Newman, B.; Eyck, P. T.

    2005-01-01

    During prebaseline observations, three students diagnosed with autism were unable to make social initiations to another individual. The ability to make initiations would be considered a "pivotal response" in that it would allow an individual to come into contact with a wide variety of social reinforcement. A multiple-baseline design was…

  1. 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)

  2. 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…

  3. Initial Validation of the Children's Worry Management Scale

    ERIC Educational Resources Information Center

    Zeman, Janice Lillian; Cassano, Michael; Suveg, Cynthia; Shipman, Kimberly

    2010-01-01

    We investigated the psychometric properties of a new instrument, the Children's Worry Management Scale (CWMS). The CWMS has three subscales that specify methods of regulating worry: inhibition (the suppression of worry), dysregulation (exaggerated displays of worry), and coping (constructive ways of managing worry). Using a Caucasian, middle-class…

  4. Recent initiatives in U.S. hospital supply management.

    PubMed

    Sykucki, T

    1996-02-01

    A variety of health care industry changes affect hospital/system materiel management directors as never before. Among them: the switch to patient care in alternative sites, system integration, new health care partnerships, and evolving technology and benchmarking needs. The key drivers for management include total product cost, compliance, standardization, utilization, and long-term partnering.

  5. 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.…

  6. 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

  7. 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.

  8. 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. PMID:26724246

  9. Initial management of open hand fractures in an emergency department.

    PubMed

    Capo, John T; Hall, Michael; Nourbakhsh, Ali; Tan, Virak; Henry, Patrick

    2011-12-01

    We retrospectively reviewed the cases of patients with open hand fractures and/or dislocations managed at our institution between 2001 and 2009. The management protocol consisted of irrigation and debridement, reduction (if necessary), splinting, and antibiotics administration in the emergency department. Patients with vascular compromise or severe mangling open wounds were taken to the operating room for treatment. Data regarding demographics, wound size and modified Gustilo-Anderson classification, and timing of interventions were recorded. Included in the study were 145 cases (91 class III, 41 class II, and 13 class I injuries). In 102 cases, definitive and final management took place in the emergency department; in the other 43 cases, additional management took place in the operating room. Antibiotics were administered within 4 hours after injury, and irrigation and debridement were performed within 6 hours. Each of the 2 infections (1.4%) developed in a class III injury. In open hand fractures, particularly type I and type II wounds, the protocol we followed can be appropriate when the injury is not the severe mangling type and does not require acute vascular repair. PMID:22268015

  10. 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.

  11. Management PhD Candidates' Job Search: The Initial Interview.

    ERIC Educational Resources Information Center

    Hunt, Steven C.; Sawhney, Rajeev

    2003-01-01

    A survey of 200 doctoral students who interviewed with business schools at the Academy of Management conference received 74 responses. On average, they interviewed with 15.74 schools and did considerable preconference information gathering. Many complained of the physical conditions and lack of interviewer preparation. (Contains 20 references.)…

  12. 77 FR 10695 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-23

    ... URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives...) the capital ratio of the MMIF; and (5) FHA risk management. Each one of these five statutory grounds... allowable amount of seller concessions is part of FHA's ongoing risk management practices. FHA is a...

  13. 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...

  14. 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.

  15. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules.

    PubMed

    Schwarz, Carsten; Schönfeld, Nicolas; Bittner, Roland C; Mairinger, Thomas; Rüssmann, Holger; Bauer, Torsten T; Kaiser, Dirk; Loddenkemper, Robert

    2013-01-01

    The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin. Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n=1, small cell lung cancer n=1, bacterial pneumonia n=2), and the surgical strategy had to be modified to bilobectomy in one patient. Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular pre-operative work-up of patients with SPN. PMID:22496316

  16. Initial management of patients in an emergency situation.

    PubMed

    Dean, Rick; Mulligan, Joe

    Success in first aid is based on the ability to make the most of the resources available and on maintaining the casualty in the best possible condition until specialist help arrives. This article, the second in a series of eight, discusses how to assess and stabilise the casualty's condition and how to manage the emergency situation. Using case examples, it provides a methodical approach to risk assessment for casualties, bystanders and rescuers, as well as ascertaining and providing clear and accurate information for the relevant emergency services.

  17. 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

  18. 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

  19. 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.

  20. IBFAN Africa training initiatives: code implementation and lactation management.

    PubMed

    Mbuli, A

    1994-01-01

    As part of an ongoing effort to halt the decline of breast feeding rates in Africa, 35 representatives of 12 different African countries met in Mangochi, Malawi, in February 1994. The Code of Marketing of Breastmilk Substitutes was scrutinized. National codes were drafted based on the "Model Law" of the IBFAN Code Documentation Centre (ICDC), Penang. Mechanisms of implementation, specific to each country, were developed. Strategies for the promotion, protection, and support of breast feeding, which is very important to child survival in Africa, were discussed. The training course was organized by ICDC, in conjunction with IBFAN Africa, and with the support of the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). Countries in eastern, central, and southern Africa were invited to send participants, who included professors, pediatricians, nutritionists, MCH personnel, nurses, and lawyers. IBFAN Africa has also been conducting lactation management workshops for a number of years in African countries. 26 health personnel (pediatricians, nutritionists, senior nursing personnel, and MCH workers), representing 7 countries in the southern African region, attended a training of trainers lactation management workshop in Swaziland in August, 1993 with the support of their UNICEF country offices. The workshop included lectures, working sessions, discussions, and slide and video presentations. Topics covered included national nutrition statuses, the importance of breast feeding, the anatomy and physiology of breast feeding, breast feeding problems, the International Code of Marketing, counseling skills, and training methods. The field trip to a training course covering primary health care that was run by the Traditional Healers Organization (THO) in Swaziland was of particular interest because of the strong traditional medicine sector in many African countries. IBFAN Africa encourages use of community workers (traditional healers, Rural Health

  1. 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

  2. Implementing a Case Management Initiative in High-Need Schools

    PubMed Central

    Gifford, Elizabeth J.

    2013-01-01

    States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive. PMID:23976809

  3. Successful initiation of and management through a distributed computer upgrade

    SciTech Connect

    Barich, F.T.; Crawford, T.H.

    1995-12-31

    Processing capacity, the lack of data analysis tools, obsolescence, and spare parts issues are forcing utilities to upgrade or replace their plant computer systems with newer, larger systems. As a result, the utility faces an increasing number of new technologies, such as fiber optics and communication standards (FDDI, ATM, etc.), Graphic User Interface using X-Windows, and distributed architectures that eliminate the host based computer. Technologies such as these, if properly applied, can greatly enhance the capabilities and functions of the existing system. Besides this, the utility also faces funtionality previously not available through the plant computer, such as integrated plant monitoring and digital controls, voice, imaging, etc. With computing technology vastly changing from traditional host systems, the utility confronts the question, {open_quotes}what are my needs (now and for the future), and what new system can meet those needs most effectively?{close_quotes}. This paper describes the management process necessary to define the needs and then carry out a successful computer replacement project.

  4. Cryogenic Fluid Management Technologies for the Space Launch Initiative

    NASA Astrophysics Data System (ADS)

    Chato, D. J.; Plachta, D. W.; Gaby, J. D.; Tucker, S. P.; Harisson, A.; Hastings, L. J.

    2002-01-01

    This paper will detail the results and finding of an investigation to identify key cryogenic fluid management (CFM) techonologies to reseach for the NASA space launch initative (SLI). The SLI Propulsion Project Office identified CFM as potential technology gap and assembled a team of NASA researchers to validate their conclusion. The purpose of this investigation was to assist the SLI program in selecting research opportunities in forth coming efforts to mitigate valid program risk. Technical experts were selected from NASA Glenn and NASA Marshall from the NASA CFM working group. The NASA CFM Working Group has provided previously insight for prioritizing many test objectives regarding long-term storage of sub-critical LH2 for upperstages, deep space/planetary missions, and on-orbit depot applications. The assembled team visited key SLI contractors to accomplish the following goals: CFM Technology Elements discussed included;Zero-G Pressure Control Without Propellant Settling All SLI Contractors verified a CFM technology gap exists. All SLI Contractors either had cryogenic propellants baselined or as their first option in their 2nd Generation architecture studies. From information gathered the Cryogenic Working Group (CWG) has developed technical plan for SLI to address the issuses raised and mature CFM for use on a operational next generation space transportation system. This paper will detail the technical assessments presented by the CWG team, the SLI contractors response, the use of CFM in SLI architectures, as well as the current state of research efforts and plans for continued work.

  5. 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... effectively manage financial risk. As a result, FHA has been continually evaluating its portfolio to identify and respond to risks in ways that benefit the Fund and, ultimately, consumers and taxpayers....

  6. 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…

  7. Implementation guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511

    SciTech Connect

    McDaniel, L.B.

    1998-04-17

    This report is an Implementation Guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511 to provide a set of uniform instructions for managing the two contractors selected. The primary objective is to produce the necessary deliverables and services for the HTI project within schedule and budget.

  8. U.S. Army Social Work Care Manager Program: an initial program analysis.

    PubMed

    Henderson, Jill J

    2007-05-01

    Since the Global War on Terror, the U.S. Army has been transforming to meet national security needs. The transformation includes Army mental health programs serving soldiers and their families. These programs must be relevant to the needs of soldiers and their families and effective at maintaining the force throughout the Global War on Terror. The Army Social Work Care Manager Program was initiated in July 2003 to enhance mental health support for combat veterans and their families. This study provides an initial assessment of this program. A seven-item provider questionnaire was administered to 66 care managers (N=66) to obtain an initial assessment of their utilization and satisfaction. Findings from 33 (n=33) respondents revealed diverse usage across and within installations and modest satisfaction with their jobs. Additionally, the biggest challenges care managers faced were resourcing and supervision. Recommendations for additional research, policy, and practice are provided in this study. PMID:17521105

  9. Statewide Adoption and Initial Implementation of Contingency Management for Substance Abusing Adolescents

    PubMed Central

    Chapman, Jason E.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Randall, Jeff; Shackelford, Jennifer; Schoenwald, Sonja K.

    2008-01-01

    Four hundred and thirty-two public sector therapists attended a workshop in contingency management and were interviewed monthly for the following 6 months to assess their adoption and initial implementation of contingency management to treat substance abusing adolescent clients. Results showed that 58% of the practitioners (n = 131) with at least one substance abusing adolescent client (n = 225) adopted contingency management. Rates of adoption varied with therapist service sector (mental health versus substance abuse), educational background, professional experience, and attitudes toward treatment manuals and evidence-based practices. Competing clinical priorities and client resistance were most often reported as barriers to adopting contingency management, whereas unfavorable attitudes toward and difficulty in implementing contingency management were rarely cited as barriers. The fidelity of initial contingency management implementation among adopters was predicted by organizational characteristics as well as by several demographic, professional experience, attitudinal, and service sector characteristics. Overall, the findings support the amenability of public sector practitioners to adopt evidence-based practices and suggest that the predictors of adoption and initial implementation are complex and multifaceted. PMID:18665685

  10. College crisis intervention: an initiative to develop regional campus Critical Incident Stress Management teams.

    PubMed

    Wiesen, F Elizabeth; Lischer, David K

    2006-01-01

    This article presents a statewide initiative that was undertaken to develop regional Critical Incident Stress Management (CISM) teams among colleges and universities within a northeastern state. In light of the unique needs and culture of institutions of higher education, this initiative was intended to improve each member college or university's capacity to respond comprehensively and effectively to critical incidents that affect its community. A step-by-step description of the implementation of the initiative is presented as well as discussion of what was learned through the process and future directions. PMID:16944791

  11. A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

    NASA Astrophysics Data System (ADS)

    Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

    The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

  12. Self-Management of Social Initiations by Kindergarten Students with Disabilities in the General Education Classroom

    ERIC Educational Resources Information Center

    Reynolds, Brooke M.; Gast, David L.; Luscre, Deanna

    2014-01-01

    The effectiveness of a self-management intervention on social interaction behaviors was evaluated for students with disabilities and social deficits. Four students enrolled in a general education kindergarten classroom were taught to self-monitor social initiations during nonstructured social time via a digital wrist counter. The number of social…

  13. Statewide Adoption and Initial Implementation of Contingency Management for Substance-Abusing Adolescents

    ERIC Educational Resources Information Center

    Henggeler, Scott W.; Chapman, Jason E.; Rowland, Melisa D.; Halliday-Boykins, Colleen A.; Randall, Jeff; Shackelford, Jennifer; Schoenwald, Sonja K.

    2008-01-01

    Four hundred thirty-two public sector therapists attended a workshop in contingency management (CM) and were interviewed monthly for the following 6 months to assess their adoption and initial implementation of CM to treat substance-abusing adolescent clients. Results showed that 58% (n = 131) of the practitioners with at least one…

  14. 13 CFR 108.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA approval of initial Management Expenses. 108.140 Section 108.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Organizing A Nmvc Company §...

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

    ERIC Educational Resources Information Center

    Major, E.

    2003-01-01

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

  16. Managing Systemic Curriculum Change: A Critical Analysis of Hong Kong's Target-Oriented Curriculum Initiative.

    ERIC Educational Resources Information Center

    Carless, David

    1997-01-01

    Describes Hong Kong's Target-Oriented Curriculum (TOC), a major curriculum renewal initiative designed to improve the quality of learning in local primary schools. Discusses the context in which it was introduced and factors that proved problematic in managing change. Focuses on five elements in the change process: practicality, ownership, teacher…

  17. 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...

  18. 77 FR 11798 - Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-28

    ... methods for submitting public comments. All submissions must refer to the docket number (FR-5572-N-01) and... URBAN DEVELOPMENT 24 CFR Chapter II Federal Housing Administration (FHA) Risk Management Initiatives: Revised Seller Concessions; Addresses for the Submission of Public Comments AGENCY: Office of...

  19. 13 CFR 107.140 - SBA approval of initial Management Expenses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false SBA approval of initial Management Expenses. 107.140 Section 107.140 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Qualifying for an SBIC License Organizing An Sbic § 107.140 SBA approval...

  20. 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.

  1. 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)

  2. A Performance Management Initiative for Local Health Department Vector Control Programs

    PubMed Central

    Gerding, Justin; Kirshy, Micaela; Moran, John W.; Bialek, Ron; Lamers, Vanessa; Sarisky, John

    2016-01-01

    Local health department (LHD) vector control programs have experienced reductions in funding and capacity. Acknowledging this situation and its potential effect on the ability to respond to vector-borne diseases, the U.S. Centers for Disease Control and Prevention and the Public Health Foundation partnered on a performance management initiative for LHD vector control programs. The initiative involved 14 programs that conducted a performance assessment using the Environmental Public Health Performance Standards. The programs, assisted by quality improvement (QI) experts, used the assessment results to prioritize improvement areas that were addressed with QI projects intended to increase effectiveness and efficiency in the delivery of services such as responding to mosquito complaints and educating the public about vector-borne disease prevention. This article describes the initiative as a process LHD vector control programs may adapt to meet their performance management needs. This study also reviews aggregate performance assessment results and QI projects, which may reveal common aspects of LHD vector control program performance and priority improvement areas. LHD vector control programs interested in performance assessment and improvement may benefit from engaging in an approach similar to this performance management initiative. PMID:27429555

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

    PubMed Central

    Reid, Cary; 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

  4. The National Oncology Working Group (NOW) initiative: payer and provider collaborations in oncology benefits management.

    PubMed

    Soper, Aileen M; Reeder, C E; Brown, Loreen M; Stojanovska, Ana; Lennert, Barbara J

    2010-04-01

    Payers recognize the need to expand benefits management for oncology but struggle to find effective solutions amid the complexity of available therapies and skepticism from oncologists, who are facing their own set of economic pressures. An effort called the National Oncology Working Group (NOW) Initiative is trying to change the sometimes adversarial relationship between payers and oncologists through a collaborative model. The group, which is supported by pharmaceutical manufacturer sanofi-aventis, is developing patient-centered strategies for successful and sustainable oncology benefits management. The focus includes finding consensus between payers and providers and devising solutions for oncology management such as decreasing variability of cancer care and improving end-of-life care for patients with terminal illness. NOW is designing tools that will be tested in small-scale regional demonstration projects, which NOW participants anticipate will set an example for successful oncology benefits management that can be replicated and expanded.

  5. 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.

  6. 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 screening…

  7. Initial development of a practical safety audit tool to assess fleet safety management practices.

    PubMed

    Mitchell, Rebecca; Friswell, Rena; Mooren, Lori

    2012-07-01

    Work-related vehicle crashes are a common cause of occupational injury. Yet, there are few studies that investigate management practices used for light vehicle fleets (i.e. vehicles less than 4.5 tonnes). One of the impediments to obtaining and sharing information on effective fleet safety management is the lack of an evidence-based, standardised measurement tool. This article describes the initial development of an audit tool to assess fleet safety management practices in light vehicle fleets. The audit tool was developed by triangulating information from a review of the literature on fleet safety management practices and from semi-structured interviews with 15 fleet managers and 21 fleet drivers. A preliminary useability assessment was conducted with 5 organisations. The audit tool assesses the management of fleet safety against five core categories: (1) management, systems and processes; (2) monitoring and assessment; (3) employee recruitment, training and education; (4) vehicle technology, selection and maintenance; and (5) vehicle journeys. Each of these core categories has between 1 and 3 sub-categories. Organisations are rated at one of 4 levels on each sub-category. The fleet safety management audit tool is designed to identify the extent to which fleet safety is managed in an organisation against best practice. It is intended that the audit tool be used to conduct audits within an organisation to provide an indicator of progress in managing fleet safety and to consistently benchmark performance against other organisations. Application of the tool by fleet safety researchers is now needed to inform its further development and refinement and to permit psychometric evaluation.

  8. While waiting: early recognition and initial management of neonatal hypoxic-ischemic encephalopathy.

    PubMed

    Sussman, Craig B; Weiss, Michael D

    2013-12-01

    Hypoxic-ischemic encephalopathy (HIE) occurring during the perinatal period is one of the primary causes of severe, long-term neurological deficits in children. Initial systemic supportive therapy remains a critical aspect of HIE management. In addition to support therapy, the widespread use of hypothermia has demonstrated a reduction in death and neurodevelopmental disability in infants with moderate to severe HIE. Neonates with HIE born outside of tertiary care centers must be rapidly identified as hypothermia candidates and have emergent transport arranged. While waiting for the transport team to arrive, these neonates often require intensive stabilization, including meticulous temperature management. This article examines the need for HIE outreach teaching programs, assists in the identification of a neonate for hypothermia therapy, and supplies evidence-based recommendations for the initial stabilization and care of neonates delivered at nontertiary care facilities. The guidelines and materials supplied represent the outreach model used by our regional hypothermia center and disseminated to the surrounding referral hospitals.

  9. [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.

  10. Experience of initiating collaboration of traditional healers in managing HIV and AIDS in Tanzania

    PubMed Central

    Kayombo, Edmund J; Uiso, Febronia C; Mbwambo, Zakaria H; Mahunnah, Rogasian L; Moshi, Mainen J; Mgonda, Yasin H

    2007-01-01

    Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods. The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas. After consultative meetings these leaders showed to be willing to collaborate; and opened doors to other traditional healers, who too were willing to collaborate with the Institute of Traditional Medicine in managing HIV/AIDS patients. Seventy five percent of traditional healers who claimed to be treating HIV/AIDS knew some HIV/AIDS symptoms; and some traditional healers attempted to manage these symptoms. Even though, they were willing to collaborate with the Institute of Traditional Medicine there were nevertheless some reservations based on questions surrounding sharing from collaboration. The reality of past experiences of mistreatment of traditional healers in the colonial period informed these reservations. General findings suggest that initiating

  11. Setting the Stage: Measure Selection, Coordination, and Data Collection for a National Self-Management Initiative

    PubMed Central

    Kulinski, Kristie P.; Boutaugh, Michele; Smith, Matthew Lee; Ory, Marcia G.; Lorig, Kate

    2015-01-01

    This paper describes the history and rationale behind the development of a centralized data collection system for the national rollout of the Chronic Disease Self-Management Program (CDSMP) through the American Recovery and Reinvestment Act of 2009 Communities Putting Prevention to Work: CDSMP initiative. In addition to justifying the need for solutions to the burgeoning burden of chronic disease in the United States, this paper provides details about CDSMP and related self-management education programs, including their structure, facilitator training, and effectiveness. These topics set the stage for the processes and procedures to create and manage the database for use at the national, state, and local levels. Furthermore, this paper describes the processes related to selecting variables, coordinating data collection, and utilizing data to inform research and policy. PMID:25964919

  12. The Family Medicine Residency Training Initiative in Miscarriage Management: Impact on Practice in Washington State

    PubMed Central

    Darney, Blair G.; Weaver, Marcia R.; Stevens, Nancy; Kimball, Jeana; Prager, Sarah W.

    2013-01-01

    BACKGROUND AND OBJECTIVES Non-complicated spontaneous abortion cases should be counseled about the full range of management approaches, including uterine evacuation using manual vacuum aspiration (MVA). The Residency Training Initiative in Miscarriage Management (RTI-MM) is an intensive, multidimensional intervention designed to facilitate implementation of office-based management of spontaneous abortion using MVA in family medicine residency settings. The purpose of this study was to test the impact of the RTI-MM on self-reported use of MVA for management of spontaneous abortion. METHODS We used a pretest/posttest one group study design and a web-based, anonymous survey to collect data on knowledge, attitudes, perceived barriers, and practice of office-based management of spontaneous abortion. We used multivariable models to estimate incident relative risks and accounted for data clustering at the residency site level. RESULTS Our sample included 441 residents and faculty from 10 family medicine residency sites. Our findings show a positive association between the RTI-MM and self-reported use of MVA for management of spontaneous abortion (adjusted RR=9.11 [CI=4.20-19.78]) and were robust to model specification. Male gender, doing any type of management of spontaneous abortion (eg, expectant, medication), other on-site reproductive health training interventions, and support staff knowledge scores were also significant correlates of physician practice of MVA. CONCLUSIONS Our findings suggest that the RTI-MM was successful in influencing the practice of management of spontaneous abortion using MVA in this population and that support staff knowledge may impact physician practice. Integrating MVA into family medicine settings would potentially improve access to evidence-based, comprehensive care for women. PMID:23378077

  13. A commentary on recent water safety initiatives in the context of water utility risk management.

    PubMed

    Hamilton, Paul D; Gale, Paul; Pollard, Simon J T

    2006-12-01

    Over the last decade, suppliers of drinking water have recognised the limitations of relying solely on end-product monitoring to ensure safe water quality and have sought to reinforce their approach by adopting preventative strategies where risks are proactively identified, assessed and managed. This is leading to the development of water safety plans; structured 'route maps' for managing risks to water supply, from catchment to consumer taps. This paper reviews the Hazard Analysis and Critical Control Point (HACCP) procedure on which many water safety plans are based and considers its appropriateness in the context of drinking water risk management. We examine water safety plans in a broad context, looking at a variety of monitoring, optimisation and risk management initiatives that can be taken to improve drinking water safety. These are cross-compared using a simple framework that facilitates an integrated approach to water safety. Finally, we look at how risk management practices are being integrated across water companies and how this is likely to affect the future development of water safety plans.

  14. 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.

  15. Outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer

    PubMed Central

    Kimura, Kosei; Tanaka, Satoru; Iwamoto, Mitsuhiko; Fujioka, Hiroya; Sato, Nayuko; Terasawa, Risa; Kawaguchi, Kanako; Matsuda, Junna; Umezaki, Nodoka; Uchiyama, Kazuhisa

    2016-01-01

    The purpose of this study was to retrospectively analyze the feasibility of outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer. A total of 131 consecutive patients with breast cancer treated with adjuvant or neoadjuvant chemotherapy from 2011 to 2013 at Osaka Medical College Hospital (Osaka, Japan) were retrospectively reviewed. In the case of developing a fever (body temperature, ≥38°C), the outpatients had been instructed to take previously prescribed oral antibiotics for 3 days without any initial assessment, and if no improvement had occurred by then, they were required to visit the hospital for examination and to undergo treatment based on the results of a risk assessment for complications. The primary aim of the present study was to assess the outcome of febrile episodes, while the secondary aim was to assess the incidence of febrile episodes, hospitalizations, and the type of chemotherapy. The 131 patients received 840 chemotherapy administrations. Fifty-five patients (42.0%) had a total of 75 febrile episodes after 840 chemotherapy administrations (8.9%). Treatment failure occurred in 12 of the 75 episodes (16.0%) in 11 of the 55 patients (20.0%). Only four episodes required hospitalization. Treatment success was achieved in 63 episodes (84.0%). In conclusion, the feasibility of outpatient management without initial assessment was evaluated in the present study for febrile patients undergoing adjuvant chemotherapy for breast cancer, and the outpatient strategy regimen may be safe and convenient for these patients. PMID:27699031

  16. Outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer

    PubMed Central

    Kimura, Kosei; Tanaka, Satoru; Iwamoto, Mitsuhiko; Fujioka, Hiroya; Sato, Nayuko; Terasawa, Risa; Kawaguchi, Kanako; Matsuda, Junna; Umezaki, Nodoka; Uchiyama, Kazuhisa

    2016-01-01

    The purpose of this study was to retrospectively analyze the feasibility of outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer. A total of 131 consecutive patients with breast cancer treated with adjuvant or neoadjuvant chemotherapy from 2011 to 2013 at Osaka Medical College Hospital (Osaka, Japan) were retrospectively reviewed. In the case of developing a fever (body temperature, ≥38°C), the outpatients had been instructed to take previously prescribed oral antibiotics for 3 days without any initial assessment, and if no improvement had occurred by then, they were required to visit the hospital for examination and to undergo treatment based on the results of a risk assessment for complications. The primary aim of the present study was to assess the outcome of febrile episodes, while the secondary aim was to assess the incidence of febrile episodes, hospitalizations, and the type of chemotherapy. The 131 patients received 840 chemotherapy administrations. Fifty-five patients (42.0%) had a total of 75 febrile episodes after 840 chemotherapy administrations (8.9%). Treatment failure occurred in 12 of the 75 episodes (16.0%) in 11 of the 55 patients (20.0%). Only four episodes required hospitalization. Treatment success was achieved in 63 episodes (84.0%). In conclusion, the feasibility of outpatient management without initial assessment was evaluated in the present study for febrile patients undergoing adjuvant chemotherapy for breast cancer, and the outpatient strategy regimen may be safe and convenient for these patients.

  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 Astrophysics Data System (ADS)

    Ponchak, Denise S.; Zuzek, John E.

    1991-04-01

    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. 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.

  20. 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.

  1. Advanced Monitoring Systems Initiative Project Achievements for Environmental Restoration and Waste Management

    SciTech Connect

    Hohman, E.H.; Lohrstorfer, C.L.; Venedam, R.J.; Weeks, S.J.; Fannin, C.R.

    2006-07-01

    The Advanced Monitoring Systems Initiative (AMSI) project has been in existence since 2002. In this short time period, AMSI has successfully developed, tested and/or demonstrated over 30 advanced sensors and monitoring systems for applications in environmental restoration, waste management and other areas of national interest. This presentation summarizes the AMSI project, and gives examples of recent successes. The purpose of the presentation is to make Symposium attendees aware of AMSI's capabilities and experience, for possible use in the future. Example successes include the following: - Automated hexavalent chromium (Cr(VI)) monitoring in wells alongside the Columbia River; - Atmospheric chemical sensor array for remote, real-time plume tracking; - Wireless sensor platform for long-term monitoring of subsurface moisture; - Embedded piezo-resistive micro-cantilever (EPM) units for carbon tetrachloride (CCl{sub 4}) and hydrogen cyanide (HCN) detection; - 'iHistorian' for efficient, real-time data management of chemical releases. (authors)

  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. PMID:26879574

  3. 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

  4. 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.

  5. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.

    PubMed

    Jenssen, Christian; Annema, Jouke Tabe; Clementsen, Paul; Cui, Xin-Wu; Borst, Mathias Maximilian; Dietrich, Christoph Frank

    2015-10-01

    Ultrasound imaging has gained importance in pulmonary medicine over the last decades including conventional transcutaneous ultrasound (TUS), endoscopic ultrasound (EUS), and endobronchial ultrasound (EBUS). Mediastinal lymph node (MLN) staging affects the management of patients with both operable and inoperable lung cancer (e.g., surgery vs. combined chemoradiation therapy). Tissue sampling is often indicated for accurate nodal staging. Recent international lung cancer staging guidelines clearly state that endosonography should be the initial tissue sampling test over surgical staging. Mediastinal nodes can be sampled from the airways [endobronchial ultrasound combined with transbronchial needle aspiration (EBUS-TBNA)] or the esophagus [endoscopic ultrasound fine needle aspiration (EUS-FNA)]. EBUS and EUS have a complementary diagnostic yield and in combination virtually all MLNs can be biopsied. Additionally endosonography has an excellent yield in assessing granulomas in patients suspected of sarcoidosis. The aim of this review in two integrative parts is to discuss the current role and future perspectives of all ultrasound techniques available for the evaluation of mediastinal lymphadenopathy and mediastinal staging of lung cancer. A specific emphasis will be on learning mediastinal endosonography. Part 1 deals with an introduction into ultrasound techniques, MLN anatomy and diagnostic reach of ultrasound techniques and part 2 with the clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography.

  6. Engaging and empowering patients to manage their type 2 diabetes, Part II: Initiatives for success.

    PubMed

    Jacob, Stephan; Serrano-Gil, Manuel

    2010-10-01

    Type 2 diabetes (T2D) has reached pandemic proportions. The impact of it and its long-term sequelae represent a significant burden for many healthcare systems around the world, and a significant number of patients struggle to achieve the internationally recommended targets for the modifiable risk factors that optimize healthy outcomes. In the first part of this two-part review, the scene was set showing that there seems to be a knowledge, attitude, and practice (KAP) gap hindering successful management of T2D. Although theoretical knowledge about how T2D should be managed exists, the attitude of patients and healthcare professionals seems to influence the practicalities of implementing life-enhancing changes for patients living with diabetes. Following the chronic care model, macro-level initiatives such as Finland's national diabetes program, "The Development Programme for the Prevention and Care of Diabetes" (DEHKO), encourage a coordinated, supportive policy and financial environment for healthcare system change, and are advocated by the International Diabetes Federation. Over a 10-year period, the DEHKO program aims to demonstrate that a top-down population approach to prevention, focusing on reducing obesity, increasing physical activity, and encouraging healthier eating habits, may improve the overall health of the nation. However, the patient is the focus of day-to-day management of T2D, and innovative strategies that use a community (meso-level) approach to encourage self-management, or that embrace new technologies to access diabetes self-management education or support networks, are likely to be the way forward. Such measures may close the apparent KAP gap and bring about real and measurable benefits in quality of life and life expectancy. The second part of this review describes some of the many and varied initiatives designed to engage and empower patients to self-manage their T2D, with the aim of increasing the proportion of patients reaching health

  7. Direct cost for initial management of prostate cancer: a systematic review

    PubMed Central

    Sanyal, C.; Aprikian, A.G.; Chevalier, S.; Cury, F.L.; Dragomir, A.

    2013-01-01

    Background Prostate cancer (pca) is the most common non-skin cancer among men in Canada and other Western countries. Increased prevalence and higher cost of newer treatments have led to a significant rise in the economic burden of pca. The objectives of the present study were to systematically review the literature on direct costs for the initial management of pca, and to examine the methodologic considerations across studies. Methods Bibliographic databases were systematically searched for peer-reviewed articles in English. Studies were reviewed for methodologic considerations and mean direct cost of active surveillance or watchful waiting (as/ww) and initial treatments. Direct cost was standardized to 2011 Canadian dollars. Results After a review of abstracts and full-text papers, seventeen articles met the eligibility criteria and were included in the review. Studies were published during 1992–2010. The studies reported on health care systems in the United States, France, the United Kingdom, German, Italy, and Spain. Our review identified a lack of methodologic consensus, leading to variation in direct costs between studies. Nevertheless, results indicate a significant direct cost of pca treatments. Conclusions The existing literature lacks methodologically rigorous studies on the direct costs of pca treatments specific to publicly funded health care systems. Additional studies are required to appreciate the direct costs of newer treatments and the impact of their adoption on the growing economic burden of pca management. PMID:24311952

  8. Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

    PubMed

    Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

    2013-01-01

    With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects. PMID:23744468

  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. 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.

  12. 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

  13. 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...

  14. 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

  15. 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. PMID:18991141

  16. 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.

  17. 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".

  18. Economic analysis of Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative

    PubMed Central

    de Oliveira, Claire; Wijeysundera, Harindra C; Tobe, Sheldon W; Lum-Kwong, Margaret Moy; Von Sychowski, Shirley; Wang, Xuesong; Tu, Jack V; Krahn, Murray D

    2012-01-01

    Objectives Hypertension is suboptimally treated in primary care settings. We evaluated the cost-effectiveness of the Heart and Stroke Foundation of Ontario’s Hypertension Management Initiative (HMI), an interdisciplinary, evidence-informed chronic disease management model for primary care that focuses on improving blood pressure management and control by primary care providers and patients according to clinical best practice guidelines. Methods The perspective of our analysis was that of the Ontario Ministry of Health and Long-Term Care with a lifetime horizon and 5% annual discount rate. Using data from a prospective cohort study from the HMI, we created two matched groups: pre-HMI (standard care), and post-HMI (n = 1720). For each patient, we estimated the 10-year risk of cardiovascular disease (CVD) using the Framingham risk equation and life expectancy from life tables. Long-term health care costs incurred with physician visits, acute and chronic care hospitalizations, emergency department visits, same-day surgeries, and medication use were determined through linkage to administrative databases, using a bottom-up approach. Results The HMI intervention was associated with significant reductions in systolic blood pressure (126 mmHg vs 134 mmHg with standard care; P-value < 0.001). These improvements were associated with a reduction in the 10-year risk of CVD (9.5% risk vs 10.7% in standard care; P-value < 0.001) and a statistically significant improvement in discounted life expectancy (9.536 years vs 9.516 in standard care; P-value < 0.001). The HMI cohort had a discounted mean lifetime cost of $22,884 CAD vs $22,786 CAD for standard care, with an incremental cost-effectiveness ratio of $4939 CAD per life-year gained. Conclusion We found that the HMI is a cost-effective means of providing evidence-informed, chronic disease management in primary care to patients with hypertension. PMID:23180969

  19. Associations of race and ethnicity with anemia management among patients initiating renal replacement therapy.

    PubMed Central

    Weisbord, Steven D.; Fried, Linda F.; Mor, Maria K.; Resnick, Abby L.; Kimmel, Paul L.; Palevsky, Paul M.; Fine, Michael J.

    2007-01-01

    BACKGROUND: Many patients initiate renal replacement therapy with suboptimal anemia management. The factors contributing to this remain largely unknown. The aim of this study was to assess the associations of race and ethnicity with anemia care prior to the initiation of renal replacement therapy. METHODS: Using data from the medical evidence form filed for patients who initiated renal replacement therapy between 1995-2003, we assessed racial and ethnic differences in pre-end-stage renal disease hematocrit levels, the use of erythropoiesis stimulation agents (ESAs), the proportion of patients with hematocrit levels > or = 33% and the proportion of patients with hematocrit levels < 33% that did not receive ESA. We also examined secular trends in racial and ethnic differences in these parameters. RESULTS: In multivariable analyses, non-Hispanic blacks had lower hematocrit levels (delta hematocrit = -0.97%, 95% CI: -1.00-0.94%), and were less likely to receive ESA (OR = 0.82, 95% CI: 0.81-0.84), to initiate renal replacement therapy with hematocrit > or = 33% (OR = 0.78, 95% CI: 0.77-0.79) or to receive ESA if the hematocrit was < 33% (OR = 0.79, 95% CI: 0.77-0.80) than non-Hispanic whites. White Hispanics also had lower hematocrit levels (delta hematocrit = -0.42%, 95% CI:-0.47% to -0.37%), and were less likely to receive ESA (OR = 0.86, 95% CI: 0.85-0.88), to have hematocrit levels > or = 33% (OR = 0.91, 95% CI: 0.89-0.93) or to receive ESA if the hematocrit was < 33% (OR = 0.85, 95% CI: 0.83-0.87) than non-Hispanic whites. These disparities persisted over the eight-year study period. CONCLUSIONS: African-American race and Hispanic ethnicity are associated with suboptimal pre-end-stage renal disease anemia management. Efforts to improve anemia care should incorporate targeted interventions to decrease these disparities. PMID:18020096

  20. Aeronautical System Center's environmental compliance assessment and management program's cost-saving initiatives support the Air Force's acquisition reform initiative

    SciTech Connect

    Meanor, T.

    1999-07-01

    The Environmental Management directorate of ASC (ASC/EM) has the responsibility of providing government oversight for the Government Owned Contractor Operated Aircraft and Missile plants (GOCOs). This oversight is manifested as a landlord role where Air Force provides the funding required to maintain the plant facilities including buildings and utilities as well as environmental systems. By agreement the companies operating the plants are required to operate them in accordance with environmental law. Presently the GOCOs include Air Force Plant (AFP) 6 in Marietta Ga., AFP 4 in Fort Worth, Tx., AFP 44 in Tucson, Az., AFP 42 in Palmdale, Ca., and AFP PJKS in Denver, Co. Lockheed Martin corporation operates AFPs 4,6, PJKS and a portion of AFP 42 while AFP 44 is operated by Raytheon Missile Systems Company. Other GOCOs at AFP 42 are Northrup-Grumman, Boeing, and Cabaco, the facilities engineer. Since 1992 the Environmental Management division has conducted its Environmental Compliance Assessment and Management Program assessments (ECAMP) annually at each of the plants. Using DOD's ECAMP Team Guide and teams comprised of both Air Force and consultant engineering personnel, each plant is assessed for its environmental compliance well being. In the face of rising operational costs and diminishing budgets ASC/EM performed a comprehensive review of its ECAMP. As a result, the basic ECAMP program was improved to reduce costs without compromising on quality of the effort. The program retained its emphasis in providing a snap-shot evaluation of each Air Force plant's environmental compliance health supported by complete but tailored protocol assessments.

  1. 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...

  2. The African Capacity Building Initiative: Toward Improved Policy Analysis and Development Management in Sub-Saharan Africa.

    ERIC Educational Resources Information Center

    World Bank, Washington, DC.

    The objective of the African Capacity Building Initiative is to build and strengthen local capabilities for policy analysis and development management in Sub-Saharan Africa. This report examines the nature and magnitude of the problem, which basically consists of a shortage of development management skills combined with weakness in the area of…

  3. 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.

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

    NASA Technical Reports Server (NTRS)

    Yan, Jerry C.

    1987-01-01

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

  5. Monteggia fracture-dislocation: a case report, its' initial management and review of bado's classification.

    PubMed

    Musa, Abdullahi Agaba-Idu

    2006-12-01

    Fracture of proximal ulna and dislocation of the proximal radio-ulna joint in the same arm is called Monteggia fracture- dislocation. Four clinical variants of this fracture- dislocation have been described in literature. This is a report and description of initial management of a fracture- dislocation, which was consequent to a sideswipe injury and consisted of a combination of the following injuries; lateral dislocation of the radial head, fractures of the olecranon and proximal ulna in the left forearm. The radial head dislocation and fracture of the olecranon were open. The head of the radius was exposed through the same wound. This fracture-dislocation resembled type 3 Bado's classification of Monteggia fracture-dislocation because of fracture of the olecranon close to the coronoid process and lateral dislocation of the head of radius.

  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. Initial Abstinence Status and Contingency Management Treatment Outcomes: Does Race Matter?

    PubMed Central

    Montgomery, LaTrice; Carroll, Kathleen M.; Petry, Nancy M.

    2015-01-01

    Objective Limited research has evaluated African American substance users’ response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. Method A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. Results African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. Conclusions CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. PMID:25798729

  8. Evaluation of the fire simulation processes of the National Fire Management System's Initial Attack Analysis processor.

    PubMed

    Dimitrakopoulos, A P; Omi, P N

    2003-01-01

    The fire simulation processes of the National Fire Management System's (NFMAS) Initial Attack Analysis (IAA) processor were evaluated by conducting two types of sensitivity analysis: one based on a hypothetical set of data to assess IAA's outputs under a wide range of fire input values, and the other using an actual Stanislaus National Forest database to test IAA's validity with a real set of data. The results revealed that IAA's outputs (projected annual number of fires and area burned) were most sensitive, in descending order, to the input values of the fire spread rate, the productivity rates of the suppression forces, and the initial attack time, for all fuel models tested. In contrast, IAA's outputs were extremely insensitive to variations in the fire size at discovery. Changes are necessary in the ways IAA incorporates the fire size at discovery to facilitate the comparison among various fire detection options. The program's "escaped fire situation" analysis was found inadequate, because the projected annual frequencies and final sizes of the simulated escaped fire events produced unacceptable results with the Stanislaus National Forest database. Assigning final sizes to simulated escaped fires according to the fire intensity level in which they are historically expected to occur provides a consistent way of calculation of the projected annual area burned and the consequent cost plus net value change (C + NVC).

  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. 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.

  11. Five Years On: Tsunami Risk Mitigation and Disaster Management Initiatives in Sri Lanka

    NASA Astrophysics Data System (ADS)

    Jayasekera Wijetunge, J.

    2009-12-01

    The Indian Ocean tsunami in 2004 caused unprecedented loss of lives and damage to property in Sri Lanka with over 35,000 killed, 20,000 injured and about 100,000 dwellings and other buildings destroyed or damaged. This catastrophic event also exposed lack of disaster preparedness at the time in Sri Lanka and underscored the need for pro-active disaster planning and risk mitigation. Given the apparently low probability of recurrence of destructive ocean-wide tsunami similar to that in 2004, Sri Lanka preferred an integrated approach to tsunami risk mitigation consisting primarily of non-structural measures, namely, public education and awareness; early warning and evacuation; hazard and risk mapping; and necessary institutional and legislative initiatives. The Indian Ocean Tsunami Warning System currently under development, though by no means foolproof, will help improve Sri Lanka’s tsunami early warning capability and reliability. Yet, the more difficult and challenging task will be the dissemination of such tsunami warnings fast and effectively to the vulnerable communities so as to enable their evacuation to safe locations. The Disaster Management Centre of the Government of Sri Lanka has been coordinating all activities related to disaster risk mitigation in the country. Their efforts have indeed been commendable, particularly in setting up of institutional mechanisms to better coordinate risk mitigation activities and in strengthening, streamlining and directing the capabilities and resources of relevant governmental and non-governmental organizations towards a common goal of disaster risk reduction through a multi-hazard approach. The university system in Sri Lanka also has made many contributions towards disaster mitigation through capacity building initiatives, hazard mapping and research. On the whole, Sri Lanka has taken significant steps towards disaster risk reduction since the tsunami devastation in 2004. The country now has a sound disaster risk

  12. 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

  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. The initial management of trauma patients is an especially relevant setting to evaluate professional practice patterns.

    PubMed

    Harrois, A; Mertes, P-M; Tazarourte, K; Atchabahian, A; Duranteau, J; Langeron, O; Vigué, B

    2013-01-01

    The initial management of trauma patients in a dedicated location is a crucial step in the treatment of these patients. The characteristics of this phase are such that they meet all the criteria for a professional practice patterns evaluation (PPPE or PPE): formalized protocols, clear-cut timeframes, specific roles of different stakeholders, and multidisciplinary medical and paramedical team. In addition, the expected result of the PPE approach, improved care, will have a direct impact on patient outcomes. This PPE modeled on an audit aims at evaluating the care process based on representative criteria. These criteria should include: the planned structure and organization; the protocols; the strategy and time frames for procedure implementation; the relationships between stakeholders; the results. For each criterion, differences between the expected characteristics and the observed reality are analyzed. The prospective (independent observer or video) and/or retrospective (records, register) collection of data during 20 consecutive encounters should be sufficient to identify dysfunctions and provide guidance on the changes that need to be implemented. The proposed data collection form includes 15 items representative of the five defined criteria. These items often describe departmental choice. The pursuit of quality is defined first in terms of medical and paramedical results, but also in administrative and financial terms. Following the analysis produced by a representative group of actors, a multidisciplinary discussion of the results should be followed by proposals for simple changes approved by everyone. After a few months of implementation, the impact of the proposed improvement measures will be assessed by a new survey. This approach, in addition to improving the quality of care, allows better team stress management and greater work enjoyment. PMID:23916520

  16. Physicians' Initial Management of Acute Low Back Pain Versus Evidence-Based Guidelines

    PubMed Central

    Webster, Barbara S; Courtney, Theodore K; Huang, Yueng-Hsiang; Matz, Simon; Christiani, David C

    2005-01-01

    Background Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain. Objective To assess whether physicians' management decisions are consistent with the Agency for Health Research Quality's guideline and whether responses varied with the presentation of sciatica or by physician characteristics. Design Cross-sectional study using a mailed survey. Participants Participants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties. Measurements A questionnaire asked for recommendations for 2 case scenarios, representing patients without and with sciatica, respectively. Results Seven hundred and twenty surveys were completed (response rate=25%). In cases 1 (without sciatica) and 2 (with sciatica), 26.9% and 4.3% of physicians fully complied with the guideline, respectively. For each year in practice, the odds of guideline noncompliance increased 1.03 times (95% confidence interval [CI]=1.01 to 1.05) for case 1. With occupational medicine as the referent specialty, general practice had the greatest odds of noncompliance (3.60, 95% CI=1.75 to 7.40) in case 1, followed by internal medicine and emergency medicine. Results for case 2 reflected the influence of sciatica with internal medicine having substantially higher odds (vs case 1) and the greatest odds of noncompliance of any specialty (6.93, 95% CI=1.47 to 32.78), followed by family practice and emergency medicine. Conclusions A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors

  17. Current trends in initial management of oropharyngeal cancer: the declining use of open surgery.

    PubMed

    Haigentz, Missak; Silver, Carl E; Corry, June; Genden, Eric M; Takes, Robert P; Rinaldo, Alessandra; Ferlito, Alfio

    2009-12-01

    The widespread availability of novel primary treatment approaches against oropharyngeal cancers has provided several potentially curative surgical and nonsurgical treatment options for patients, generating both hope and controversy. As treatment is usually curative in intent, management considerations must include consideration of primary tumor and nodal disease control as well as long-term toxicities and functional outcomes. Anatomical and functional organ preservation (speech and deglutition) remains of paramount importance to patients with oropharyngeal cancer and the physicians involved in their care, accounting for the growing popularity of chemoradiotherapy and transoral surgical techniques for this indication. These novel approaches have greatly diminished the role of open surgery as initial therapy for oropharyngeal cancers. Open surgery which is often reserved for salvage on relapse, may still be an appropriate therapy for certain early stage primary lesions. The growing treatment armamentarium requires careful consideration for optimal individualized care. The identification of oncogenic human papillomavirus as a predictive and prognostic marker in patients with oropharyngeal cancer has great potential to further optimize the choice of treatment. In this review, novel primary therapies against oropharyngeal squamous cell carcinoma are presented in the context of anatomical, quality of life, and emerging biological considerations. PMID:19866522

  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. 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.

  20. 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

  1. 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. PMID:23895936

  2. 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.

  3. 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.

  4. A novel convenient procedure for extractive work-up of whole-cell biotransformations using de-emulsifying hydrolases.

    PubMed

    Jörg, Gerhard; Leppchen, Kathrin; Daussmann, Thomas; Bertau, Martin

    2004-08-20

    Extractive work-up of whole-cell biotransformations generally suffers from the formation of stable gels and slimes upon addition of the organic solvent to the cell suspension and the cell-free solution, respectively. This problem has been overcome by enzymatic lysis of emulsifying agents present in the medium through addition of hydrolases. Of these agents, proteases have exhibited the most powerful de-emulsifying activity. Enzyme treatment of cell-free culture media of Saccharomyces cerevisiae with pronase E drastically reduced phase separation time (t(p)) from 1 week to 30 min without significantly affecting product integrity. Yeast cell suspensions were de-emulsified best with protease N-01, where phase separation was complete after 1 h. As was exemplified with cell-free culture media of Lactobacillus kefir, wherein addition of pronase E or protease N-01 reduced t(p) from 1 week to 2 h each, this practical, ready-to-use method is appropriate for both fungal and bacterial biocatalysts.

  5. 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.

  6. 75 FR 54020 - Federal Housing Administration Risk Management Initiatives: New Loan-to-Value and Credit Score...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-03

    ... URBAN DEVELOPMENT 24 CFR Ch. II Federal Housing Administration Risk Management Initiatives: New Loan-to...: I. Background--HUD's July 15, 2010 Notice On July 15, 2010, at 75 FR 41217, HUD issued a proposed... reduce the maximum loan-to-value (LTV) for borrowers with lower credit scores who represent a higher...

  7. 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,…

  8. 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.

  9. 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.…

  10. "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:…

  11. 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...

  12. Stridor and apnea as the initial presentation of primary hypoparathyroidism.

    PubMed

    Chou, Courtney T; Siegel, Bianca; Mehta, Deepak

    2016-01-01

    We present a previously undescribed case of stridor and apnea as the initial presentation of primary hypoparathyroidism. A neonate presenting with these symptoms was initially diagnosed with laryngopharyngeal reflux and laryngomalacia. After failing medical management, she underwent supraglottoplasty with improvement of stridor, but persistent apneic events. Further work-up showed severe hypocalcemia due to hypoparathyroidism. Subsequent genetic testing revealed a diagnosis of Bartter Syndrome Type V, a rare cause of primary hypoparathyroidism. Although uncommon, hypocalcemic tetany can present as apneic episodes in the setting of unrecognized primary hypoparathyroidism. Electrolyte abnormalities should be explored in neonates with recurrent apnea of unknown etiology. PMID:26746608

  13. Stridor and apnea as the initial presentation of primary hypoparathyroidism.

    PubMed

    Chou, Courtney T; Siegel, Bianca; Mehta, Deepak

    2016-01-01

    We present a previously undescribed case of stridor and apnea as the initial presentation of primary hypoparathyroidism. A neonate presenting with these symptoms was initially diagnosed with laryngopharyngeal reflux and laryngomalacia. After failing medical management, she underwent supraglottoplasty with improvement of stridor, but persistent apneic events. Further work-up showed severe hypocalcemia due to hypoparathyroidism. Subsequent genetic testing revealed a diagnosis of Bartter Syndrome Type V, a rare cause of primary hypoparathyroidism. Although uncommon, hypocalcemic tetany can present as apneic episodes in the setting of unrecognized primary hypoparathyroidism. Electrolyte abnormalities should be explored in neonates with recurrent apnea of unknown etiology.

  14. Managing Curriculum: Rapid Implementation and Sustainability of a Districtwide Data Initiative

    ERIC Educational Resources Information Center

    Wayman, Jeffrey C.; Conoly, Katherine

    2006-01-01

    In March 2003, the Corpus Christi Independent School District (CCISD) received a Curriculum Management Audit report from the Texas Curriculum Management Audit Center of the Texas Association of School Administrators. One of the findings of this audit was that CCISD lacked a clear comprehensive management plan to define and guide the design,…

  15. 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…

  16. 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.

  17. 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…

  18. The Han River watershed management initiative for the South-to-North Water Transfer project (Middle Route) of China.

    PubMed

    Zhang, Quanfa; Xu, Zhifang; Shen, Zehao; Li, Siyue; Wang, Shusen

    2009-01-01

    The South-to-North Water Transfer (SNWT) Project of China is the largest of its kind ever implemented. Of its three routes (i.e., East, Middle and West), the middle one will transfer 14 billion m(3) of water annually from the Han River, a tributary of the Yangtze and the water supplying area, to Beijing by 2030. Thus water quality in the 95,000 km(2) upper Han River basin is of great concern. A watershed management initiative has been implemented in the basin, and the ultimate objectives are to quantify basin's ecosystem functioning and to develop an integrated management system with respect to water resources conservation. Specifically, the program includes five activities: characterization of riparian ecosystems, detection of land use and land cover change, quantification of nutrient cycling of representative ecosystems, determination of spatial and temporal variations of water quality, and finally development of a watershed management system for water conservation. This article provides the justifications of the watershed management initiative and the initial results are comprehended with respect to the water conservation in the Han River basin.

  19. Managing and Creating an Image in the Interview: The Role of Interviewee Initial Impressions

    ERIC Educational Resources Information Center

    Swider, Brian W.; Barrick, Murray R.; Harris, T. Brad; Stoverink, Adam C.

    2011-01-01

    In employment interviews, individuals use impression management tactics to present themselves as suitable candidates to interviewers. However, not all impression management tactics, or the interviewees who employ them, are effective at positively influencing interview scores. Results of this study indicate that the relationship between impression…

  20. 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…

  1. Trials, tribulations, and triumphs of a pilot initiative to optimize the management of wounds complicated by diabetes within the home.

    PubMed

    Hodgins, Marilyn J; Logan, Susan M; Price, Karla; Thompson, Carol

    2014-01-01

    To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program.

  2. Meaningful, measurable, and manageable approaches to evaluating healthy food financing initiatives: an overview of resources and approaches.

    PubMed

    Fleischhacker, Sheila E; Flournoy, Rebecca; Moore, Latetia V

    2013-01-01

    More than 23 million Americans have limited access to grocery stores. Healthy food financing initiatives have been emerging at local, state, and federal levels to address grocery gaps. Through public-private partnerships, retailers have been awarded funding to open or renovate a variety of food outlets. Preliminary findings have reported increased access to healthy foods, as well as improved community and economic development. As policy makers continue to consider enacting or expanding these initiatives and as all program stakeholders increasingly seek information on program impacts, this article provides guidance on using meaningful, measurable, and manageable methods to evaluate program's multifaceted outcomes.

  3. 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.

  4. Comprehensive allergy work-up is mandatory in cystic fibrosis patients who report a history suggestive of drug allergy to beta-lactam antibiotics

    PubMed Central

    2012-01-01

    Background In the general population, reports on suspected ß-lactam hypersensitivity are common. After a drug allergy work-up at best 20% of the selected patients are positive. However, these considerations have not been explored in cystic fibrosis patients for whom antibiotics are even more crucial. Methods The study, part of the Drug Allergy and Hypersensitivity (DAHD) cohort, was performed in the regional cystic fibrosis center of Montpellier, France. After identifying patients with a clinical history suggestive of drug allergy to ß-lactams, a complete drug allergy work-up, was carried out according to the EAACI recommendations. Results Among the 171 patients involved, 23 reported clinical manifestations potentially compatible with a drug allergy to ß-lactams. After performing the complete drug-allergy work-up, 7 were considered as drug hypersensitive (3 had positive skin tests, 1 a positive provocation test, 3 declined the tests). Excluding the latter 3 patients with incomplete drug allergy work-up, the rate of proven drug allergy was 2.3%. Conclusions Drug allergy to ß-lactams in cystic fibrosis patients is of importance. A full drug allergy work-up is mandatory in case of suspicion, because ß-lactam responsibility is often ruled out. PMID:22697261

  5. 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.

  6. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome.

    PubMed

    Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T

    2012-07-01

    Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.

  7. Evaluation of Transitioning Management of the Nuclear Hydrogen Initiative to Idaho National Laboratory

    SciTech Connect

    Charles Park; Mike Patterson

    2009-08-01

    This report describes the current capabilities of the INL to manage the NHI, the planned increases in capability to support NHI, and the cost and schedule and strategy for developing a commercially viable hydrogen production technology for deployment with NGNP.

  8. System Engineering Management and Implementation Plan for Project W-211 Initial Tank Retrieval Systems (ITRS)

    SciTech Connect

    VAN BEEK, J.E.

    2000-05-05

    This systems Engineering Management and Implementation Plan (SEMIP) describes the Project W-211 implementation of the Tank Farm Contractor Systems Engineering Management Plan (TFC SEMP). The SEMIP defines the systems engineering products and processes used by the project to comply with the TFC SEMP, and provides the basis for tailoring systems engineering processes by applying a graded approach to identify appropriate systems engineering requirements for W-211.

  9. 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

  10. 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

    ... initial production on a newly completed or recompleted well? 250.521 Section 250.521 Mineral Resources... AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.521 How do I manage the thermal effects caused by initial production...

  11. 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

    ... initial production on a newly completed or recompleted well? 250.521 Section 250.521 Mineral Resources... OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.521 How do I manage the thermal effects caused by initial production on a newly completed or recompleted...

  12. 30 CFR 250.522 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... initial production on a newly completed or recompleted well? 250.522 Section 250.522 Mineral Resources... SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.522 How do I manage the thermal effects caused by initial production on a newly completed...

  13. 30 CFR 250.521 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... initial production on a newly completed or recompleted well? 250.521 Section 250.521 Mineral Resources... SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.521 How do I manage the thermal effects caused by initial production on a newly completed...

  14. 30 CFR 250.522 - How do I manage the thermal effects caused by initial production on a newly completed or...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... initial production on a newly completed or recompleted well? 250.522 Section 250.522 Mineral Resources... SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Completion Operations Casing Pressure Management § 250.522 How do I manage the thermal effects caused by initial production on a newly completed...

  15. 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. PMID:27670207

  16. Radioactive Waste Management in the European Union: Initiatives for New Legislation

    SciTech Connect

    Taylor, D.

    2003-02-25

    Improving the management of radioactive waste in the European Union is a major theme of the ''nuclear package'' recently adopted by the European Commission. Included in the package are proposals for new legislation that would bring about the development of common safety standards in Europe covering the full nuclear sector, segregated funds to cover all nuclear liabilities that remain after the operating lifetime of an installation and clearly defined waste programs for radioactive waste management in each of the Member States of the Union. Included in these programs must be firm dates for a number decision points leading to disposal of all forms of radioactive waste. The package also puts significant emphasis on more, and better coordinated, research on radioactive waste management as the present levels are thought to be inadequate.

  17. 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…

  18. 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…

  19. 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…

  20. 75 FR 10865 - Shoreline Management Initiative, Reservoirs in Alabama, Georgia, Kentucky, Mississippi, North...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-09

    ... Initiative (SMI). On August 20, 2009, the TVA Board of Directors decided to amend SMP to terminate the... SMI and SMP would still be met without the Maintain and Gain program. FOR FURTHER INFORMATION CONTACT... environmental and project goals of the SMI and SMP would still be met. Consequently, the TVA Board of...

  1. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... use proposals. 2920.3 Section 2920.3 Public Lands: Interior Regulations Relating to Public Lands... initiated land use proposals. Where, as a result of the land use planning process, the desirability of allowing use of the public lands or providing increased service to the public from such use of the...

  2. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... use proposals. 2920.3 Section 2920.3 Public Lands: Interior Regulations Relating to Public Lands... initiated land use proposals. Where, as a result of the land use planning process, the desirability of allowing use of the public lands or providing increased service to the public from such use of the...

  3. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... use proposals. 2920.3 Section 2920.3 Public Lands: Interior Regulations Relating to Public Lands... initiated land use proposals. Where, as a result of the land use planning process, the desirability of allowing use of the public lands or providing increased service to the public from such use of the...

  4. 43 CFR 2920.3 - Bureau of Land Management initiated land use proposals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... use proposals. 2920.3 Section 2920.3 Public Lands: Interior Regulations Relating to Public Lands... initiated land use proposals. Where, as a result of the land use planning process, the desirability of allowing use of the public lands or providing increased service to the public from such use of the...

  5. Adult bacterial meningitis-a quality registry study: earlier treatment and favourable outcome if initial management by infectious diseases physicians.

    PubMed

    Grindborg, Ö; Naucler, P; Sjölin, J; Glimåker, M

    2015-06-01

    Acute bacterial meningitis (ABM) is challenging for the admitting physician because it is a rare but fulminant disease, usually presenting without typical symptoms, and rapid treatment is pivotal. The purpose of this study was to evaluate the effect of initial management by infectious diseases (ID) physicians vs. non-ID physicians. A total of 520 consecutive adults (>17 years old), 110 with initial ID management and 410 with non-ID management, registered in the Swedish quality registry for community-acquired ABM January 2008 to December 2013, were analysed retrospectively. Primary outcome was appropriate treatment with antibiotics and corticosteroids <1 hour from admission. Secondary analyses were mortality during hospital stay and persisting neurological and hearing deficits at follow-up after 2 to 6 months. Differences in diagnostic treatment sequences also were analysed. Appropriate treatment <1 hour from admission was achieved significantly more often (41%) by ID physicians vs. non-ID physicians (24%) with an odds ratio (OR) of 2.4 (95% confidence interval [CI]: 1.40 to 4.14; p < 0.01) adjusted for confounders. The door-to-antibiotic time was significantly shorter, and significantly more patients were administered corticosteroids together with the first doses of antibiotics in the ID group. A trend of decreased mortality (4.5% vs. 8.0%) and sequelae at follow-up (24% vs. 44%; adjusted OR 0.55: 95% CI 0.31 to 1.00; p 0.05) were observed in the ID group vs. the non-ID group. Antibiotics were started without prior neuroimaging more often in the ID group (86% vs. 57%; p < 0.001). Initial management at the emergency department by ID physicians is associated with earlier appropriate treatment, more appropriate diagnostic treatment sequences and favourable outcome.

  6. 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…

  7. 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…

  8. 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

    ... Criteria) published in the Federal Register on December 28, 1984 (49 FR 50582), are available at http://www... 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),...

  9. [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.

  10. Exchanging Ideas on Evaluation: Evaluating an Initial Management Skills Course: A Case Study.

    ERIC Educational Resources Information Center

    Lyman, Pat

    1979-01-01

    Describes an evaluation study of an interpersonal effectiveness management course for first-level supervisors. The evaluator collected information using graduate appraisal of course content, skill retention, measures, significant incident techniques, analysis of work products/records, appraisal of instructor, observation checklists, and…

  11. Initial results of a statewide extension program in calf and heifer management in Pennsylvania.

    PubMed

    Heinrichs, A J; Kiernan, N E

    1994-01-01

    This study was designed to evaluate changes in calf and heifer management in a sample of Pennsylvania dairy farms in conjunction with a statewide extension program on dairy replacements. The extension program reached dairy farmers in addition to individuals in agribusiness, veterinarians, and others who have frequent contact with dairy farmers through a multiplicity of information channels. An extensive survey was conducted during the 1st yr of the project on 329 commercial dairy farms throughout Pennsylvania. The same farms were contacted 2.5 to 3 yr later for comparison. Most (84.7%) of the farmers in the original random sample learned new information about calf and heifer management during this time, and 77.3% reported that they received all or part of this new information from extension. Sources of information most often used by the farmers in this study were dairy magazines, extension newsletters, and meetings organized either through extension or agribusiness. Adoption by farmers of many of the targeted practices specific to calving management, preweaned calves, and health management increased over this period.

  12. Standards in Action. Using National Standards for Human Resource Management and Development in Further Education. 5. Standards-based Initial Teacher Training.

    ERIC Educational Resources Information Center

    Further Education Unit, London (England).

    This booklet explores the use of national standards to structure work-based initial teacher training for teachers working within British further education colleges. Section 1 examines the following aspects of the use of Training and Development Lead Body (TDLB) and Management Charter Initiative (MCI) standards for initial teacher training: reasons…

  13. Selection of the initial methadone regimen for the management of iatrogenic opioid abstinence syndrome in critically ill children.

    PubMed

    Johnson, Peter N; Boyles, Krystal A; Miller, Jamie L

    2012-02-01

    Iatrogenic opioid abstinence syndrome (IOAS) is a common complication in critically ill infants and children receiving prolonged exposure to continuous infusions of opioids. Although no guidelines are available regarding management of IOAS in children, several treatment options are available, including clonidine, morphine, and methadone. Methadone is commonly prescribed due to its long half-life and antagonism of the N-methyl-d-aspartate receptor. Different approaches, such as weight-based and formula-based methods, have been used to determine the initial methadone dosing regimen. Because of the vast differences in the recommended dosing regimen from these sources, we conducted a literature search to identify articles evaluating the initial methadone dosing regimen for prevention and/or treatment of IOAS in children. Specifically, we evaluated the reported frequency of withdrawal and oversedation after initiation of methadone treatment. Our literature search was limited to English-language articles in the MEDLINE (1950-March 2011), EMBASE (1988-March 2011), International Pharmaceutical Abstracts (1970-March 2011), and Cochrane Library (1996-March 2011) databases. Relevant abstracts and reference citations were also reviewed. A total of eight reports representing 183 patients were included in the analysis. There was wide discrepancy in the initial methadone dosing regimen. Approximately one-third of all patients experienced withdrawal after starting methadone, and there did not appear to be a difference between weight-based and formula-based regimens. Seven patients experienced oversedation; however, not all articles reported this complication. It appears that a standard approach to initial methadone dosing does not exist because withdrawal occurred despite the regimen started. Therefore, it seems best to begin with the lowest dose possible and titrate to the child's response to avoid complications such as oversedation. Routine monitoring should be performed in all

  14. The Saudi initiative for asthma – 2012 update: Guidelines for the diagnosis and management of asthma in adults and children

    PubMed Central

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

    2012-01-01

    This an updated guidelines 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 updated guidelines, which are simple to understand and easy to use by non-asthma specialists, including primary care and general practice physicians. This new version includes updates of acute and chronic asthma management, with more emphasis on the use of Asthma Control Test in the management of asthma, and a new section on “difficult-to-treat asthma.” Further, the section on asthma in children was re-written to cover different aspects in this age group. The SINA panel is a group of Saudi experts with well-respected academic backgrounds and experience in the field of asthma. The guidelines are formatted based on the available evidence, local literature, and the current situation in Saudi Arabia. There was an emphasis on patient–doctor partnership in the management that also includes a self-management plan. The approach adopted by the SINA group is mainly based on disease control as it is the ultimate goal of treatment. PMID:23189095

  15. An Ontology of Quality Initiatives and a Model for Decentralized, Collaborative Quality Management on the (Semantic) World Wide Web

    PubMed Central

    2001-01-01

    This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be. PMID:11772549

  16. An ontology of quality initiatives and a model for decentralized, collaborative quality management on the (semantic) World-Wide-Web.

    PubMed

    Eysenbach, G

    2001-01-01

    This editorial provides a model of how quality initiatives concerned with health information on the World Wide Web may in the future interact with each other. This vision fits into the evolving "Semantic Web" architecture - ie, the prospective that the World Wide Web may evolve from a mess of unstructured, human-readable information sources into a global knowledge base with an additional layer providing richer and more meaningful relationships between resources. One first prerequisite for forming such a "Semantic Web" or "web of trust" among the players active in quality management of health information is that these initiatives make statements about themselves and about each other in a machine-processable language. I present a concrete model on how this collaboration could look, and provide some recommendations on what the role of the World Health Organization (WHO) and other policy makers in this framework could be.

  17. Has dialysis payment reform led to initial racial disparities in anemia and mineral metabolism management?

    PubMed

    Turenne, Marc N; Cope, Elizabeth L; Porenta, Shannon; Mukhopadhyay, Purna; Fuller, Douglas S; Pearson, Jeffrey M; Dahlerus, Claudia; Lantz, Brett; Tentori, Francesca; Robinson, Bruce M

    2015-03-01

    Implementation of the Medicare ESRD prospective payment system (PPS) and changes to dosing guidelines for erythropoiesis-stimulating agents (ESAs) in 2011 appear to have influenced use of injectable medications among dialysis patients. Given historically higher ESA and vitamin D use among black patients, we assessed the effect of these policy changes on racial disparities in the management of anemia and mineral metabolism. Analyses used cross-sectional monthly cohorts for a period-prevalent sample of 7384 maintenance hemodialysis patients at 132 facilities from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor. Linear splines with knots at each policy change were used in survey-weighted regressions to estimate time trends in hemoglobin (Hgb), erythropoietin (EPO) dose, intravenous (IV) iron dose, ferritin, transferrin saturation (TSAT) concentration, parathyroid hormone (PTH), IV vitamin D dose, cinacalcet use, and phosphate binder use. From August 2010 to December 2011, mean Hgb declined from 11.5 to 11.0 g/dl (P<0.001), mean EPO dose declined from 20,506 to 14,777 U/wk (P<0.001), and mean serum PTH increased from 340 to 435 pg/ml (P<0.001). No meaningful differences by race were observed regarding the rates of change of management practices or laboratory measures (all P>0.21). Mean EPO and vitamin D dose and serum PTH levels remained higher in blacks. Despite evidence that anemia and mineral metabolism management practices have changed significantly over time, there was no immediate indication of racial disparities resulting from implementation of the PPS or ESA label change. Further studies are needed to examine effects among patient and facility subgroups. PMID:25300289

  18. Has dialysis payment reform led to initial racial disparities in anemia and mineral metabolism management?

    PubMed

    Turenne, Marc N; Cope, Elizabeth L; Porenta, Shannon; Mukhopadhyay, Purna; Fuller, Douglas S; Pearson, Jeffrey M; Dahlerus, Claudia; Lantz, Brett; Tentori, Francesca; Robinson, Bruce M

    2015-03-01

    Implementation of the Medicare ESRD prospective payment system (PPS) and changes to dosing guidelines for erythropoiesis-stimulating agents (ESAs) in 2011 appear to have influenced use of injectable medications among dialysis patients. Given historically higher ESA and vitamin D use among black patients, we assessed the effect of these policy changes on racial disparities in the management of anemia and mineral metabolism. Analyses used cross-sectional monthly cohorts for a period-prevalent sample of 7384 maintenance hemodialysis patients at 132 facilities from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor. Linear splines with knots at each policy change were used in survey-weighted regressions to estimate time trends in hemoglobin (Hgb), erythropoietin (EPO) dose, intravenous (IV) iron dose, ferritin, transferrin saturation (TSAT) concentration, parathyroid hormone (PTH), IV vitamin D dose, cinacalcet use, and phosphate binder use. From August 2010 to December 2011, mean Hgb declined from 11.5 to 11.0 g/dl (P<0.001), mean EPO dose declined from 20,506 to 14,777 U/wk (P<0.001), and mean serum PTH increased from 340 to 435 pg/ml (P<0.001). No meaningful differences by race were observed regarding the rates of change of management practices or laboratory measures (all P>0.21). Mean EPO and vitamin D dose and serum PTH levels remained higher in blacks. Despite evidence that anemia and mineral metabolism management practices have changed significantly over time, there was no immediate indication of racial disparities resulting from implementation of the PPS or ESA label change. Further studies are needed to examine effects among patient and facility subgroups.

  19. Criteria for CT and Initial Management of Head Injured Infants: A Review.

    PubMed

    Shiomi, Naoto; Echigo, Tadashi; Hino, Akihiko; Hashimoto, Naoya; Yamaki, Tarumi

    2016-07-15

    Criteria for computed tomography (CT) to head injured infants have not been established. Since the identification of neurological findings is difficult in infants, examination by CT may be necessary in some cases, but it may be difficult to perform CT because of problems with radiation exposure and body movement. Moreover, even though no intracranial abnormality was found immediately after injury, abnormal findings may appear after several hours. From this viewpoint, course observation after injury may be more important than CT in the initial treatment of head trauma in infants. The complaints and neurological manifestations of infants, particularly those aged 2 or younger, are frequently unclear; therefore, there is an opinion that CT is recommended for all pediatric patients. However, the appropriateness of its use should be determined after confirming the mechanism of injury, consciousness level, neurological findings, and presence/absence of a history of abuse. Among the currently available rules specifying criteria for CT of infants with head trauma, the Pediatric Emergency Care Applied Research Network (PECARN) study may be regarded as reliable at present. In Japan, where the majority of emergency hospitals are using CT, it may be necessary to develop criteria for CT in consideration of the actual situation. CT diagnosis for pediatric head trauma is not always necessary. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on a state of the patients by telephone is useful for both patients and physicians. PMID:27194179

  20. Criteria for CT and Initial Management of Head Injured Infants: A Review.

    PubMed

    Shiomi, Naoto; Echigo, Tadashi; Hino, Akihiko; Hashimoto, Naoya; Yamaki, Tarumi

    2016-07-15

    Criteria for computed tomography (CT) to head injured infants have not been established. Since the identification of neurological findings is difficult in infants, examination by CT may be necessary in some cases, but it may be difficult to perform CT because of problems with radiation exposure and body movement. Moreover, even though no intracranial abnormality was found immediately after injury, abnormal findings may appear after several hours. From this viewpoint, course observation after injury may be more important than CT in the initial treatment of head trauma in infants. The complaints and neurological manifestations of infants, particularly those aged 2 or younger, are frequently unclear; therefore, there is an opinion that CT is recommended for all pediatric patients. However, the appropriateness of its use should be determined after confirming the mechanism of injury, consciousness level, neurological findings, and presence/absence of a history of abuse. Among the currently available rules specifying criteria for CT of infants with head trauma, the Pediatric Emergency Care Applied Research Network (PECARN) study may be regarded as reliable at present. In Japan, where the majority of emergency hospitals are using CT, it may be necessary to develop criteria for CT in consideration of the actual situation. CT diagnosis for pediatric head trauma is not always necessary. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on a state of the patients by telephone is useful for both patients and physicians.

  1. Criteria for CT and Initial Management of Head Injured Infants: A Review

    PubMed Central

    SHIOMI, Naoto; ECHIGO, Tadashi; HINO, Akihiko; HASHIMOTO, Naoya; YAMAKI, Tarumi

    2016-01-01

    Criteria for computed tomography (CT) to head injured infants have not been established. Since the identification of neurological findings is difficult in infants, examination by CT may be necessary in some cases, but it may be difficult to perform CT because of problems with radiation exposure and body movement. Moreover, even though no intracranial abnormality was found immediately after injury, abnormal findings may appear after several hours. From this viewpoint, course observation after injury may be more important than CT in the initial treatment of head trauma in infants. The complaints and neurological manifestations of infants, particularly those aged 2 or younger, are frequently unclear; therefore, there is an opinion that CT is recommended for all pediatric patients. However, the appropriateness of its use should be determined after confirming the mechanism of injury, consciousness level, neurological findings, and presence/absence of a history of abuse. Among the currently available rules specifying criteria for CT of infants with head trauma, the Pediatric Emergency Care Applied Research Network (PECARN) study may be regarded as reliable at present. In Japan, where the majority of emergency hospitals are using CT, it may be necessary to develop criteria for CT in consideration of the actual situation. CT diagnosis for pediatric head trauma is not always necessary. When no imaging is performed, this should be fully explained at the initial treatment before selecting course observation at home. Checking on a state of the patients by telephone is useful for both patients and physicians. PMID:27194179

  2. 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.

  3. ADHD in managed care: an assessment of the burden of illness and proposed initiatives to improve outcomes.

    PubMed

    Minkoff, Neil B

    2009-05-01

    Attention-deficit/hyperactivity disorder (ADHD) often results in persistent problems with attention and impulsivity; these problems, in turn, contribute to impairments in a wide range of functions that affect academic, social, and workplace performance. The chronic and cumulative effects of these difficulties can be overwhelming and outline the significant burden of illness associated with ADHD, which is realized in diminished quality of life for patients and their families and increasing costs or loss of revenue for payers and employers. This burden warrants significant consideration and action from managed care stakeholders to foster sound clinical practice and optimal care. For example, educational interventions and evidence-based tools can be implemented to assist providers with accurate diagnosis and more effective treatment. Furthermore, extensive data documenting the benefits of pharmacotherapy and provider follow-up have demonstrated that initiatives designed to encourage treatment adherence may be the best investment for managed care plans seeking to improve outcomes in patients with ADHD. PMID:19601690

  4. Identifying and improving knowledge deficits of emergency airway management of tracheotomy and laryngectomy patients: a pilot patient safety initiative.

    PubMed

    El-Sayed, Ivan H; Ryan, Susan; Schell, Hildy; Rappazini, Rosanne; Wang, Steven J

    2010-01-01

    Objectives. To evaluate the knowledge base of hospital staff regarding emergent airway management of tracheotomy and laryngectomy patients, and the impact of the introduction of a bedside airway form. Methods. Cross-sectional surveys of physicians, nurses, and respiratory therapists at a tertiary care hospital prior to and 24 months after introduction of a bedside Emergency Airway Access (EAA) form. Results. Pre- and postintervention surveys revealed several knowledge deficits. Preintervention, 37% of medical internists and 19% overall did not know that laryngectomy patients cannot be orally ventilated, and 67% of internists could not identify the purpose of stay sutures in recently created tracheotomies. Postintervention, these numbers improved for all groups. Furthermore, 80% of respiratory therapists reported encountering the EAA form in an emergent situation and found it useful. Conclusion. A knowledge deficit is identified in caregivers expected to provide emergency management of patients with airway anatomy altered by subspecialty surgeons. Safety initiatives such as the EAA form may improve knowledge among providers.

  5. 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.

  6. Integrated hydrological modelling of a managed coastal Mediterranean wetland (Rhone delta, France): initial calibration

    NASA Astrophysics Data System (ADS)

    Chauvelon, P.; Tournoud, M. G.; Sandoz, A.

    This paper presents a model of a heavily managed coastal Mediterranean wetland. The hydrosystem studied , called ``Ile de Camargue", is the central part of the Rhone river delta. It comprises flat agricultural drainage basins, marshes, and shallow brackish lagoons whose connection to the sea is managed. This hydrosystem is subject to strong natural hydrological variability due to the combination of a Mediterranean climate and the artificial hydrological regime imposed by flooded rice cultivation. To quantify the hydrological balance at different spatial and temporal scales, a simplified model is developed — including the basin and the lagoons — using a time step that enables the temporal dynamic to be reproduced that is adapted to data availability. This modelling task takes into account the functioning of the natural and anthropogenic components of the hydrosystem. A conceptual approach is used for modelling drainage from the catchment, using a GIS to estimate water input for rice irrigation. The lagoon system is modelled using a two-dimensional finite element hydrodynamic model. Simulated results from the hydrodynamic model run under various hydro-climatic forcing conditions (water level, wind speed and direction, sea connection) are used to calculate hydraulic exchanges between lagoon sub units considered as boxes. Finally, the HIC ("Hydrologie de l’Ile de Camargue") conceptual model is applied to simulate the water inputs and exchanges between the different units, together with the salt balance in the hydrosystem during a calibration period.

  7. 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.

  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. PMID:26458410

  9. 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.

  10. Early initiation of low-dose corticosteroid therapy in the management of septic shock: a retrospective observational study

    PubMed Central

    2012-01-01

    Introduction The use of low-dose steroid therapy in the management of septic shock has been extensively studied. However, the association between the timing of low-dose steroid therapy and the outcome has not been evaluated. Therefore, we evaluated whether early initiation of low-dose steroid therapy is associated with mortality in patients with septic shock. Methods We retrospectively analyzed the clinical data of 178 patients who received low-dose corticosteroid therapy for septic shock between January 2008 and December 2009. Time-dependent Cox regression models were used to adjust for potential confounding factors in the association between the time to initiation of low-dose corticosteroid therapy and in-hospital mortality. Results The study population consisted of 107 men and 71 women with a median age of 66 (interquartile range, 54 to 71) years. The 28-day mortality was 44% and low-dose corticosteroid therapy was initiated within a median of 8.5 (3.8 to 19.1) hours after onset of septic shock-related hypotension. Median time to initiation of low-dose corticosteroid therapy was significantly shorter in survivors than in non-survivors (6.5 hours versus 10.4 hours; P = 0.0135). The mortality rates increased significantly with increasing quintiles of time to initiation of low-dose corticosteroid therapy (P = 0.0107 for trend). Other factors associated with 28-day mortality were higher Simplified Acute Physiology Score (SAPS) 3 (P < 0.0001) and Sequential Organ Failure Assessment (SOFA) scores (P = 0.0007), dose of vasopressor at the time of initiation of low-dose corticosteroid therapy (P < 0.0001), need for mechanical ventilation (P = 0.0001) and renal replacement therapy (P < 0.0001), while the impaired adrenal reserve did not affect 28-day mortality (81% versus 82%; P = 0.8679). After adjusting for potential confounding factors, the time to initiation of low-dose corticosteroid therapy was still significantly associated with 28-day mortality (adjusted odds

  11. Initial Emergency Department Diagnosis and Management of Adult Patients with Severe Sepsis and Septic Shock

    PubMed Central

    2012-01-01

    Severe sepsis is a medical emergency affecting up to 18 million individuals world wide, with an annual incidence of 750,000 in North America alone. Mortality ranges between 28-50% of those individuals stricken by severe sepsis. Sepsis is a time critical illness, requiring early identification and prompt intervention in order to improve outcomes. This observation has led to increased awareness and education in the field of Emergency Medicine; it has also led to the implementation of critical interventions early in the course of patient management, specifically Early-Goal Directed Therapy, and rapid administration of appropriate antimicrobials. This review begins with a brief summary of the pathophysiology of sepsis, and then addresses the fundamental clinical aspects of ED identification and resuscitation of the septic patient. PMID:22737991

  12. Radiology Image Management in a Teaching Hospital Network Scenario: Initial Experience.

    PubMed

    Indrajit, I K; Souza, J D; Singh, Rajvir; Shekar, Anjanish

    2003-07-01

    INHS Asvini has the distinction of emerging as the first Armed Forces Hospital with networked radiology images, sourced principally from a recently installed Digital Substraction Angiography (DSA) machine (Siemens Polystar Top 1000 MA). In recent times, newer imaging machines offer digital images that are in DICOM format. DICOM denotes 'Digital Imaging and Communications in Medicine". Image management at INHS Asvini, involves transfer of DSA images in DICOM format, their conversion into Joint Photographic Experts Group (JPG) format and subsequent transmission of JPG images through a robust networking system that connects all departments/OPD/Wards, facilitating direct access of images to a variety of specialists and specialities. Clearly, this encouraging outcome is a small but useful step heralding the concept of 'anytime anywhere' images, and has the scalable expansibility of including CT and MRI images in future. PMID:27407523

  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. An evaluation of a primary care-based weight management initiative.

    PubMed

    Muckle, Sarah

    2007-07-01

    Obesity is a significant issue in public health. There is a wealth of research that will be discussed as part of this article that identifies what has been effective in helping obese people reach a healthy weight. Health visitors and practice nurses are ideally situated to provide evidence-based support and monitoring to those living with obesity who want to improve their health and well-being. This article evaluates a primary-care-based weight management programme that was devised from the research evidence available. A total of nine women were offered a combination of interactive group education sessions, monitoring and supoort over a period of six months. Success was measured using quantitative and qualitative measures. The intervention effectively reduced the BMI of participants and demonstrated the adverse effects obesity has on individual quality of life.

  15. 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

  16. 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

  17. Strategies for selecting optimal sampling and work-up procedures for analysing alkylphenol polyethoxylates in effluents from non-activated sludge biofilm reactors.

    PubMed

    Stenholm, Ake; Holmström, Sara; Hjärthag, Sandra; Lind, Ola

    2012-01-01

    Trace-level analysis of alkylphenol polyethoxylates (APEOs) in wastewater containing sludge requires the prior removal of contaminants and preconcentration. In this study, the effects on optimal work-up procedures of the types of alkylphenols present, their degree of ethoxylation, the biofilm wastewater treatment and the sample matrix were investigated for these purposes. The sampling spot for APEO-containing specimens from an industrial wastewater treatment plant was optimized, including a box that surrounded the tubing outlet carrying the wastewater, to prevent sedimented sludge contaminating the collected samples. Following these changes, the sampling precision (in terms of dry matter content) at a point just under the tubing leading from the biofilm reactors was 0.7% RSD. The findings were applied to develop a work-up procedure for use prior to a high-performance liquid chromatography-fluorescence detection analysis method capable of quantifying nonylphenol polyethoxylates (NPEOs) and poorly investigated dinonylphenol polyethoxylates (DNPEOs) at low microg L(-1) concentrations in effluents from non-activated sludge biofilm reactors. The selected multi-step work-up procedure includes lyophilization and pressurized fluid extraction (PFE) followed by strong ion exchange solid phase extraction (SPE). The yields of the combined procedure, according to tests with NP10EO-spiked effluent from a wastewater treatment plant, were in the 62-78% range. PMID:22519096

  18. Possible land management uses of common cypress to reduce wildfire initiation risk: a laboratory study.

    PubMed

    Della Rocca, G; Hernando, C; Madrigal, J; Danti, R; Moya, J; Guijarro, M; Pecchioli, A; Moya, B

    2015-08-15

    Accurate determination of flammability is required in order to improve knowledge about vegetation fire risk. Study of the flammability of different plant species is essential for the Mediterranean area, where most ecosystems are adapted to natural fire but vulnerable to recurrent human-induced fires, which are the main cause of forest degradation. However, the methods used to evaluate vegetation flammability have not yet been standardized. Cupressus sempervirens is a native or naturalized forest tree species in the Mediterranean area that is able to tolerate prolonged drought and high temperatures. The aim of this study was to characterize the flammability of C. sempervirens var. horizontalis at particle level by using different bench-scale calorimetry techniques (mass loss calorimeter, epiradiator and oxygen bomb) to determine the main flammability descriptors (ignitability, sustainability, combustibility and consumability) in live crown and litter samples. Our findings indicate that this variety of cypress is relatively resistant to ignition because of the high ash content, the high critical heat flux, the high time to ignition displayed by both crown and litter samples and the ability of the leaves to maintain a high water content during the summer. We also discuss the possibility of exploiting some morphological, functional and ecological traits of the species to construct a barrier system (with selected varieties of cypress) as a promising complementary land management tool to reduce the fire spread and intensity in a Mediterranean context. PMID:26046989

  19. Possible land management uses of common cypress to reduce wildfire initiation risk: a laboratory study.

    PubMed

    Della Rocca, G; Hernando, C; Madrigal, J; Danti, R; Moya, J; Guijarro, M; Pecchioli, A; Moya, B

    2015-08-15

    Accurate determination of flammability is required in order to improve knowledge about vegetation fire risk. Study of the flammability of different plant species is essential for the Mediterranean area, where most ecosystems are adapted to natural fire but vulnerable to recurrent human-induced fires, which are the main cause of forest degradation. However, the methods used to evaluate vegetation flammability have not yet been standardized. Cupressus sempervirens is a native or naturalized forest tree species in the Mediterranean area that is able to tolerate prolonged drought and high temperatures. The aim of this study was to characterize the flammability of C. sempervirens var. horizontalis at particle level by using different bench-scale calorimetry techniques (mass loss calorimeter, epiradiator and oxygen bomb) to determine the main flammability descriptors (ignitability, sustainability, combustibility and consumability) in live crown and litter samples. Our findings indicate that this variety of cypress is relatively resistant to ignition because of the high ash content, the high critical heat flux, the high time to ignition displayed by both crown and litter samples and the ability of the leaves to maintain a high water content during the summer. We also discuss the possibility of exploiting some morphological, functional and ecological traits of the species to construct a barrier system (with selected varieties of cypress) as a promising complementary land management tool to reduce the fire spread and intensity in a Mediterranean context.

  20. Vulvar cancer: initial management and systematic review of literature on currently applied treatment approaches.

    PubMed

    Sznurkowski, Jacek Jan

    2016-07-01

    This review provides guidelines and aims to estimate utilisation rates of treatment modalities applied in vulvar cancer. Current standards of treatment are as follows: wide local excision instead of radical vulvectomy in the case of small tumour (T < 2 cm), no lymph node dissection in the case of a micro-invasive tumour (invasion <1 mm), unilateral lymph node dissection in the case of a lateral tumour and inguinal-femoral lymphadenectomy by separate incisions instead of en bloc inguinal-femoral lymph node excision. Implementation of sentinel lymph node biopsy in patients with tumours not exceeding 4 cm is safe and efficiently eliminates redundant groin dissections. Pre-operative treatment with chemoradiotherapy reduces tumour size and improves surgical excision of inoperable primary tumours or fixed lymph nodes, but side effects are considerable. Literature search performed using PubMed database (from: 1 June 2005 to 1 June 2015) with the terms 'consecutive', 'vulvar cancer', 'treatment' identified seven full-text manuscripts, including data on 1114 patients. Utilisation rates of neoadjuvant radiochemotherapy, chemotherapy alone, surgery, adjuvant radiotherapy and adjuvant radiochemotherapy were 5.9%, 0.3%, 89.3%, 22.6% and 0.2% respectively. An evidence-based estimation of appropriate rates of surgery, radiotherapy and chemotherapy for vulvar cancer is needed to compare management reflecting guidelines with presented here real frequency of applied modalities. PMID:26880231

  1. Responses of Canada's health care management education programs to health care reform initiatives.

    PubMed

    Angus, D E; Lay, C M

    2000-01-01

    Canada's provincial health care systems have been experiencing significant changes, mostly through horizontal integration achieved by merging hospitals, and, in a few cases, through vertical integration of public health, long term care, home care and hospital services. The government motivation for forcing these changes seems to have been primarily financial. In a few cases, the integration seems to have resulted in a stable and successful outcome, but, in most others, there has been destabilization, and in some, there has been chaos. The question posed in this research was how the five accredited Canadian graduate programs in health care management were responding to these changes. Two of the programs have recently made major changes in structure and/or delivery processes, following careful examination of their perceived environments. One has rationalized by subdividing courses. Another is repatriating courses from the business school in order to achieve more health-related content. Four of the five programs have added a number of courses in the last few years, or plan to do so in the next year or two, either because of accreditation criteria or student or faculty interest. The program directors viewed the educational requirements for clinicians and non-clinicians as being identical. In spite of the major structural changes, and the resulting destabilization of the health care organizations (and even governments), none of the programs emphasized the changes as factors in their plans for program changes. They expressed some concern about the possibility of fads as opposed to significant changes. It may be that these changes are dealt with in the content of individual courses. This aspect was not examined by the survey nor by interviews with the directors. Each of the programs has emphasized its own niche, with no consensus about changes required.

  2. Current and future initiatives for vascular health management in clinical practice.

    PubMed

    Cameron, James D; Asmar, Roland; Struijker-Boudier, Harry; Shirai, Kohji; Sirenko, Yuriy; Kotovskaya, Yulia; Topouchian, Jirar

    2013-01-01

    Central arterial structure and function comprise a primary determinant of vascular health, and are integral to the important concept of ventriculo-vascular coupling or interaction. Central aortic stiffening is a major influence on central blood pressure, and directly relates to coronary perfusion. The joint session of the International Society of Vascular Health (Eastern Region) and the Ukrainian Congress of Cardiology was held in Kiev, Ukraine, on September 23, 2011; it provided an expert forum to discuss arterial evaluations, clinical applications, and progress toward translating arterial protection into cardiovascular benefits. The conclusions of the expert panel were: 1. Aortic stiffness is not presently a treatment target but may be useful for substratifying cardiovascular risk in individuals in order to better target the intensity of conventional therapy, and it may be useful in assessing response to treatment. 2. Crosstalk between macro- and microcirculation in hypertension has important implications for pharmacological treatment. An antihypertensive regimen should abolish the vicious cycle between the increased resistance in the microcirculation and the increased stiffness of the larger arteries. Such treatment should be based on drugs with multiple actions on the vascular tree, or on drug combinations that target the various segments of the arterial system. 3. Several blood pressure-independent mechanisms of large artery stiffness exist. Future considerations for clinical understanding of large artery stiffness should involve new drugs and new evaluation methods - with a focus on vascular health, for the initiation of cardiovascular prevention, for newly designed studies for treatment evaluation, and for new studies of drug combinations. 4. Arterial stiffening is a sign of cardiovascular aging and is a major factor affecting the biomechanics of large arteries. Arterial stiffness is an attractive therapeutic target in terms of vascular aging. Healthy

  3. 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. PMID:22836303

  4. Impact of the Department of Health initiative to equip and train acute trusts to manage chemically contaminated casualties

    PubMed Central

    Al-Damouk, M; Bleetman, A

    2005-01-01

    Background: Before 1999, there was no national model or standard doctrine for managing casualties from chemical incidents in the UK. A Department of Health (DoH) initiative to prepare the National Health Service (NHS) for chemical incidents was launched in the same year. This led to the distribution of an NHS standard chemical personal protective equipment suit (CPPE) together with a new single half day training package (Structured Approach to Chemical Casualties (SACC)) in 2001. Objectives: To assess the impact of the DoH initiative on acute hospital and ambulance trusts. To identify deficiencies in the design and operational deployment of the new CPPE, training initiative, and decontamination procedures at hospital level. Method: A survey to assess progress in specific areas of chemical incident preparedness and two simulated incidents with "live" chemically contaminated casualties conducted in two acute trusts. Umpires evaluated the operational performance against DoH SACC standards. Results: There has been marked improvement in many aspects of preparedness for chemical incidents since the original National Focus survey. Some deficiencies remain and this study identified areas for further work. In the live casualty exercises, hospital staff complied well with SACC protocols. Some practical difficulties were encountered with the deployment of the CPPE and in some aspects of the operational response, leading to some delays in the delivery of care to the casualties and to the integrity of the uncontaminated (clean) zones within the hospitals. Conclusion: Problems with the design and deployment of the CPPE, together with training difficulties have been fed back into the planning and development process. PMID:15843703

  5. 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. PMID:24910157

  6. [Initial management of advanced ovarian cancer: What radiological, pathological and surgical information are important for optimal therapeutic strategy?].

    PubMed

    Heudel, Pierre-Etienne; Selle, Frédéric; Morice, Philippe; Rouzier, Roman; Taieb, Sophie; Devouassoux-Shisheboran, Mojgan; Genestie, Catherine; Balleyguier, Corinne; Ray-Coquard, Isabelle

    2015-09-01

    Because the majority of patients present advanced disease at diagnosis, the management of epithelial ovarian cancer needs specialist multidisciplinary teamwork. Expertise in surgery, chemotherapy, imaging and histopathology is essential to achieve optimum outcomes. Computed tomography scans are routinely used to determine the extent of disease and to aid in surgical planning. The histologic classification is crucial to plan the best therapeutic strategy and to define the prognosis of disease. Pathological prognostic factors, such as degree of differentiation, FIGO-stage, and histological type have to be described. This report is fundamental to assessing prognosis and selection of appropriate treatment strategy. An adequate staging procedure is an extensive staging by an experienced gynecological oncologist, exploring the entire upper abdomen, and the pelvic and para-aortic lymph node regions to define the Peritoneal Cancer Index (PCI). The final assessment is the completeness of cytoreduction (CC) score, which is an assessment of residual disease after a maximal surgical effort. Initial management of advanced ovarian cancer is best provided by a specialist multidisciplinary team, including a radiologist, a pathologist, a gynecologic oncologist and a medical oncologist.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. 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

  12. 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

  13. Evaluation of a practice guideline for the management of respiratory distress syndrome in preterm infants: A quality improvement initiative

    PubMed Central

    Read, Brooke; Lee, David SC; Fraser, Debbie

    2016-01-01

    BACKGROUND: The use of mechanical ventilation to treat respiratory distress syndrome in preterm infants has been associated with the development of bronchopulmonary dysplasia. As part of a quality improvement initiative to reduce the incidence of bronchopulmonary dysplasia in preterm infants, a new practice guideline for the management of respiratory distress syndrome was developed and adopted into practice in a neonatal intensive care unit in February 2012. OBJECTIVE: To evaluate the effects of implementing the new guideline in regard to the use of mechanical ventilation and surfactant, and the incidence of bronchopulmonary dypslasia. METHODS: An historical cohort of very preterm infants (gestational age 260 to 326 weeks) born one year before guideline implementation was compared with a similar cohort of infants born one year following guideline implementation. Data were collected retrospectively from the local neonatal intensive care unit database. RESULTS: A total of 272 preterm infants were included in the study: 129 in the preguideline cohort and 143 in the postguideline cohort. Following the implementation of the guideline, the proportion of infants treated with ongoing mechanical ventilation was reduced from 49% to 26% (P<0.001) and there was a trend toward a reduction in bronchopulmonary dysplasia (27% versus 18%; P=0.07). There was no difference in the proportion of infants treated with surfactant (54% versus 50%). CONCLUSION: The implementation of the practice guideline helped to minimize the use of ongoing mechanical ventilation in preterm infants. PMID:26941562

  14. [Pathological diagnosis, work-up and reporting of breast cancer. Recommendations of the 3rd Hungarian Consensus Conference on Breast Cancer].

    PubMed

    Cserni, Gábor; Kulka, Janina; Francz, Monika; Járay, Balázs; Kálmán, Endre; Kovács, Ilona; Krenács, Tibor; Udvarhelyi, Nóra; Vass, László

    2016-09-01

    There have been relevant changes in the diagnosis and treatment of breast cancer to implement the updating of the 2010 recommendations made during the 2nd national consensus conference on the disease. Following a wide interdisciplinary consultation, the present recommendations have been finalized after their public discussion at the 3rd Hungarian Consensus Conference on Breast Cancer. The recommendations cover non-operative and intraoperative diagnostics, the work-up of operative specimens, the determination of prognostic and predictive markers and the content of the cytology and histology reports. Furthermore, it touches some special issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, some relevant points about the future. PMID:27579721

  15. 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

  16. 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.

  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. 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.

  19. 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. PMID:27149316

  20. 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.

  1. Trials and tribulations of year one: initiating cross-continuum care management in a community-based hospital.

    PubMed

    Edson, J W; Hyland-Hill, B M; Kronlund, S

    2000-02-01

    To prepare to enter the Last Great Race, the Iditarod, you need a great team with experience, dedication, training, sponsorship, and the ability to work towards the desired goal. Planning a cross-continuum care management system is equally challenging. In this article, we present a real-life example of how a community-based hospital system has begun to integrate existing case management and care coordination efforts into a unified approach to care management. This scenario challenges organizations developing, refining, and evaluating care management efforts to think about what is being done, how, and why. PMID:10747431

  2. Diagnostic imaging work-up for disease relapse after radical treatment for prostate cancer: how to differentiate local from systemic disease? The urologist point of view.

    PubMed

    Schiavina, R; Brunocilla, E; Borghesi, M; Vagnoni, V; Castellucci, P; Nanni, C; Ceci, F; Gacci, M; Martorana, G; Fanti, S

    2013-01-01

    About 40% of all patients undergoing radical treatment for localized prostate cancer (PCa) develop biochemical relapse (BCR) during lifetime but only 10-20% of them will show clinically detectable recurrences. Prostatic bed, pelvic or retroperitoneal lymph nodes (LN) and bones (especially the spine) are the sites where we must focus our attention in the early phase of PSA relapse. Time to PSA relapse, PSA kinetics, pathological Gleason score and pathological stage are the main factors related to the likelihood of local vs. distant relapse. Before an extensive diagnostic work-up in patients with BCR, is mandatory to understand if there is a therapeutic consequence or not for the patient. Current imaging techniques have some potential but many limits are yet encountered in the diagnosis of disease relapse. Transrectal ultrasound (TRUS) and Multiparametric Magnetic Resonance Imaging (MRI) have low accuracy in the detection of the recurrence. Today, Choline PET/CT may visualize the site of recurrence earlier, with better accuracy than conventional imaging, in a single step and even in the presence of low PSA level. In recent years, the new radiotracer (18)F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. From a clinical point of view, first clinical studies showed very promising and reproducible results with an improvement in sensitivity is about 20-25% with respect to Choline PET/CT, rendering the FACBC the possible radiotracer of the future for PCa. In conclusion, many improvements have been recently achieved in imaging techniques for PCa restaging, essentially in Nuclear Medicine and MRI, but negative results remain in many cases. Low sensitivity, costs, availability of technologies and confirmation of the results remain the major limitations in most cases.

  3. Adolescents with co-occurring substance use and mental conditions in a private managed care health plan: prevalence, patient characteristics, and treatment initiation and engagement.

    PubMed

    Chi, Felicia W; Sterling, Stacy; Weisner, Constance

    2006-01-01

    This study examined the prevalence, patient characteristics, and treatment initiation and engagement of adolescents with co-occurring substance use (SU) and serious mental health (MH) diagnoses in a private, managed care health plan. We identified 2,005 adolescents aged 12-17, who received both SU and MH diagnoses within a 1-year window between 1/1/2000 and 12/31/2002; 57% were girls. Gender variations were found in diagnoses received and point of identification. Being dually diagnosed in specialty departments (rather than Primary Care and Emergency) and receiving both diagnoses within a shorter time period were associated with treatment initiation and engagement. PMID:17182422

  4. 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…

  5. 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

  6. Bringing Canadian healthcare closer to home: the initial stages of change for senior managers within the province of British Columbia.

    PubMed

    Preston, D

    2000-05-01

    This paper explores some recent healthcare reforms within the Canadian healthcare sector. As in most countries across the world, healthcare managers in Canada have been faced with the dilemma of how to achieve a balance between equity of provision and expenditure control. This study explores the external and internal pressures for change at the provincial and national levels within Canada. More significantly, it focuses on how the early stages of these changes have resulted in altered work roles and relationships for healthcare managers. A case study of British Columbia is described, where radical changes occurred in the healthcare sector in the mid-1990s. Interviews conducted with a sample of senior healthcare managers in the province illustrate how the restructuring of healthcare impacted upon management roles, structures and communication. The qualitative interview data is intended to provide an important addition to the body of largely quantitative, statistical data that is collected on international health systems on a regular basis. How the findings of the case study can contribute to learning and practice within the health services management arena is discussed. PMID:11184008

  7. Incorporating Video Feedback into Self-Management Training to Promote Generalization of Social Initiations by Children with Autism

    ERIC Educational Resources Information Center

    Deitchman, Carole; Reeve, Sharon A.; Reeve, Kenneth F.; Progar, Patrick R.

    2010-01-01

    Self-monitoring is a well-studied and widely used self-management skill in which a person observes and records his or her own behavior. Video feedback (VFB) occurs when an instructor videotapes a child's performances and reviews the footage with the child and potentially allows the child to score or evaluate their own behavior. A multiple-probe…

  8. 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…

  9. 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…

  10. 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.

  11. [A Case of Primary Renal Malignant Lymphoma Initially Managed as Severe Pyelonephritis in a Patient Undergoing Hemodialysis].

    PubMed

    Fujizuka, Yuji; Suzuki, Tomomi; Suzuki, Koichi; Kubota, Yutaka; Matsuo, Yasushige

    2016-03-01

    A 75-year-old male undergoing hemodialysis because of diabetic nephropathy was referred to our hospital complaining of high fever and swelling of the left kidney. Our initial clinical diagnosis was severe pyelonephritis. He was initially treated with intravenous antibiotics and his clinical symptoms subsequently improved but only temporarily. The high fever soon recurred, accompanied by progressive thrombocytopenia. His general condition deteriorated despite conservative treatment. He then underwent nephrectomy of the left kidney. However, the thrombocytopenia persisted and his general condition did not improve. The pathological diagnosis was malignant lymphoma (non-Hodgkin's lymphoma, diffuse large B-cell type). He received chemotherapy, but his status rapidly deteriorated and he died 1.5 months after the operation. Primary renal malignant lymphoma is very rare, because the kidney lacks lymphatic tissue. PMID:27133886

  12. Reassembling the Information Technology Innovation Process: An Actor Network Theory Method for Managing the Initiation, Production, and Diffusion of Innovations

    NASA Astrophysics Data System (ADS)

    Zendejas, Gerardo; Chiasson, Mike

    This paper will propose and explore a method to enhance focal actors' abilities to enroll and control the many social and technical components interacting during the initiation, production, and diffusion of innovations. The reassembling and stabilizing of such components is the challenging goal of the focal actors involved in these processes. To address this possibility, a healthcare project involving the initiation, production, and diffusion of an IT-based innovation will be influenced by the researcher, using concepts from actor network theory (ANT), within an action research methodology (ARM). The experiences using this method, and the nature of enrolment and translation during its use, will highlight if and how ANT can provide a problem-solving method to help assemble the social and technical actants involved in the diffusion of an innovation. Finally, the paper will discuss the challenges and benefits of implementing such methods to attain widespread diffusion.

  13. An examination of the Total Quality Management (TQM) concept given current Federal/DoD competition initiatives

    NASA Astrophysics Data System (ADS)

    Stabile, Michael E.

    1992-06-01

    Quality is vital to our defense and quality improvement is key to increasing productivity. The Department of Defense (DoD) Total Quality Management (TQM) effort has been given top priority by the Secretary of Defense. Many questions exist concerning the problems encountered when implementing TQM throughout DoD. This thesis looks at the compatibility of the TQM philosophy with current Federal Acquisition Regulation competition requirements. The writer concludes that the TQM philosophy implementation is compatible with existing competition policy.

  14. 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.

  15. Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

    PubMed

    van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

    2014-01-01

    Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

  16. 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.

  17. Management of Neovascular Age-Related Macular Degeneration in Clinical Practice: Initiation, Maintenance, and Discontinuation of Therapy

    PubMed Central

    Keane, Pearse A.; Tufail, Adnan; Patel, Praveen J.

    2011-01-01

    Neovascular age-related macular degeneration (AMD) is a leading cause of irreversible visual loss in elderly populations. In recent years, pharmacological inhibition of vascular endothelial growth factor (VEGF), via intravitreal injection of ranibizumab (Lucentis) or bevacizumab (Avastin), has offered the first opportunity to improve visual outcomes in patients diagnosed with this disorder. In this paper, we provide recommendations on how bevacizumab and ranibizumab may be best applied in current clinical practice, with an emphasis on their underlying pharmacology and efficacy. In addition, we review current guidelines for the initiation, maintenance, and discontinuation of anti-VEGF therapies, as well as emerging treatment strategies and future directions in the field. PMID:22174995

  18. Influence of the initial management regimen and family social situation on glycemic control and medical care in children with type I diabetes mellitus.

    PubMed

    Forsander, G A; Sundelin, J; Persson, B

    2000-12-01

    It is well known that social family factors are of importance in diabetes care, but it is not clear whether the initial management regimen can buffer these factors. In a prospective, randomized intervention study, 36 children with diabetes mellitus (type I) were followed, the aim being to study if a family psychosocial intervention at diagnosis could improve glycemic control and minimize hospital admissions. The control group was treated initially in a hospital ward, while the study group received problem-based learning and family-therapeutic and social support in an out-hospital training apartment. A number of family social variables were evaluated at the time of diagnosis and 6, 12 and 24 mo later. Family function was assessed using the self-estimated Family Climate Test at these same time-points. HbAlc values and information concerning in- and out-hospital visits to the pediatric clinic were collected for the 5-y period following diagnosis. We found no association between the offered management regimen and glycemic control or rate of readmission. In the study group only, both parents reported a significant improvement of the family climate. An increased risk for poor glycemic control was recorded in children living in one-parent families (p = 0.03) or in families where the father had a low level of education (p = 0.04). Younger age (p = 0.05), a single-parent family (p = 0.05) and poor glycemic control (p = 0.02) were associated with more days of rehospitalization. The rate of divorce in the whole group was at least as high as in the normal population but, surprisingly, maternal dysfunction was associated with lower HbAlc value. The conclusion is that even with an initial management regimen designed to offer a family-individual care regimen based on accurate estimation of the psychological and pedagogical needs, the social family background is a most important factor for the glycemic control and need for readmission.

  19. Initial Usability and Feasibility Evaluation of a Personal Health Record-Based Self-Management System for Older Adults

    PubMed Central

    Sheehan, Barbara; Lucero, Robert J.

    2015-01-01

    Introduction: Electronic personal health record-based (ePHR-based) self-management systems can improve patient engagement and have an impact on health outcomes. In order to realize the benefits of these systems, there is a need to develop and evaluate heath information technology from the same theoretical underpinnings. Methods: Using an innovative usability approach based in human-centered distributed information design (HCDID), we tested an ePHR-based falls-prevention self-management system—Self-Assessment via a Personal Health Record (i.e., SAPHeR)—designed using HCDID principles in a laboratory. And we later evaluated SAPHeR’s use by community-dwelling older adults at home. Results: The innovative approach used in this study supported the analysis of four components: tasks, users, representations, and functions. Tasks were easily learned and features such as text-associated images facilitated task completion. Task performance times were slow, however user satisfaction was high. Nearly seven out of every ten features desired by design participants were evaluated in our usability testing of the SAPHeR system. The in vivo evaluation suggests that older adults could improve their confidence in performing indoor and outdoor activities after using the SAPHeR system. Discussion/Conclusion: We have applied an innovative consumer-usability evaluation. Our approach addresses the limitations of other usability testing methods that do not utilize consistent theoretically based methods for designing and testing technology. We have successfully demonstrated the utility of testing consumer technology use across multiple components (i.e., task, user, representational, functional) to evaluate the usefulness, usability, and satisfaction of an ePHR-based self-management system. PMID:26290889

  20. 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

  1. 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

  2. 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.

  3. 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

    2015-01-01

    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. PMID:26730963

  4. Dosage Effects of Diabetes Self-Management Education for Mexican Americans: The Starr County Border Health Initiative

    PubMed Central

    Brown, Sharon A.; Blozis, Shelley A.; Kouzekanani, Kamiar; Garcia, Alexandra A.; Winchell, Maria; Hanis, Craig L.

    2007-01-01

    Objective To compare 2 diabetes self-management interventions designed for Mexican Americans: “extended” (24 hours of education, 28 hours of support groups) and “compressed” (16 hours of education, 6 hours of support groups). Both interventions were culturally competent regarding language, diet, social emphasis, family participation, and incorporating cultural beliefs. Research Design and Methods We recruited 216 persons between 35 and 70 years of age, diagnosed with type 2 diabetes ≥1 year. Intervention groups of 8 participants and 8 support persons were randomly assigned to the “compressed” or “extended” conditions. The interventions differed in total number of contact hours over the yearlong intervention period, with the major difference being the number of support group sessions held. The same information provided in the educational sessions of the “extended” intervention was “compressed” into fewer sessions, thus providing more information during each group meeting. Results The interventions were not statistically different in reducing HbA1c; however, both were effective. A “dosage effect” of attendance was detected with the largest HbA1c reductions achieved by those who attended more of the “extended” intervention. For individuals who attended ≥50% of the intervention, baseline-to-12-month HbA1c change was −0.6%-age points for the “compressed” and −1.7%-age points for the “extended.” Conclusions Both culturally competent diabetes self-management education interventions were effective in promoting improved metabolic control and diabetes knowledge. A “dosage effect” was evident; attending more sessions resulted in greater improvements in metabolic control. PMID:15735182

  5. Is there a Role for Spect with 99mTc-Tetrofosmin in the Diagnostic Work Up of a Brain Tumor?

    PubMed Central

    BIRBILIS, Theodossios; BOUSSIOS, Nikolaos; PAPATHEODOSSIOU, Lazaros; MATIS, Georgios; ZISSIMOPOULOS, Athanassios

    2013-01-01

    ABSTRACT Brain MRI is the gold standard for diagnosis of brain tumors. In some cases preoperative MRI cannot predict the grade of malignancy, diagnostic information that could be very helpful to the surgeon. In such cases functional imaging with nuclear medicine techniques may prove quite useful. We present a case of a 58-year-old man with a brain tumor in the parieto-occipital region. Anatomic brain imaging by magnetic resonance imaging was indicative of a low grade astrocytoma. This was followed by planar imaging and single-photon emission computed tomography (SPECT) with 99mTc-tetrofosmin which showed increased radiotracer accumulation in the lesion, suggesting a glioblastoma which was histologically confirmed. We think that in the MRI era sometimes a 99mTc-tetrofosmin brain scan can contribute to diagnostic workup and improve the final management of the patient. PMID:24790666

  6. 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.

  7. 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.

  8. 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. PMID:20568619

  9. 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.

  10. 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

  11. Seventh Joint Meeting of K-J-CaP and CaPSURE: extending the global initiative to improve prostate cancer management

    PubMed Central

    Akaza, Hideyuki; Kim, Choung Soo; Carroll, Peter; Choi, In Young; Chung, Byung Ha; Cooperberg, Matthew R.; Hirao, Yoshihiko; Hinotsu, Shiro; Horie, Shigeo; Lee, Ji Youl; Namiki, Mikio; Ng, Chi-Fai; Onozawa, Mizuki; Ozono, Seiichiro; Ueno, Satoru; Umbas, Rainy; Ye, Dingwei; Zhu, Gang

    2014-01-01

    This report summarizes the presentations and discussions that took place at the Seventh Joint Meeting of the Korea–Japan Study Group of Prostate Cancer (K-J-CaP) and the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) held in Seoul, Korea, in September 2013. The original J-CaP and CaPSURE Joint Initiative has now been established since 2007 and since the initial collaboration between research teams in the United States (US) and Japan, the project has expanded to include several other Asian countries. The objective of the initiative is to analyze and compare data for prostate cancer patients in the participating countries, looking at similarities and differences in patient management and outcomes. Until now the focus has been primarily on data generated within J-CaP and CaPSURE, both large-scale, longitudinal, observational databases of prostate cancer patients in Japan and the US, respectively. This year’s meeting was hosted for the first time in Korea which has recently established its own national database–K-CaP–to add to the wealth of data generated by J-CaP and CaPSURE. As a newly-developed database, K-CaP has also provided a valuable ‘template’ for other countries, such as China and Indonesia, planning to establish their own national databases and this will ultimately allow greater opportunities for international data comparisons. A range of topics was discussed at this Seventh Joint Meeting including comparison of outcomes following androgen deprivation therapy or radical prostatectomy in patients with localized prostate cancer, the use of active surveillance as a treatment option and the triggers for intervention when employing this regimen, patient quality of life during treatment, the impact of comorbidities on outcomes, and a comparison of recent outcomes data between J-CaP and CaPSURE. The participants recognized that prostate cancer was now a global disease and therefore major insights into understanding and improving

  12. A survey of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation in east, central, and southern Africa.

    PubMed

    Zuber, Alexandra; McCarthy, Carey F; Verani, Andre R; Msidi, Eleanor; Johnson, Carla

    2014-01-01

    In sub-Saharan Africa, nurses and midwives perform many HIV service delivery tasks, such as diagnosis of HIV and prescription of antiretroviral therapy (ART), which used to be the responsibility of physicians. While this task shifting is critical to scaling-up HIV services in Africa, the extent of HIV task shifting is not well understood. A survey of senior nursing leadership teams from 15 African countries was carried out to describe the extent of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation. The survey took place at the African Health Professions Regulatory Collaborative meeting in Pretoria, South Africa, in June 2012. The findings indicated that NIMART is widely practiced and authorized in policy, but is not reinforced by regulation nor incorporated into preservice education. Further investment in policy, regulation, and pre-service education is needed to ensure sustainable, high quality ART service expansion through the region.

  13. 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

  14. Identify-Isolate-Inform: A Modified Tool for Initial Detection and Management of Middle East Respiratory Syndrome Patients in the Emergency Department

    PubMed Central

    Koenig, Kristi L.

    2015-01-01

    Middle East respiratory syndrome (MERS) is a novel infectious disease caused by a coronavirus (MERS-CoV) first reported in Saudi Arabia in September 2012. MERS later spread to other countries in the Arabian Peninsula, followed by an outbreak in South Korea in 2015. At least 26 countries have reported MERS cases, and these numbers may increase over time. Due to international travel opportunities, all countries are at risk of imported cases of MERS, even if outbreaks do not spread globally. Therefore, it is essential for emergency department (ED) personnel to be able to rapidly assess MERS risk and take immediate actions if indicated. 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, can be adapted for real-time use for any emerging infectious disease. This paper reports a modification of the 3I tool for use in initial detection and management of patients under investigation for MERS. Following an assessment of epidemiologic risk factors, including travel to countries with current MERS transmission and contact with patients with confirmed MERS within 14 days, patients are risk stratified by type of exposure coupled with symptoms of fever and respiratory illness. If criteria are met, patients must be immediately placed into airborne infection isolation (or a private room until this type of isolation is available) and the emergency practitioner must alert the hospital infection prevention and control team and the local public health department. The 3I tool will facilitate rapid categorization and triggering of appropriate time-sensitive actions for patients presenting to the ED at risk for MERS. PMID:26587081

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. Acute poisoning following ingestion of medicines: initial management. How to treat life-threatening complications and to evaluate the risk of delayed effects and psychological distress.

    PubMed

    2010-12-01

    Acute poisoning following ingestion of medications, both intentional and unintentional, is frequent and more or less severe. It is often unclear whether a toxic dose has been ingested. This review examines the initial management of patients with suspected acute poisoning, based on a review of the literature using the standard Prescrire methodology. We examined clinical practice guidelines, which are mostly based on observational, pharmacological and toxicological data, as well as empirical data. Few comparative trials are available. In life-threatening situations, the first priority is to call an emergency response mobile unit and to implement life-support techniques, i.e., resuscitation for cardiorespiratory arrest; respiratory support if necessary; and the left lateral head-down position and glucose injection if the patient is unconscious. Prompt, initial measures may also include: anticonvulsant injection for status epilepticus (diazepam, for example); a sedative for extreme agitation (diazepam or clorazepate if there is no risk of respiratory depression; otherwise haloperidol); atropine for severe bradycardia; elevating the legs for hypotension; and naloxone in case of respiratory depression due to opioids. Drug poisoning can be life-threatening.The extent of the risk should be assessed by questioning the patient and close contacts, examining the immediate environment, and carrying out a clinical examination to identify a major toxic condition. The severity of poisoning is assessed by gathering all information about the patient, the drug(s) ingested, the circumstances of ingestion, and any other substances ingested at the same time. A poison control centre may be called to assist with diagnosis, to predict the clinical consequences, and to guide patient management. Activated charcoal can reduce the gastrointestinal absorption of some drugs. It should be given as soon as possible, preferably within 2 hours after ingestion of a drug known to be adsorbed by

  1. Frostbite: prevention and initial management.

    PubMed

    Zafren, Ken

    2013-03-01

    Frostbite is a local freezing injury that can cause tissue loss. Historically, it has been a disease of wars, but it is a hazard for anyone who ventures outdoors in cold weather. Frozen tissue is damaged both during freezing and rewarming. Frozen tissue is numb. Rewarming causes hyperemia and is often painful. Blisters and edema develop after rewarming. Hard eschar may form with healthy tissue deep to the eschar. Frostbite can be classified as superficial, without permanent tissue loss, or deep, with varying degrees of permanent tissue loss, often less than appearances suggest. It can be difficult to predict the amount of tissue loss at the time of presentation and early in the subsequent course. Prevention is better than treatment. It may be advisable not to rewarm frozen extremities in the field, but spontaneous thawing is often unavoidable. Extremities that have thawed should be protected from refreezing at all costs. Once in a protected environment, extremities that are still frozen should be rapidly thawed in warm water. Therapy with aspirin or ibuprofen may be helpful, but evidence is limited. Thrombolytic treatment within the first 24 hours after rewarming seems to be beneficial in some cases of severe frostbite. Prostacyclin therapy is very promising. PMID:23537254

  2. Fever and musculoskeletal symptoms in an adult: differential diagnosis and management.

    PubMed

    Revaz, Sylvie; Dudler, Jean; Kai-Lik So, Alexander

    2006-08-01

    Fever in the context of a patient with musculoskeletal symptoms is a sign of systemic inflammation. Initial management should be targeted at the identification of the organ systems affected and the search for a precise diagnosis. The main challenge is to differentiate between an infectious aetiology from an immune-inflammatory cause. Patient history and physical examination are key elements in the diagnostic work-up in order to direct appropriate laboratory investigations, as well as radiological and biopsy procedures. Advances in microbiological techniques and molecular genetics have provided additional tools for the clinician. Unfortunately, there is no simple algorithm to direct the diagnostic work-up, which still largely depends on the recognition of patterns of clinical presentations and the corresponding laboratory abnormalities.

  3. 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

  4. [Sudden onset vertigo: imaging work-up].

    PubMed

    Craighero, F; Casselman, J W; Safronova, M M; De Foer, B; Delanote, J; Officiers, E F

    2011-11-01

    Vertigo and dysequilibrium are a frequent cause of medical consultation. Clinical evaluation is essential. Some cases of vertigo are diagnosed clinically while others require imaging, sometimes emergently (suspected stroke). MRI is the imaging modality of choice to assess the labyrinth (labyrinthitis? labyrinthine hemorrhage?), internal auditory canal (vestibular schwannoma? other tumor?…) and brain parenchyma including all structures of the auditory pathways: vestibular nuclei, vestibulocerebellar tract, tracts involved with ocular motricity, vestibular cortex… Multiple central etiologies exist: stroke, multiple sclerosis, tumor… However, some etiologies are best depicted with CT, especially lesions of the labyrinth: cholesteatoma, trauma, suspected dehiscence of the superior semicircular canal, suspected labyrinthine fistula… Finally, imaging may be negative (Benign Paroxysmal Positional Vertigo, Meniere's disease, vestibular neuritis, migraine…), merely reducing the differential diagnosis.

  5. Should I stay or should I go? Understanding families’ decisions regarding initiating, continuing, and terminating health services for managing pediatric obesity: the protocol for a multi-center, qualitative study

    PubMed Central

    2012-01-01

    Background At least two million Canadian children meet established criteria for weight management. Due to the adverse health consequences of obesity, most pediatric weight management research has examined the efficacy and effectiveness of interventions to improve lifestyle behaviors, reduce co-morbidities, and enable weight management. However, little information is available on families’ decisions to initiate, continue, and terminate weight management care. This is an important knowledge gap since a substantial number of families fail to initiate care after being referred for weight management while many families who initiate care discontinue it after a brief period of time. This research aims to understand the interplay between individual, family, environmental, and systemic factors that influence families’ decisions regarding the management of pediatric obesity. Methods/Design Individual interviews will be conducted with children and youth with obesity (n = 100) and their parents (n = 100) for a total number of 200 interviews with 100 families. Families will be recruited from four Canadian multi-disciplinary pediatric weight management centers in Vancouver, Edmonton, Hamilton, and Montreal. Participants will be purposefully-sampled into the following groups: (i) Non-Initiators (5 families/site): referred for weight management within the past 6 months and did not follow-up the referral; (ii) Initiators (10 families/site): referred for weight management within the past 6 months and did follow-up the referral with at least one clinic appointment; and (iii) Continuers (10 families/site): participated in a formal weight management intervention within the past 12 months and did continue with follow-up care for at least 6 months. Interviews will be digitally recorded and analyzed using an ecological framework, which will enable a multi-level evaluation of proximal and distal factors that underlie families’ decisions regarding initiation

  6. Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative.

    PubMed

    McDonnell, Juliet; Williams, Siân; Chavannes, Niels H; Correia de Sousa, Jaime; Fardy, H John; Fletcher, Monica; Stout, James; Tomlins, Ron; Yusuf, Osman M; Pinnock, Hilary

    2012-12-01

    This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts. It is essential that any development project considers the local circumstances in terms of economic resources, political circumstances, organisation and administrative capacities, as well as the specific quality issue to be addressed. There is limited evidence (in terms of changed clinician behaviour and/or improved health outcomes) regarding the merits of different educational and quality improvement approaches. Features of educational interventions that were most likely to show some evidence of effectiveness included being carefully designed, multifaceted, engaged health professionals in their learning, provided ongoing support, were sensitive to local circumstances, and delivered in combination with other quality improvement strategies. To be effective, educational interventions must consider the complex healthcare systems within which they operate. The criteria for the IPCRG E-Quality awards thus require applicants not only to describe their proposed educational initiative but also to consider the practical and local barriers to successful implementation, and to propose a robust evaluation in terms of changed clinician behaviour or improved health outcomes. PMID:22875141

  7. Research Initiatives

    Cancer.gov

    This page provides detailed information about currently funded RFA initiatives both led by DCCPS, and those led by other NIH Institutes and Centers (I/Cs) that include DCCPS as a partner. Each initiative includes a table of funded grants and a map that shows the location of funded institutions.

  8. 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.

    2015-01-01

    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.

  9. 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.

    2015-01-01

    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.

  10. 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.

  11. 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.

  12. 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.

  13. Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients

    PubMed Central

    Lau, Ka Hei Karen; Huang, Ruyi; Ghiloni, Suzanne; Le, Hung; Gilroy, Scott; Abrahamson, Martin; Moore, John

    2016-01-01

    Abstract Background: Overseeing proper insulin initiation and titration remains a challenging task in diabetes care. Recent advances in mobile technology have enabled new models of collaborative care between patients and healthcare providers (HCPs). We hypothesized that the adoption of such technology could help individuals starting basal insulin achieve better glycemic control compared with standard clinical practice. Materials and Methods: This was a 12 ± 2-week randomized controlled study with 40 individuals with type 2 diabetes who were starting basal insulin due to poor glycemic control. The control group (n = 20) received standard face-to-face care and phone follow-up as needed in a tertiary center, whereas the intervention group (n = 20) received care through the cloud-based diabetes management program where regular communications about glycemic control and insulin doses were conducted via patient self-tracking tools, shared decision-making interfaces, secure text messages, and virtual visits (audio, video, and shared screen control) instead of office visits. Results: By intention-to-treat analysis, the intervention group achieved a greater hemoglobin A1c decline compared with the control group (3.2 ± 1.5% vs. 2.0% ± 2.0%; P = 0.048). The Diabetes Treatment Satisfaction Questionnaire showed a significant improvement in the intervention group compared with the control group (an increase of 10.1 ± 11.7 vs. 2.1 ± 6.5 points; P = 0.01). HCPs spent less time with patients in the intervention group compared with those in the control group (65.9 min per subject vs. 81.6 min per subject). However, the intervention group required additional training time to use the mobile device. Conclusions: Mobile health technology could be an effective tool in sharing data, enhancing communication, and improving glycemic control while enabling collaborative decision making in diabetes care. PMID:26645932

  14. SCB initiator

    DOEpatents

    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.

  15. 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.

  16. Environmental initiatives

    SciTech Connect

    James, R.C. Jr.

    1991-11-01

    J I Case, a leading worldwide maker of agricultural and construction equipment based in Racine, Wisconsin, is taking an aggressive and responsible approach to environmental issues. From integrated solid waste handling plans and Freon recovery initiatives, to special employee training programs and voluntary participation in the EPA's Industrial Toxics Program, Case is addressing environmental issues at its facilities and in its products. One of the key environmental initiatives at Case is the company's voluntary participation in the US EPA's Industrial Toxics Program, also known as the 33/50 Program. This program is an EPA pollution prevention initiative started in 1990 that is designed to reduce industrial toxics generation quickly through voluntary actions by industry. The program derives its name from the EPA's national reduction goals for 17 high priority toxic pollutants - 33 percent reduction by 1992 and 50 percent by 1995. As a result, the Pryor Foundry has slashed its emissions of industrial toxic pollutants by 98 percent, from over 350,000 pounds (159 metric tons) in 1988 to around 5,000 pounds (2.27 metric tons) in 1991, with a projected reduction to only 750 pounds (340 kilograms) by 1995.

  17. Shoulder Myeloid Sarcoma: An Initial Presentation of CML Blast Crisis.

    PubMed

    Jain, Ankur; Sahu, Kamal Kant; Sharma, Saniya; Rajwanshi, Arvind; Suri, Vikas; Malhotra, Pankaj

    2016-06-01

    Myeloid sarcoma (MS) represents extra medullary accumulation of the immature cells of granulocytic series and occurs most commonly in the setting of acute myelogenous leukemia. Its occurrence in chronic myeloid leukemia (CML), myelodysplastic syndrome and other myeloproliferative neoplasm is uncommon. We here in report a 35-year old lady who was diagnosed as CML-chronic phase (CP) in the year 2004 and was on imatinib (400 mg OD) since then with regular follow up and good compliance. She had progression to accelerated phase in April 2014 which was managed by increasing the dose of imatinib to 600 mg OD. In August 2015, she presented with complaints of pain and swelling of the left shoulder suggestive of septic arthritis. Investigations revealed an ill-defined lesion involving muscles around the shoulder and clavicle. Absence of response to antibiotics and negative work up for infectious etiology raised the suspicion for MS which was later confirmed by immunohistochemistry of the aspirate from the lesion. Bone marrow examination was consistent with CML-CP. Hence, the diagnosis of CML with extra medullary blast crises was made. Patient was treated with a combination of high dose imatinib, hydroxyurea, cytarabine and local radiotherapy. Rarity of MS involving the shoulder and it's resemblance to septic arthritis has been highlighted in the present case. We emphasize the importance of immunohistochemistry of the aspirate for the timely and correct diagnosis of the cases who do not respond to an initial antibiotic trial. PMID:27408438

  18. [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.

  19. 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.

  20. 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

  1. International perspectives and initiatives.

    PubMed

    Murphy, Jeannette

    2007-03-01

    This article introduces a new column which will explore the way different regions and nation states are dealing with the challenges of managing health information. The intention is to draw together trends which are relevant to both health science librarians and health informatics professionals. This inaugural piece maps out the territory. It provides a rationale for the column, along with evidence of current initiatives to articulate a global perspective on the application of communication and information technologies to health information. PMID:17331146

  2. 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.

  3. 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…

  4. 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…

  5. 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.

  6. 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.

  7. Federal government expands compliance initiatives.

    PubMed

    Dugan, J K

    1997-09-01

    In 1995, the Federal government initiated Operation Restore Trust to increase enforcement of fraud and abuse regulations in Medicare and Medicaid programs. With the success of the original initiative, the government is expanding the project to additional states and program areas. The initial scrutiny of home health agencies, nursing homes, hospice care, and durable medical equipment is being expanded to managed care plans and acute care hospitals with an eye toward DRG creep. To manage this increased enforcement activity, healthcare organizations should institute comprehensive corporate compliance programs. Such programs should provide a framework that delineates responsibilities and provides a systematic means to resolve issues in a timely manner. PMID:10170318

  8. Federal government expands compliance initiatives.

    PubMed

    Dugan, J K

    1997-09-01

    In 1995, the Federal government initiated Operation Restore Trust to increase enforcement of fraud and abuse regulations in Medicare and Medicaid programs. With the success of the original initiative, the government is expanding the project to additional states and program areas. The initial scrutiny of home health agencies, nursing homes, hospice care, and durable medical equipment is being expanded to managed care plans and acute care hospitals with an eye toward DRG creep. To manage this increased enforcement activity, healthcare organizations should institute comprehensive corporate compliance programs. Such programs should provide a framework that delineates responsibilities and provides a systematic means to resolve issues in a timely manner.

  9. Role of biomarkers in the management of antibiotic therapy: an expert panel review II: clinical use of biomarkers for initiation or discontinuation of antibiotic therapy

    PubMed Central

    2013-01-01

    Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that PCT be measured to help predict infection; however, available data are insufficient to decide on initiating antibiotics based on PCT levels. In adult patients suspected of community-acquired LRTI, we suggest withholding antibiotic therapy when the serum PCT level is low (<0.25 ng/mL); in patients having nosocomial LRTI, data are insufficient to recommend initiating therapy based on a single PCT level or even repeated measurements. For children with suspected bacterial meningitis, we recommend using a decision rule as an aid to therapeutic decisions, such as the Bacterial Meningitis Score or the Meningitest®; a single PCT level ≥0.5 ng/mL also may be used, but false-negatives may occur. In adults with suspected bacterial meningitis, we suggest integrating serum PCT measurements in a clinical decision rule to help distinguish between viral and bacterial meningitis, using a 0.5 ng/mL threshold. For ICU patients suspected of community-acquired infection, we do not recommend using a threshold serum PCT value to help the decision to initiate antibiotic therapy; data are insufficient to recommend using PCT serum kinetics for the decision to initiate antibiotic therapy in patients suspected of ICU-acquired infection. In children, CRP can probably be used to help discontinue therapy, although the evidence is limited. In adults, antibiotic discontinuation can be based on an algorithm using repeated PCT measurements. In non-immunocompromised out- or in- patients treated for RTI, antibiotics can be discontinued if the PCT level at day 3 is < 0.25 ng/mL or has decreased by >80-90%, whether or not microbiological documentation has

  10. 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

  11. EUROANDRILL Initiative

    NASA Astrophysics Data System (ADS)

    Florindo, Fabio; Steering Committee, Euroandrill

    2010-05-01

    EuroANDRILL is a new initiative to create a European network with the goal to increase future involvement of European countries in the ANDRILL [ANtarctic geological DRILLing] Programme. Antarctica has been heavily glaciated for approximately 34 million years, but its ice sheets have fluctuated considerably and are one of the major driving forces for changes in climate throughout the Cenozoic Era. The spatial scale and temporal pattern of these fluctuations is subject to considerable debate. Understanding the response of large ice masses to climatic forcing is of vital importance because ice volume variations drive global sea level changes and also alter the capacity of ice sheets and sea-ice to act as major heat sinks/insulators. It is particularly important to assess the stability of the cryosphere in the face of rising CO2 levels, as modelling of the climate shift from a warm, vegetated Antarctica to a cold, ice-covered state 34 million years ago suggests a powerful greenhouse gas influence. As Antarctica is the major driver of Earth's climate and sea level, much effort has been expended in deriving models of its behaviour. Some of these models have been successfully validated against modern conditions. EuroANDRILL will provide a coherent, integrated platform for European leadership and involvement in the international ANDRILL programme. The coordination and networking provided by EuroANDRILL will seek to expand participation by European nations, institutions, and individual scientists in the study of the geologic history of the polar regions and their paleoclimatic significance. During the IPY, ANDRILL has been a highly visible and successful programme. This programme seeks to expand on this legacy beyond the IPY and make these contributions sustainable in the European Research Area through networking of research projects and future planning efforts, which establish Europe as a key player in future polar sediment and rock drilling. EuroANDRILL is set up under

  12. 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.

  13. 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

  14. 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.

  15. [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. PMID:26971975

  16. [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.

  17. 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

  18. 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.

  19. 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

  20. Framework for Evaluating Educational Systemic Initiatives.

    ERIC Educational Resources Information Center

    Ikegulu, T. Nelson

    This paper describes the implementation of the Holistic Systemic Evaluation (HSE), a component of an Education Systemic Initiative's strategic management. The HSE provides general guidance for the implementation and continual improvement of an Education Systemic Initiative Reform (ESIR). The implementation of the education system initiative plan:…

  1. False Positive FDG PET/CT Resulting from Fibrous Dysplasia of the Bone in the Work-Up of a Patient with Bladder Cancer: Case Report and Review of the Literature.

    PubMed

    Aras, Mustafa; Ones, Tunc; Dane, Faysal; Nosheri, Omid; Inanir, Sabahat; Erdil, Tanju Yusuf; Turoglu, Halil Turgut

    2012-12-01

    Fibrous dysplasia of the bone (FDB) is a common, genetic, developmental disorder with a benign course. FDB can be seen anywhere throughout the skeleton. It is usually asymptomatic and found incidentally on imaging studies that are performed for other purposes. Although whole body 18 F-flourodeoxyglucose PET/CT (FDG PET/CT) is widely used in tumor imaging, infections and benign pathologies like FDB may cause false positive results. Herein we report the case of a 48-year-old FDB patient with transitional cell carcinoma of the urinary bladder. Restaging FDG PET/CT showed multiple mild to moderate hypermetabolic bone lesions which were initially misinterpreted as bone metastases. In this case report, we aimed to guide physicians in evaluating bone lesions in cancer patients with FDB in the light of the literature.

  2. 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.

  3. Global cancer research initiative.

    PubMed

    Love, Richard R

    2010-05-03

    Cancer is an increasing problem for low- and middle-income countries undergoing an epidemiologic transition from dominantly acute communicable disease to more frequent chronic disease with increased public health successes in the former domain. Progress against cancer in high-income countries has been modest and has come at enormous expense. There are several well-conceived global policy and planning initiatives which, with adequate political will, can favorably impact the growing global cancer challenges. Most financial resources for cancer, however, are spent on diagnosis and management of patients with disease in circumstances where specific knowledge about effective approaches is significantly limited, and the majority of interventions, other than surgery, are not cost-effective in resource-limited countries by global standards. In summary, how to intervene effectively on a global scale for the majority of citizens who develop cancer is poorly defined. In contrast to technology-transfer approaches, markedly increased clinical research activities are more likely to benefit cancer sufferers. In these contexts, a global cancer research initiative is proposed, and mechanisms for realizing such an effort are suggested.

  4. New Directions in Campus Management: Personnel Initiatives

    ERIC Educational Resources Information Center

    McCormick, James H.

    1976-01-01

    In a speech to CUPA's 1976 convention, a college president examines the personnel function of an institution. He calls for a human resources planning system that includes (1) a manpower forecast, (2) a succession plan, (3) a development plan, and (4) a staffing plan. (LBH)

  5. 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.

  6. 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.

  7. [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'.

  8. [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'. PMID:23764559

  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'. PMID:23756219

  10. 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.

  11. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Initial referral. 549.62 Section 549.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or...

  12. 28 CFR 549.62 - Initial referral.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Initial referral. 549.62 Section 549.62 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MEDICAL SERVICES Hunger Strikes, Inmate § 549.62 Initial referral. (a) Staff shall refer an inmate who is observed to be on a hunger strike to medical or...

  13. New compensation strategies support quality initiatives.

    PubMed

    Roeder, R

    1994-09-01

    Three significant trends will dramatically affect human resources management within the healthcare industry in the next decade: changing workforce demographics, declining reimbursement revenues, and increasing demands for high quality services. These trends will require healthcare organizations to develop compensation programs that tie the effectiveness of their human resources to productivity measurements, total quality management initiatives, and individual employee empowerment.

  14. 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.

  15. Pathophysiology and Clinical Work-Up of Acute Kidney Injury.

    PubMed

    Meola, Mario; Nalesso, Federico; Petrucci, Ilaria; Samoni, Sara; Ronco, Claudio

    2016-01-01

    Acute kidney injury (AKI), also known in the past as acute renal failure, is a syndrome characterized by the rapid loss of kidney excretory function. It is usually diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output or both. AKI is the clinical consequence of several disorders that acutely affect the kidney, causing electrolytes and acid-base imbalance, hyperhydration and loss of depurative function. AKI is common in critical care patients in whom it is often secondary to extrarenal events. No specific therapies can attenuate AKI or accelerate renal function recovery; thus, the only treatment is supportive. New diagnostic techniques such as renal biomarkers might improve early diagnosis. Also ultrasonography helps nephrologists in AKI diagnosis, in order to describe and follow kidney alterations and find possible causes of AKI. Renal replacement therapy is a life-saving treatment if AKI is severe. If patients survive to AKI, and did not have previous chronic kidney disease (CKD), they typically recover to dialysis independence. However, evidence suggests that patients who have had AKI are at increased risk of subsequent CKD. PMID:27169469

  16. [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'.

  17. [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'.

  18. 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'. PMID:23764557

  19. [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'. PMID:23764558

  20. Randomised controlled trial and cost consequences study comparing initial physiotherapy assessment and management with routine practice for selected patients in an accident and emergency department of an acute hospital

    PubMed Central

    Richardson, B; Shepstone, L; Poland, F; Mugford, M; Finlayson, B; Clemence, N

    2005-01-01

    Objective: The Department of Health is reviewing the effectiveness of accident and emergency (A&E) departments. This study aimed to compare health and economic effects of physiotherapy initial assessment and management with routine practice in an A&E department. Methods: Randomised controlled trial and cost and consequences study. Patients presenting at A&E were eligible if suspected at triage to have soft tissue injury without fracture. The efficacy end point was "days to return to usual activities". Secondary end points included patient satisfaction with their care and further health outcomes and cost data. Results: 766 of 844 (915) patients were randomised. The median days before return to usual activities (available for 73% of those randomised) was greater in the physiotherapist group (41 days compared with 28.5 days; hazard ratio 0.85 p = 0.071). The physiotherapy group expressed greater satisfaction with their A&E care (on a scale of 1 to 5, median was 4.2 compared with 4.0, p<0.001), were more likely to be given advice and reassurance, and more likely to be provided with aids and appliances. Costs were the same between the two arms. Conclusion: There is evidence that physiotherapy leads to a prolonged time before patients return to usual activities. This study shows no clear danger from physiotherapy intervention and long term outcomes may be different but given these findings, a best estimate is that introducing physiotherapist assessment will increase costs to the health service and society. Routine care should continue be provided unless there is some reason why it is not feasible to do so and an alternative must be found. PMID:15662054

  1. Strategic Initiatives and Goals.

    ERIC Educational Resources Information Center

    Howard Community Coll., Columbia, MD.

    This document outlines Howard Community College's (HCC) six strategic initiatives and goals. Each of the strategic initiatives is presented, along with a context for the statement and a list of goals to be achieved in support of the overall initiative. First, HCC will be a learning community that provides possibilities for learning that address…

  2. APEC Smart Grid Initiative

    SciTech Connect

    Bloyd, Cary N.

    2012-03-01

    This brief paper describes the activities of the Asia Pacific Economic Cooperation (APEC) Smart Grid Initiative (ASGI) which is being led by the U.S. and developed by the APEC Energy Working Group. In the paper, I describe the origin of the initiative and briefly mention the four major elements of the initiative along with existing APEC projects which support it.

  3. 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.

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. Who initiates emergency commitments?

    PubMed

    Christy, Annette; Handelsman, Jessica B; Hanson, Ardis; Ochshorn, Ezra

    2010-04-01

    Florida's Mental Health Act was amended in 2005 and 2006 to include licensed mental health counselors and licensed marriage and family therapists, respectively, to the list of professionals authorized to initiate emergency commitments. The present study evaluates the volume of involuntary emergency commitments by type of initiator for a 5 year period. The results indicate that allowing licensed mental health counselors and licensed marriage and family therapist to initiate emergency commitments has not been related to increased numbers of emergency commitments or a higher proportion of emergency commitments being initiated by mental health professionals. Potential policy and fiscal implications, as well as future directions for research, are discussed. PMID:19597746

  9. Illinois: Prevention Initiative

    ERIC Educational Resources Information Center

    Center for Law and Social Policy, Inc. (CLASP), 2012

    2012-01-01

    The Illinois Prevention Initiative provides grants to home-based and center-based programs to expand access to the Early Head Start (EHS) model as well as other birth to 3 models. The goal is to serve additional children birth to age 3 and help grantees increase program quality. The initiative to expand access to EHS and other models was…

  10. 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)

  11. 78 FR 38358 - Call for Nominations: North Slope Science Initiative, Science Technical Advisory Panel, Alaska

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

    ... Bureau of Land Management Call for Nominations: North Slope Science Initiative, Science Technical Advisory Panel, Alaska AGENCY: Bureau of Land Management, Alaska State Office, North Slope Science... North Slope Science Initiative, Science Technical Advisory Panel, in accordance with the provisions...

  12. 43 CFR 2711.1 - Initiation of sale.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Initiation of sale. 2711.1 Section 2711.1..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) SALES: FEDERAL LAND POLICY AND MANAGEMENT ACT Sales: Procedures § 2711.1 Initiation of sale....

  13. 43 CFR 2711.1 - Initiation of sale.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Initiation of sale. 2711.1 Section 2711.1..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) SALES: FEDERAL LAND POLICY AND MANAGEMENT ACT Sales: Procedures § 2711.1 Initiation of sale....

  14. 43 CFR 2711.1 - Initiation of sale.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Initiation of sale. 2711.1 Section 2711.1..., DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) SALES: FEDERAL LAND POLICY AND MANAGEMENT ACT Sales: Procedures § 2711.1 Initiation of sale....

  15. The Saudi Initiative for Asthma

    PubMed Central

    Al-Moamary, Mohamed S.; Al-Hajjaj, Mohamed S.; Idrees, Majdy M.; Zeitouni, Mohamed O.; Alanezi, Mohammed O.; Al-Jahdal, Hamdan H.; Al Dabbagh, Maha

    2009-01-01

    The Saudi Initiative for Asthma (SINA) provides up-to-date guidelines for healthcare workers managing patients with asthma. SINA was developed by a panel of Saudi experts with respectable academic backgrounds and long-standing experience in the field. SINA is founded on the latest available evidence, local literature, and knowledge of the current setting in Saudi Arabia. Emphasis is placed on understanding the epidemiology, pathophysiology, medications, and clinical presentation. SINA elaborates on the development of patient-doctor partnership, self-management, and control of precipitating factors. Approaches to asthma treatment in SINA are based on disease control by the utilization of Asthma Control Test for the initiation and adjustment of asthma treatment. This guideline is established for the treatment of asthma in both children and adults, with special attention to children 5 years and younger. It is expected that the implementation of these guidelines for treating asthma will lead to better asthma control and decrease patient utilization of the health care system. PMID:19881170

  16. Management Trends in Prenatally-Detected Hydronephrosis: A National Survey of Pediatrician Practice Patterns and Antibiotic Use

    PubMed Central

    Yiee, Jenny H.; Tasian, Gregory E.; Copp, Hillary L.

    2011-01-01

    Objectives Hydronephrosis is the most common abnormality found on prenatal ultrasound. The utility of prophylactic antibiotics in the postnatal management of this condition is controversial. No study has assessed practice patterns of general pediatricians in the management of prenatally-detected hydronephrosis. Methods An 18 question survey was sent to a random cross-sectional national sample of pediatricians from the American Medical Association Masterfile. Participants answered questions regarding practice location and type, practice experience, frequency of cases seen, familiarity with the literature, use of antibiotics, work-up of hydronephrosis, and specialist referral. Multivariate logistic regression identified factors associated with prescribing antibiotics. Results 244 of 461 (53%) subjects responded. 56% routinely prescribe antibiotics for prenatally-detected hydronephrosis. 57% perform postnatal work-up themselves. Of these, 98% routinely order ultrasounds while ~40% routinely order voiding cystourethrograms. 94% have specialists readily available, but only 41% always refer to a specialist. On multivariate logistic regression, those who believe prophylactic antibiotics to be beneficial are significantly more likely to prescribe antibiotics compared with those who have not read the literature (OR 6.1, 95%CI 2–15). Those without specialist consultation readily available have an increased odds of starting prophylactic antibiotics compared with those who have consultation available (OR 7.2, 95%CI 1.3–39). Conclusion Most pediatricians initiate postnatal management of prenatally-detected hydronephrosis, therefore pediatricians truly are gatekeepers to children with this condition. Knowledge of practice patterns is crucial for the dissemination of evidence-based information to the appropriate providers and enables us to learn more about the utility of antibiotic prophylaxis in future studies. PMID:21696811

  17. 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.…

  18. Medical management after managed care.

    PubMed

    Robinson, James C; Yegian, Jill M

    2004-01-01

    Health insurers are under conflicting pressures to improve the quality and moderate the costs of health care yet to refrain from interfering with decision making by physicians and patients. This paper examines the contemporary evolution of medical management, drawing on examples from UnitedHealth Group, WellPoint Health Networks, and Active Health Management. It highlights the role of claims data, predictive modeling, notification requirements, and online enrollee self-assessments; the choice between focusing on behavior change among patients or among physicians; and the manner in which medical management is packaged and priced to accommodate the diversity in willingness to pay for quality initiatives in health care.

  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. 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.

  1. 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.

  2. 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...

  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. 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

  5. Dynamic pay initiatives.

    PubMed

    Pagoaga, J; Williams, J B

    1993-09-01

    In the battle to manage change and deal successfully with health care reform, hospitals are looking to innovative methods to optimize compensation for their executives. Results of the 1993 Hay Hospital Compensation Survey indicate clearly that the pressures of managed care and the uncertainty--but inevitability--of reform are forcing organizations to use new tools and strategies for achieving productivity and quality goals. Another interesting survey finding: Two positions critical to the success of integrated health care systems--the head of medical affairs and the head of managed care--show significant compensation growth during the past two years. PMID:8353561

  6. Laparoscopy in the Surgical Management of the Non-Palpable Testis

    PubMed Central

    Castillo-Ortiz, Javier; Muñiz-Colon, Luis; Escudero, Karina; Perez-Brayfield, Marcos

    2014-01-01

    Introduction: To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT). Methods: From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic. Percutaneous access to the abdomen was performed in most cases and laparoscopic management was performed with three 5 mm ports. We compared patient’s age, race, pre/post-operative exam, pre-operative work up, and IAT location upon laparoscopic intervention with surgical outcome. Fisher’s exact test for two independent proportions was used for statistical analysis and reported our results. Results: One hundred testicular units underwent diagnostic laparoscopy for NPT. All patients were from Puerto Rican descent. 55.0% were found to be intra-abdominal and were subdivided into groups according to surgical intervention. Mean post-operative follow-up was 24 months. Patients 24 months of age or younger undergoing diagnostic laparoscopy for NPT had a statistically significant probability of resulting in successful laparoscopic orchiopexy as opposed to laparoscopic orchiectomy due to an atrophied IAT (n = 55 testicular units, p < 0.05). No laparoscopic related complications were reported. Conclusion: Our findings support the use of an initial laparoscopic approach in the NPT as the majority of these patients will have IAT, avoiding unnecessary inguinal and scrotal explorations. We also recommend that patients with IAT should undergo laparoscopic orchiopexy prior to 2 years of age to increase probability of successful management. Further studies focusing in patients with NPT are needed in the future to confirm our findings. PMID:24783184

  7. Current Status of Diversity Initiatives in Selected Multinational Corporations.

    ERIC Educational Resources Information Center

    Wentling, Rose Mary; Palma-Rivas, Nilda

    2000-01-01

    Interviews with eight diversity managers in multinational corporations revealed a variety of domestic and international diversity initiatives, especially in leadership and management. Formal and informal methods were used to plan them. Business unit managers were responsible for implementation. Evaluation was difficult and time consuming. (SK)

  8. 48 CFR 2015.606-1 - Receipt and initial review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Division of Contracts and Property Management shall be responsible for controlling reproduction and... initial review. (a) The Division of Contracts and Property Management shall acknowledge receipt of an... The Division of Contracts and Property Management. The letter will provide an estimated date for...

  9. 5 CFR 9701.605 - Initial service period.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9701.605 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Adverse Actions General § 9701.605 Initial service period. (a) DHS may...

  10. Multinational evidence-based recommendations for the diagnosis and management of gout: integrating systematic literature review and expert opinion of a broad panel of rheumatologists in the 3e initiative

    PubMed Central

    Sivera, Francisca; Andrés, Mariano; Carmona, Loreto; Kydd, Alison S R; Moi, John; Seth, Rakhi; Sriranganathan, Melonie; van Durme, Caroline; van Echteld, Irene; Vinik, Ophir; Wechalekar, Mihir D; Aletaha, Daniel; Bombardier, Claire; Buchbinder, Rachelle; Edwards, Christopher J; Landewé, Robert B; Bijlsma, Johannes W; Branco, Jaime C; Burgos-Vargas, Rubén; Catrina, Anca I; Elewaut, Dirk; Ferrari, Antonio J L; Kiely, Patrick; Leeb, Burkhard F; Montecucco, Carlomaurizio; Müller-Ladner, Ulf; Østergaard, Mikkel; Zochling, Jane; Falzon, Louise; van der Heijde, Désirée M

    2014-01-01

    We aimed to develop evidence-based multinational recommendations for the diagnosis and management of gout. Using a formal voting process, a panel of 78 international rheumatologists developed 10 key clinical questions pertinent to the diagnosis and management of gout. Each question was investigated with a systematic literature review. Medline, Embase, Cochrane CENTRAL and abstracts from 2010–2011 European League Against Rheumatism and American College of Rheumatology meetings were searched in each review. Relevant studies were independently reviewed by two individuals for data extraction and synthesis and risk of bias assessment. Using this evidence, rheumatologists from 14 countries (Europe, South America and Australasia) developed national recommendations. After rounds of discussion and voting, multinational recommendations were formulated. Each recommendation was graded according to the level of evidence. Agreement and potential impact on clinical practice were assessed. Combining evidence and clinical expertise, 10 recommendations were produced. One recommendation referred to the diagnosis of gout, two referred to cardiovascular and renal comorbidities, six focused on different aspects of the management of gout (including drug treatment and monitoring), and the last recommendation referred to the management of asymptomatic hyperuricaemia. The level of agreement with the recommendations ranged from 8.1 to 9.2 (mean 8.7) on a 1–10 scale, with 10 representing full agreement. Ten recommendations on the diagnosis and management of gout were established. They are evidence-based and supported by a large panel of rheumatologists from 14 countries, enhancing their utility in clinical practice. PMID:23868909

  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. Winning physician support for your quality initiatives.

    PubMed

    Mattison, J

    2001-03-01

    Joel Mattison, MD, a member of Hospital Peer Review's editorial board, offers practical tips for bringing physicians on board for hospital quality initiatives. He is the physician advisor in the department of clinical resource management and medical director at St. Joseph's Hospital in Tampa, FL.

  14. 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.

  15. 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.

  16. Clean Coal Power Initiative

    SciTech Connect

    Doug Bartlett; Rob James; John McDermott; Neel Parikh; Sanjay Patnaik; Camilla Podowski

    2006-03-31

    This report is the fifth quarterly Technical Progress Report submitted by NeuCo, Incorporated, under Award Identification Number, DE-FC26-04NT41768. This award is part of the Clean Coal Power Initiative (''CCPI''), the ten-year, $2B initiative to demonstrate new clean coal technologies in the field. This report is one of the required reports listed in Attachment B Federal Assistance Reporting Checklist, part of the Cooperative Agreement. The report covers the award period January 1, 2006 - March 31, 2006 and NeuCo's efforts within design, development, and deployment of on-line optimization systems during that period.

  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. Standard satellite data bus initiative

    NASA Astrophysics Data System (ADS)

    Spinney, Timothy; Yousef, Hassan

    The USAF Space Technology Center manages programs to reduce satellite costs through the appropriate use of microelectronics standardization. Ongoing programs such as the Standard Spacecraft Memory Module and Generic VHSIC Spaceborne Computer have provided an insight into the value of standardization and led to an initiative to coordinate microelectronics development around a standard satellite data bus, which should reduce costs by eliminating program- and contractor-unique interfaces, increasing production runs, and developing generic test equipment. Current efforts focus on the satellite housekeeping functions, and it is expected that the mission payload would also use this data bus. Based on existing housekeeping data-traffic requirements, several candidates have been identified for the standard data bus. The two candidates selected for further work are the ANSI X3T9.5 data bus and the linear token-passing data bus being proposed as part of the Advanced Tactical Fighter effort.

  19. 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…

  20. 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,…

  1. 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…

  2. 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…

  3. Funds Fuel Graduation Initiatives

    ERIC Educational Resources Information Center

    Gewertz, Catherine

    2010-01-01

    In the first wave of funding under a revitalized high school graduation initiative, the U.S. Department of Education is betting nearly $50 million that it can help states and school districts find better ways to hang onto students who might drop out and bring back those who have disappeared without diplomas. Twenty-nine states and districts won…

  4. 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.

  5. 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.

  6. Monolithic exploding foil initiator

    DOEpatents

    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.

  7. 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…

  8. Global healthy backpack initiatives.

    PubMed

    Jayaratne, Kapila; Jacobs, Karen; Fernando, Dulitha

    2012-01-01

    Schoolbag use by children is a global common concern.. Children carry school books and other amenities in their school bags. Global evidence indicates that daily load carried by school children may have negative health implications. Backpack as a school bag model, is the healthiest way of load carriage for school children. Several initiatives have been launched world over to minimize unhealthy consequences resulting from schoolbags. Based on a situation analysis, Sri Lanka implemented a national healthy schoolbag campaign by joint efforts of Ministries of Health and Education. Actions were contemplated on; strategies for bag weight reduction, introduction of an ergonomically modeled schoolbag and bag behaviour change. New strategies were introduced with awareness campaigns to policy makers, bag manufacturers, parents, teachers and children. Four million schoolchildren benefitted. In 2000, the backpack strategy of "Pack it Light, Wear it Right" was started as a public health initiative in the United States by the American Occupational Therapy Association (AOTA). Over the last eleven years, thousands of occupational therapy practitioners and students participated in educational programs and outreach activities. In 2004, modeled after the success AOTA initiative, the Icelandic Occupational Therapy Association launched a national backpack awareness initiative. This article shares examples of practices that could be implemented in any context to the promote health of children.

  9. Initiating Change in Schools.

    ERIC Educational Resources Information Center

    Bowers, Bruce C.

    1990-01-01

    Schools are expected not only to conserve society's values and standards, but to be dynamic organizations with built-in mechanisms for incorporating rapid, far-reaching change. Although change is unlikely unless at least one highly motivated individual assumes the role of initial change agent, lasting change requires more than the efforts of a…

  10. Taking Initiative on Writing

    ERIC Educational Resources Information Center

    Gere, Anne Ruggles

    2010-01-01

    A strong schoolwide writing program supports learning across disciplines and provides a focus for collaboration and professional development for all teachers. The elements for schoolwide writing initiatives include: (1) Setting schoolwide goals for student achievement in writing; (2) Developing and implementing action steps that address both…

  11. Harmonization Initiatives in Europe

    PubMed Central

    2016-01-01

    Introduction Modern medicine is more and more based on protocols and guidelines; clinical laboratory data play very often a relevant role in these documents and for this reason the need for their harmonization is increasing. To achieve harmonized results the harmonization process must not be limited to only the analytical part, but has to include the pre- and the post-analytical phases. Results To fulfill this need the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has started several initiatives. A Working Group on harmonization of the total testing process (WG-H) has been created with the aims of: 1) surveying and summarizing national European and pan European harmonization initiatives; 2) promoting and coordinating the dissemination of especially promising harmonization initiatives among the EFLM member societies; and 3) taking initiatives to harmonize nomenclature, units and reference intervals at a European level. The activity of the WG started this year with a questionnaire targeted at surveying the status of various harmonization activities, especially those in the pre- and post-analytical phase categories, among the European laboratory medicine societies. Conclusions Based on the results of the questionnaire, some activities promoting the dissemination of best practice in blood sampling, sample storage and transportation, in collaboration with WG on the pre-analytical phase, will be promoted, and initiatives to spread to all the European countries the use of SI units in reporting, will be undertaken. Moreover, EFLM has created a Task and Finish Group on standardization of the color coding for blood collection tube closures that is actively working to accomplish this difficult task through collaboration with manufacturers. PMID:27683503

  12. Next generation initiation techniques

    NASA Technical Reports Server (NTRS)

    Warner, Tom; Derber, John; Zupanski, Milija; Cohn, Steve; Verlinde, Hans

    1993-01-01

    Four-dimensional data assimilation strategies can generally be classified as either current or next generation, depending upon whether they are used operationally or not. Current-generation data-assimilation techniques are those that are presently used routinely in operational-forecasting or research applications. They can be classified into the following categories: intermittent assimilation, Newtonian relaxation, and physical initialization. It should be noted that these techniques are the subject of continued research, and their improvement will parallel the development of next generation techniques described by the other speakers. Next generation assimilation techniques are those that are under development but are not yet used operationally. Most of these procedures are derived from control theory or variational methods and primarily represent continuous assimilation approaches, in which the data and model dynamics are 'fitted' to each other in an optimal way. Another 'next generation' category is the initialization of convective-scale models. Intermittent assimilation systems use an objective analysis to combine all observations within a time window that is centered on the analysis time. Continuous first-generation assimilation systems are usually based on the Newtonian-relaxation or 'nudging' techniques. Physical initialization procedures generally involve the use of standard or nonstandard data to force some physical process in the model during an assimilation period. Under the topic of next-generation assimilation techniques, variational approaches are currently being actively developed. Variational approaches seek to minimize a cost or penalty function which measures a model's fit to observations, background fields and other imposed constraints. Alternatively, the Kalman filter technique, which is also under investigation as a data assimilation procedure for numerical weather prediction, can yield acceptable initial conditions for mesoscale models. The

  13. 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…

  14. 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.

  15. Successful integration of ergonomics into continuous improvement initiatives.

    PubMed

    Monroe, Kimberly; Fick, Faye; Joshi, Madina

    2012-01-01

    Process improvement initiatives are receiving renewed attention by large corporations as they attempt to reduce manufacturing costs and stay competitive in the global marketplace. These initiatives include 5S, Six Sigma, and Lean. These programs often take up a large amount of available time and budget resources. More often than not, existing ergonomics processes are considered separate initiatives by upper management and struggle to gain a seat at the table. To effectively maintain their programs, ergonomics program managers need to overcome those obstacles and demonstrate how ergonomics initiatives are a natural fit with continuous improvement philosophies. PMID:22316947

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. Project Management Plan (PMP) for Work Management Implementation

    SciTech Connect

    SHIPLER, C.E.

    2000-01-13

    The purpose of this document is to provide a project plan for Work Management Implementation by the River Protection Project (RPP). Work Management is an information initiative to implement industry best practices by replacing some Tank Farm legacy system

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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).

  9. Where is the culprit? A case of acromegaly that defied the management algorithm

    PubMed Central

    Tamban, Celito A; Sandoval, Mark Anthony S; Lantion-Ang, Frances Lina

    2013-01-01

    A 30-year-old Filipino man presented with a 11-year history of coarse facial features and progressive enlargement of hands and feet. Initial work-up revealed elevated insulin-like growth factor-1 and non-suppressible growth hormone level after 75 g glucose challenge test. Initial cranial MRI performed in the year 2010 showed absence of pituitary adenoma. The patient was lost to follow-up. He again consulted in the year 2011 and a repeat cranial MRI and a dedicated pituitary MRI were performed and both did not reveal any pituitary mass. Further investigation included chest and abdominal CT scan, both of which did not show any neoplasm. At present, there has been no practice guideline on the management of acromegalic patients on whom the identifiable source cannot be found. The patient was given the option to undergo surgical exploration of the pituitary gland or medical treatment with somatostatin analogues. He decided to undergo surgery but has not given consent for the procedure. PMID:23329711

  10. 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.

  11. 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.

  12. 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.

  13. Humane Neonatal Care Initiative.

    PubMed

    Levin, A

    1999-04-01

    The author has worked for many years in experimental departments in the former Soviet health system. Now, with integration into the western health system, many questions are being asked about high-technology neonatal medicine and whether it is sufficiently humane. The Baby Friendly Hospital Initiative (BFHI) movement is well known all over the world, but unfortunately it is only used for healthy children in maternity hospitals. A paradoxical situation has been created: the routines of maternity wards comply with the BFHI, whereas a neonatal intensive care unit in the same hospital may not meet the requirements of the BFHI. BFHI mainly cover breastfeeding in maternity hospitals. Humane Neonatal Care Initiatives include minimum aggressive therapy, minimum contact between sick newborns and medical staff, and maximum contact with mothers; the number of tests and examinations should be reduced to a minimum. Eleven steps towards the improvement of psychosocial and medical care in units for sick newborns are presented. This article is intended to provoke serious discussion. PMID:10342526

  14. Combat Wound Initiative program.

    PubMed

    Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

    2010-07-01

    The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care. PMID:23634474

  15. 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.

  16. Causes of unplanned hemodialysis initiation.

    PubMed

    Gomis Couto, A; Teruel Briones, J L; Fernández Lucas, M; Rivera Gorrin, M; Rodríguez Mendiola, N; Jiménez Álvaro, S; Quereda Rodríguez-Navarro, C

    2011-01-01

    Half of patients starting chronic hemodialysis used a transient vascular catheter as a vascular access (unplanned initiation). An objective of the Quality Management Group of the Spanish Society of Nephrology is to achieve that 80% of the patients starting hemodialysis do it with an arteriovenous fistula. We want to review the causes of non-planned hemodialysis nowadays. In 2010, 43 patients had started chronic hemodialysis in the Hospital Ramón y Cajal in Madrid (Spain). Mean age was 61 years, 79% were men, the most frequent cause of chronic renal disease was the diabetes (23%) and Charlson Comorbidity Index was 6.3 ± 2.6. The unplanned hemodialysis occurred in 20 patients (47%), without any differences with the 23 patients who began planned hemodialysis, in none of the clinical or demographic parameters analyzed. The main cause of unplanned hemodialysis was the acute exacerbation of chronic kidney disease stage 3 or 4, previously stable, secondary to an unforeseeable intercurrent process (8 patients, 40% of the cases). One patient began after a non-recovery acute renal failure and in other 6 patients, the reason of unplanned hemodialysis initiation was not attributable to the operation Health System (in 3 cases unknown kidney chronic disease and in the other 3 cases it was patient´s responsibility). Only in 5 cases (25%), the cause could be corrigible. Most causes of unplanned hemodialysis does not come from the healthcare organization and therefore not easy to resolve it. Consequently, the objective of the Quality Group will be difficult to be achieved. PMID:22130290

  17. Adolescent-onset Krabbe disease with an initial diagnosis of multiple sclerosis and a novel mutation.

    PubMed

    Tomás, José; Durães, João; Lacerda, Lúcia; Macário, Maria Carmo

    2015-09-22

    Krabbe disease is a rare autosomal recessive leucodystrophy, with <5% of the cases having an adolescent-onset form. A 30-year-old woman with a history of a subacute episode of gait impairment at 14 years of age, and mild spastic paraparesis since then, was followed with an initial diagnosis of multiple sclerosis. After 10 years of slow disease progression without response to treatment, the initial diagnosis was reviewed, and an extensive metabolic work up revealed decreased activity of galactocerebrosidase. Genetic testing of the GALC gene proved the diagnosis of Krabbe disease and found a novel mutation. This case highlights the value of a critical eye in the initial differential diagnosis, mainly in the presence of atypical findings.

  18. 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

    Leibovitz, Eugene; David, Nuphar; Ribitzky-Eisner, Haya; Abo Madegam, Mouner; Abuabed, Said; Chodick, Gabriel; Maimon, Michal; Fruchtman, Yariv

    2016-07-19

    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.

  19. 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

    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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 75 FR 79017 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-17

    ... 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...

  9. 75 FR 17433 - Notice of Public Meeting, North Slope Science Initiative-Science Technical Advisory Panel

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-06

    ... 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...

  10. 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

    ... 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...

  11. 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...

  12. 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...

  13. 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.

  14. The Gossamer Initiative

    NASA Technical Reports Server (NTRS)

    Chmielewski, Artur B.; Moore, Chris; Howard, Rick

    2000-01-01

    The Gossamer Spacecraft Initiative is a new NASA program to begin long-range development of enabling technologies for very large, ultra-lightweight structures and apertures. Large apertures include optical, infrared and submillimeter telescopes, "photon buckets" for optical communications and "non-coherent" imaging, solar concentrators, and radio frequency antennas. Developments in the very large ultra-light structures will be forces on one of their most challenging applications-solar sails. The sail structures will include both 3-axis stabilizing and spinning. Gossamer spacecraft technology will eventually allow NASA to undertake bold new missions of discovery, such as searching for the signs of life on planets orbiting nearby stars and sailing through space on beams of light of places beyond our solar system.

  15. Congress initiates science study

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    The U.S. House of Representatives announced in October a year-long study to review the nation's science and technology policy and the government's role in funding scientific research. The Science Policy Study, led by Rep. Vernon Ehlers (R-MI), is the first comprehensive review by Congress since 1985—a time when the Cold War still was being fought and the Internet was largely unknown.At a workshop to discuss the initiative, House Science Committee Chair James Sensenbrenner, Jr., told about 30 scientists and policy experts that the challenge is “to develop a new, sensible, coherent long-range science and technology policy, including a review of our nation's science and math education programs.”

  16. 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.

  17. 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

  18. The Enzyme Function Initiative.

    PubMed

    Gerlt, John A; Allen, Karen N; Almo, Steven C; Armstrong, Richard N; Babbitt, Patricia C; Cronan, John E; Dunaway-Mariano, Debra; Imker, Heidi J; Jacobson, Matthew P; Minor, Wladek; Poulter, C Dale; Raushel, Frank M; Sali, Andrej; Shoichet, Brian K; Sweedler, Jonathan V

    2011-11-22

    The Enzyme Function Initiative (EFI) was recently established to address the challenge of assigning reliable functions to enzymes discovered in bacterial genome projects; in this Current Topic, we review the structure and operations of the EFI. The EFI includes the Superfamily/Genome, Protein, Structure, Computation, and Data/Dissemination Cores that provide the infrastructure for reliably predicting the in vitro functions of unknown enzymes. The initial targets for functional assignment are selected from five functionally diverse superfamilies (amidohydrolase, enolase, glutathione transferase, haloalkanoic acid dehalogenase, and isoprenoid synthase), with five superfamily specific Bridging Projects experimentally testing the predicted in vitro enzymatic activities. The EFI also includes the Microbiology Core that evaluates the in vivo context of in vitro enzymatic functions and confirms the functional predictions of the EFI. The deliverables of the EFI to the scientific community include (1) development of a large-scale, multidisciplinary sequence/structure-based strategy for functional assignment of unknown enzymes discovered in genome projects (target selection, protein production, structure determination, computation, experimental enzymology, microbiology, and structure-based annotation), (2) dissemination of the strategy to the community via publications, collaborations, workshops, and symposia, (3) computational and bioinformatic tools for using the strategy, (4) provision of experimental protocols and/or reagents for enzyme production and characterization, and (5) dissemination of data via the EFI's Website, http://enzymefunction.org. The realization of multidisciplinary strategies for functional assignment will begin to define the full metabolic diversity that exists in nature and will impact basic biochemical and evolutionary understanding, as well as a wide range of applications of central importance to industrial, medicinal, and pharmaceutical efforts.

  19. 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... PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining to Research Programs § 470.205 Initiation of research programs. OPM will announce opportunities for...

  20. 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.

  1. 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…

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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...

  7. 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 SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND...

  8. 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 SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND...

  9. 41 CFR 50-203.15 - Initiation of proceeding.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Initiation of proceeding. 50-203.15 Section 50-203.15 Public Contracts and Property Management Other Provisions Relating to Public Contracts PUBLIC CONTRACTS, DEPARTMENT OF LABOR 203-RULES OF PRACTICE Minimum Wage Determinations Under the Walsh-Healey Public Contracts Act...

  10. 43 CFR 2450.4 - Protests: Initial classification decision.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Protests: Initial classification decision. 2450.4 Section 2450.4 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT, DEPARTMENT OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000)...

  11. 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 Section 470.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERSONNEL MANAGEMENT RESEARCH PROGRAMS AND DEMONSTRATIONS PROJECTS Regulatory Requirements Pertaining...

  12. 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...

  13. 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...

  14. 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...

  15. How should we manage a patient with masked hypertension?

    PubMed

    Palatini, Paolo

    2015-03-01

    A number of studies have shown that masked hypertension (MH) confers an increased risk of target organ damage and of cardiovascular events suggesting that patients with MH would benefit from antihypertensive treatment. However, there is no general agreement about how this condition should be diagnosed. Although ambulatory blood pressure monitoring (ABPM) and self blood pressure measurement (SBPM) provide different and complementary clinical information, the recently published ESH/ESC guidelines for the management of arterial hypertension suggest that for initial assessment of the patient, SBPM may be more suitable in primary care and ABPM in specialist care. If SBPM provides borderline values it is advisable to confirm the diagnosis of MH with ABPM. As the prevalence of MH declines with repeated ABPMs the diagnosis of MH should be based on at least two ABPMs. Patients with MH should undergo a careful diagnostic work-up to assess the existence of additional risk factors including a worsened metabolic profile and the presence of target organ involvement. Treatment of the patient with MH should initially be addressed to improve the patient's lifestyle in order to decrease out-of-office blood pressure and to ameliorate metabolic data. If non-pharmacological measures are insufficient to normalize blood pressure, MH may benefit from pharmacological treatment but no clinical trial has been implemented as yet with the specific purpose of testing this hypothesis. Despite this lack of evidence, the 2013 ESH/ESC guidelines have recommended that in patients with MH also drug treatment should be considered because in patients with MH the risk of adverse outcome is very close to that in sustained hypertension. When ambulatory blood pressure is measured, pharmacological treatment may be modulated according to whether blood pressure is elevated during daytime hours or during sleep. PMID:24500867

  16. Research initiatives in Mauritius.

    PubMed

    Persand, Sharveen

    2005-01-15

    Mauritius forms part of the Mascarene Islands of the Indian Ocean and is situated ca. 700 km to the east of Madagascar at latitude 20 degrees S and longitude 57.5 degrees E. Mauritius has jurisdiction over a proclaimed Exclusive Economic Zone that stretches over 1,900,000 km2. This extensive area holds an immense potential for exploration and presents a wide range of scientific and industrial challenges and opportunities. At present, ocean-related activities are undertaken by various governmental and para-statal institutions as well as non-governmental organizations. Mauritius recognizes the need to coordinate all efforts in order to eliminate wasteful duplication and focus on potential for development, and this has seen the establishment of different forums and committees. This paper gives a brief overview of the different institutions involved in marine science and oceanography in Mauritius and lists the major projects that are being undertaken as well as some of the projects or new research initiatives that are in the pipeline.

  17. 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.

  18. Research initiatives in Mauritius.

    PubMed

    Persand, Sharveen

    2005-01-15

    Mauritius forms part of the Mascarene Islands of the Indian Ocean and is situated ca. 700 km to the east of Madagascar at latitude 20 degrees S and longitude 57.5 degrees E. Mauritius has jurisdiction over a proclaimed Exclusive Economic Zone that stretches over 1,900,000 km2. This extensive area holds an immense potential for exploration and presents a wide range of scientific and industrial challenges and opportunities. At present, ocean-related activities are undertaken by various governmental and para-statal institutions as well as non-governmental organizations. Mauritius recognizes the need to coordinate all efforts in order to eliminate wasteful duplication and focus on potential for development, and this has seen the establishment of different forums and committees. This paper gives a brief overview of the different institutions involved in marine science and oceanography in Mauritius and lists the major projects that are being undertaken as well as some of the projects or new research initiatives that are in the pipeline. PMID:15598638

  19. 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.

  20. 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.

  1. 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.

  2. 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. PMID:21506198

  3. Clinical profile, etiology, and management of hydropneumothorax: An Indian experience

    PubMed Central

    Kasargod, Vasunethra; Awad, Nilkanth Tukaram

    2016-01-01

    Introduction: Hydropneumothorax is an abnormal presence of air and fluid in the pleural space. Even though the knowledge of hydro-pneumothorax dates back to the days of ancient Greece, not many national or international literatures are documented. Aim: To study clinical presentation, etiological diagnosis, and management of the patients of hydropneumothorax. Materials and Methods: Patients admitted in a tertiary care hospital with diagnosis of hydropneumothorax between 2012 and 2014 were prospectively studied. Detailed history and clinical examination were recorded. Blood, pleural fluid, sputum investigations, and computed tomography (CT) thorax (if necessary) were done. Intercostal drainage (ICD) tube was inserted and patients were followed up till 3 months. Results: Fifty-seven patients were studied. Breathlessness, anorexia, weight loss, and cough were the most common symptoms. Tachypnea was present in 68.4% patients. Mean PaO2 was 71.7 mm of Hg (standard deviation ±12.4). Hypoxemia was present in 35 patients (61.4%). All patients had exudative effusion. Etiological diagnosis was possible in 35 patients by initial work-up and 22 required CT thorax for arriving at a diagnosis. Tuberculosis (TB) was etiology in 80.7% patients, acute bacterial infection in 14%, malignancy in 3.5%, and obstructive airway disease in 1.8%. All patients required ICD tube insertion. ICD was required for 24.8 days (±13.1). Conclusion: Most patients presented with symptoms and signs of cardiorespiratory distress along with cough, anorexia, and weight loss. Extensive pleural fluid analysis is essential in establishing etiological diagnosis. TB is the most common etiology. ICD for long duration with antimicrobial chemotherapy is the management. PMID:27185991

  4. 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

  5. Contemporary management of cancer of the oral cavity.

    PubMed

    Genden, Eric M; Ferlito, Alfio; 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

    2010-07-01

    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

  6. Initial Radionuclide Inventories

    SciTech Connect

    Miller, H

    2005-07-12

    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

  7. 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

  8. Initial Cladding Condition

    SciTech Connect

    E. Siegmann

    2000-08-22

    The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M&O 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis will be used in

  9. 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.

  10. 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.

  11. 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…

  12. 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. PMID:25722341

  13. National Take-Back Initiative

    MedlinePlus

    ... Physicians Drug Disposal Information Drug and Chemical Information E-commerce Initiatives Federal Agencies & Related Links Federal Register Notices ... Physicians Drug Disposal Information Drug and Chemical Information E-commerce Initiatives Federal Agencies & Related Links Federal Register Notices ...

  14. 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

  15. INITIATE: An Intelligent Adaptive Alert Environment.

    PubMed

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

    2015-01-01

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

  16. [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.

  17. [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. PMID:27276724

  18. 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.

  19. 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

  20. Managing the pharmacy manager.

    PubMed

    White, S J

    1984-03-01

    Methods of self-assessment, self-development, and coping with stress in the role of hospital pharmacy manager are described. Personal development and career growth should be systematically appraised; goals and priorities should be continually re-evaluated; and time management, response to change, and impact on others should be examined. Questions for assessment in each of these areas are provided. Advice for reducing stress and avoiding burnout is given. Managers' attitudes affect employee productivity; positive attitudes and related actions that are applicable to hospital pharmacy management are described. Managers' personal and professional goals and priorities and their methods of using time and coping with stress affect management of their departments.