Silvicultural systems - uneven-aged management

Treesearch

Morris R. Wing

1977-01-01

Uneven-aged Management, to me, indicates some form of partial cutting, perhaps selective cutting or diameter limit control in the harvesting cut, which, in most cases, removes the larger diameter, more mature trees and leaves a residual stand composed of healthy, fast-growing, well-spaced second growth timber, with a good number of trees in the 6"-12"...

Objective assessment of sperm motion characteristics of Malpura ram lambs raised under intensive management system in semiarid tropical environment.

PubMed

Kumar, Davendra; Joshi, Anil; Naqvi, S M K

2010-04-01

A study was conducted to evaluate the semen production and sperm motion characteristics of ram lambs by computer-aided semen analysis technique. Eight Malpura rams were raised under intensive management system and were trained for semen collection at a weekly interval from the age of 6 months. Rams were scheduled for semen collection at a weekly interval up to 1 year of age to assess their potential for semen production and objective evaluation of semen quality. The average age of ram lambs at the time of first ejaculation was 219 days ranging from 186 to 245 days. The age of ram lambs significantly (p < 0.05) influenced sperm concentration, sperm velocities, and beat frequency of spermatozoa, which were higher in 9-12-month-old compared to 6-9-month-old ram lambs. However, the effect of age was not significant on semen volume, percent motility, percent rapid, medium or slow motile spermatozoa, percent linearity, percent straightness, amplitude of lateral head displacement, percent elongation, and area of sperm head. The body weight of ram lambs was significantly (p < 0.01) and positively correlated (r = 0.46) with age. The results indicate that Malpura ram lambs of 9-12 months of age raised under the intensive management system in a semiarid tropical environment can produce good quality of semen.

Functional diversity response to hardwood forest management varies across taxa and spatial scales.

PubMed

Murray, Bryan D; Holland, Jeffrey D; Summerville, Keith S; Dunning, John B; Saunders, Michael R; Jenkins, Michael A

2017-06-01

Contemporary forest management offers a trade-off between the potential positive effects of habitat heterogeneity on biodiversity, and the potential harm to mature forest communities caused by habitat loss and perforation of the forest canopy. While the response of taxonomic diversity to forest management has received a great deal of scrutiny, the response of functional diversity is largely unexplored. However, functional diversity may represent a more direct link between biodiversity and ecosystem function. To examine how forest management affects diversity at multiple spatial scales, we analyzed a long-term data set that captured changes in taxonomic and functional diversity of moths (Lepidoptera), longhorned beetles (Coleoptera: Cerambycidae), and breeding birds in response to contemporary silvicultural systems in oak-hickory hardwood forests. We used these data sets to address the following questions: how do even- and uneven-aged silvicultural systems affect taxonomic and functional diversity at the scale of managed landscapes compared to the individual harvested and unharvested forest patches that comprise the landscapes, and how do these silvicultural systems affect the functional similarity of assemblages at the scale of managed landscapes and patches? Due to increased heterogeneity within landscapes, we expected even-aged silviculture to increase and uneven-aged silviculture to decrease functional diversity at the landscape level regardless of impacts at the patch level. Functional diversity responses were taxon-specific with respect to the direction of change and time since harvest. Responses were also consistent across patch and landscape levels within each taxon. Moth assemblage species richness, functional richness, and functional divergence were negatively affected by harvesting, with stronger effects resulting from uneven-aged than even-aged management. Longhorned beetle assemblages exhibited a peak in species richness two years after harvesting, while functional diversity metrics did not differ between harvested and unharvested patches and managed landscapes. The species and functional richness of breeding bird assemblages increased in response to harvesting with more persistent effects in uneven- than in even-aged managed landscapes. For moth and bird assemblages, species turnover was driven by species with more extreme trait combinations. Our study highlights the variability of multi-taxon functional diversity in response to forest management across multiple spatial scales. © 2017 by the Ecological Society of America.

Silvicultural systems and red-cockaded woodpecker management: another perspective

Treesearch

Larry D. Hedrick; Robert G. Hooper; Dennis L. Krusac; Joseph M. Dabney

1998-01-01

In 1996 Rudolph and Conner maintained that a modified even-aged silvicultural system using irregular shelterwood as the method of regenerating new stands provides greater benefits for red-cockaded woodpeckers (Picoides borealis) than uneven-aged systems. Their argument was confined to loblolly (Pinus taeda) and shortleaf (P. ecbinata) pine forest types and emphasized...

A Comparison of Learning Management Systems in a School District: Searching for the Ideal Personalized Integrated Educational System (PIES)

ERIC Educational Resources Information Center

Yildirim, Zahide; Reigeluth, Charles M.; Kwon, Seolim; Kageto, Yuichi; Shao, Zihang

2014-01-01

This study explored the use of several learning management systems (LMS), their benefits, and their limitations in relation to the desired characteristics of an ideal Personalized Integrated Educational System (PIES) for the information age. A qualitative research design was used. The participants of the study were teachers, administrators, and…

Management considerations in heifer development and puberty.

PubMed

Patterson, D J; Perry, R C; Kiracofe, G H; Bellows, R A; Staigmiller, R B; Corah, L R

1992-12-01

Management of replacement beef heifers should focus on factors that enhance physiological processes that promote puberty. Age at puberty is important as a production trait when heifers are bred to calve as 2-yr-olds and in systems that impose restricted breeding periods. Calving by 24 mo of age is necessary to obtain maximum lifetime productivity. Because the reproductive system is the last major organ system to mature, factors that influence puberty are critical. The influence of environment on the sequence of events leading to puberty in the heifer is dictated largely by the nutritional status of the animal and related effects on growth rate and development. Management strategies have been designed to ensure that heifers reach a prebreeding target weight that supports optimum reproductive performance, and consequences of inadequate or excessive development have been evaluated. Those strategies are based on evidence linking postweaning nutritional development with key reproductive events that include age at puberty and first breeding, conception, pregnancy loss, incidence and severity of dystocia, and postpartum interval to estrus. Management alternatives that ultimately affect lifetime productivity and reproductive performance of heifers begin at birth and include decisions that involve growth-promoting implants, creep-feeding, breed type and(or) species, birth date and weaning weight, social interaction, sire selection, and exogenous hormonal treatments to synchronize or induce estrus. Basic and applied future research efforts should converge to match in a realistic manner the production potential of the animal with available resources. Strategies that incorporate consideration of nutrition, genetics, and emerging management techniques will need to be tested to enable producers to make decisions that result in profit. This review evaluates the current status of knowledge relating to management of the replacement beef heifer and serves to stimulate research needed to enhance management techniques to ensure puberty at an optimal age.

Optimizing Battery Usage and Management for Long Life

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

Smith, Kandler; Shi, Ying; Wood, Eric

2016-06-16

This presentation discusses the impact of system design factors on battery aging and end of life. Topics include sizing of the SOC operating window, cell balancing and thermal management systems and their value in reducing pack degradation rates and cell imbalance growth over lifetime.

Managing aging in nuclear power plants: Insights from NRC maintenance team inspection reports

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

Fresco, A.; Subudhi, M.; Gunther, W.

1993-12-01

A plant`s maintenance program is the principal vehicle through which age-related degradation is managed. From 1988 to 1991, the NRC evaluated the maintenance program of every nuclear power plant in the United States. Forty-four out of a total of 67 of the reports issued on these in-depth team inspections were reviewed for insights into the strengths and weaknesses of the programs as related to the need to understand and manage the effects of aging on nuclear plant systems, structures, and components. Relevant information was extracted from these inspection reports and sorted into several categories, including Specific Aging Insights, Preventive Maintenance,more » Predictive Maintenance and Condition Monitoring, Post Maintenance Testing, Failure Trending, Root Cause Analysis and Usage of Probabilistic Risk Assessment in the Maintenance Process. Specific examples of inspection and monitoring techniques successfully used by utilities to detect degradation due to aging have been identified. The information also was sorted according to systems and components, including: Auxiliary Feedwater, Main Feedwater, High Pressure Injection for both BWRs and PWRs, Service Water, Instrument Air, and Emergency Diesel Generator Air Start Systems, and Emergency Diesel Generators Air Start Systems, emergency diesel generators, electrical components such as switchgear, breakers, relays, and motor control centers, motor operated valves and check valves. This information was compared to insights gained from the Nuclear Plant Aging Research (NPAR) Program. Attributes of plant maintenance programs where the NRC inspectors felt that improvement was needed to properly address the aging issue also are discussed.« less

Where Is the Knowledge? Knowledge Management, Research and Pedagogy in the Electronic Age.

ERIC Educational Resources Information Center

Gifford, Bernard R.

1992-01-01

Discusses new technology for research and pedagogy in the electronic age and gives examples of usage. The role of librarians as knowledge managers and the development of automated instructional systems for higher education are also considered; and a selected bibliography of 25 titles by the author is included. (10 references) (EA)

A case history of all-age management

Treesearch

Richard M. Godman; Gilbert A. Mattson

1992-01-01

Single-tree selection "works" in sugar maple stands in the Lake States. This system of all-age management has been used for 31 years on the Argonne Experimental Forest. In 1953, researchers found that cutting according to basal area guides is both a convenient and effective way to regulate a stand. Later experience showed that achieving good stand structure...

An Examination of Open and Technology Leadership in Managerial Practices of Education System

ERIC Educational Resources Information Center

Akcil, Umut; Aksal, Fahriye Altinay; Mukhametzyanova, Farida Sh.; Gazi, Zehra Altinay

2017-01-01

In order for a smooth and problem-free transformation to take place in a digitalizing education system, efficient management is needed. Thus, educational managers need to improve their skills and develop behaviors suitable for taking education systems into the digital age. Social networks enable leaders to become digital citizens by embracing and…

Optimizing Battery Usage and Management for Long Life

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

Smith, Kandler; Shi, Ying; Wood, Eric

2016-06-16

This presentation discusses the impact of system design factors on battery aging and end of life. Topics include sizing of the state-of-charge operating window, cell balancing, and thermal management systems and their value in reducing pack degradation rates and cell imbalance growth over lifetime.

Seroepidemiology of Brucella abortus infection in bovids in Sri Lanka.

PubMed

Silva, I; Dangolla, A; Kulachelvy, K

2000-07-03

From 1992 to 1995, 0.15% (n=3916) of the bovids (cattle and buffalo) in Sri Lanka were sampled, using a multi-stage sampling procedure. Serum antibodies for Brucella abortus were detected using the indirect enzyme-linked immunosorbent assay (ELISA). The age, the agroecological zone and the management system practiced in the farms of the sampled bovids were studied as risk factors for seropositivity. The overall seroprevalence of brucellosis in cattle was 4.7% (n=3076) and 4.2% in buffaloes (n=840). Bovids that were over 3 years of age, from the dry zone (annual rainfall 20-35 in.), and reared under an extensive management system had higher odds of being seropositive. Bovids from the dry zone were at approximately six times higher odds of being seropositive even after controlling for the possible effects of age and management system. Approximately 75% of the seropositive males were from the dry zone. Most bovids (84%) from the dry zone in this study were reared under an extensive management system (free grazing) which allows unrestricted contact between animals. These factors may have contributed to the spread of brucellosis in bovids in the dry zone. This infection might be an important cause of abortion in bovids in Sri Lanka. However, there is also evidence of other causes for abortion, repeat breeding and retained placenta.

Applications of harvesting system simulation to timber management and utilization analyses

Treesearch

John E. Baumgras; Chris B. LeDoux

1990-01-01

Applications of timber harvesting system simulation to the economic analysis of forest management and wood utilization practices are presented. These applications include estimating thinning revenue by stand age, estimating impacts of minimum merchantable tree diameter on harvesting revenue, and evaluating wood utilization alternatives relative to pulpwood quotas and...

IQARIS : a tool for the intelligent querying, analysis, and retrieval from information systems.

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

Hummel, J. R.; Silver, R. B.

Information glut is one of the primary characteristics of the electronic age. Managing such large volumes of information (e.g., keeping track of the types, where they are, their relationships, who controls them, etc.) can be done efficiently with an intelligent, user-oriented information management system. The purpose of this paper is to describe a concept for managing information resources based on an intelligent information technology system developed by the Argonne National Laboratory for managing digital libraries. The Argonne system, Intelligent Query (IQ), enables users to query digital libraries and view the holdings that match the query from different perspectives.

Using systems science for population health management in primary care.

PubMed

Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

2014-10-01

Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of <5 years. Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

Database Management Systems: A Case Study of Faculty of Open Education

ERIC Educational Resources Information Center

Kamisli, Zehra

2004-01-01

We live in the information and the microelectronic age, where technological advancements become a major determinant of our lifestyle. Such advances in technology cannot possibly be made or sustained without concurrent advancement in management systems (5). The impact of computer technology on organizations and society is increasing as new…

What have we learned about intelligent transportation systems? Chapter 3, what have we learned about ITS? Arterial management

DOT National Transportation Integrated Search

1997-12-01

The two most important societal trends today are the aging baby boom and women's increased independence. This paper compares the travel profiles of women aged 40 to 49(early baby boomers) with women aged 75 and over and with men aged 75 and over (par...

Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

PubMed

Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

2016-06-01

Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners' orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers' orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers' electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility's pharmacy, could improve patient safety.

Physiology of aging of older adults: systemic and oral health considerations.

PubMed

Abrams, Alan P; Thompson, Lisa A

2014-10-01

This article reviews the concepts of physiologic reserve, the principles of the normative aging process as exemplified by the cardiovascular, neurologic, and musculoskeletal systems. How these principles apply to oral health, and age-related changes in the oral cavity itself, is reviewed and suggests how they may affect disease management by oral health care providers. It does not focus on diseases related to aging, but rather aims to explore the normal physiologic changes associated with aging dentition and systemic changes related to age, thus enabling clinicians to obtain a better understanding of the presentation of older adults and how it may change their approach to diagnosis and treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

Ground-layer plant community responses to even-age and uneven-age silvicultural treatments in Wisconsin northern hardwood forests

Treesearch

Cristel C. Kern; Brian J. Palik; Terry F. Strong

2006-01-01

We evaluated ground-layer plant diversity and community composition in northern hardwood forests among uncut controls and stands managed with even-age or uneven-age silvicultural systems. Even-age treatments included diameter-limit cuttings (20-cm diameter at 30-cm stem height) in 1952 and shelterwood removals in 1964. Uneven-age treatments included three intensities...

Making sense of mobile- and web-based wellness information technology: cross-generational study.

PubMed

Kutz, Daniel; Shankar, Kalpana; Connelly, Kay

2013-05-14

A recent trend in personal health and wellness management is the development of computerized applications or information and communication technologies (ICTs) that support behavioral change, aid the management of chronic conditions, or help an individual manage their wellness and engage in a healthier lifestyle. To understand how individuals across 3 generations (young, middle-aged, and older) think about the design and use of collaborative health and wellness management technologies and what roles these could take in their lives. Face-to-face semistructured interviews, paper prototype systems, and video skits were used to assess how individuals from 3 age cohorts (young: 18-25 years; middle-aged: 35-50 years; and older: ≥65 years) conceptualize the role that health and wellness computing could take in their lives. A total of 21 participants in the 3 age cohorts took part (young: n=7; middle-aged: n=7; and older: n=7). Young adults expected to be able to actively manage the presentation of their health-related information. Middle-aged adults had more nuanced expectations that reflect their engagement with work and other life activities. Older adults questioned the sharing of health information with a larger audience, although they saw the value in 1-way sharing between family members or providing aggregated information. Our findings inform our suggestions for improving the design of future collaborative health and wellness applications that target specific age groups. We recommend that collaborative ICT health applications targeting young adults should integrate with existing social networking sites, whereas those targeting middle-aged and older adults should support small social networks that rely on intimate personal relationships. Systems that target middle-aged adults should support episodic needs, such as time-sensitive, perhaps intermittent, goal setting. They should also have a low barrier to entry, allowing individuals who do not normally engage with the Internet to participate with the application for the specific purposes of health engagement. Collaborative ICT health applications targeting older adults should allow discreet 1-way sharing, and also support sharing of information in aggregate with others' data. These systems should also provide mechanisms to preselect recipients of different kinds of data, or to easily direct specific information to individuals in real time.

Making Sense of Mobile- and Web-Based Wellness Information Technology: Cross-Generational Study

PubMed Central

Shankar, Kalpana; Connelly, Kay

2013-01-01

Background A recent trend in personal health and wellness management is the development of computerized applications or information and communication technologies (ICTs) that support behavioral change, aid the management of chronic conditions, or help an individual manage their wellness and engage in a healthier lifestyle. Objective To understand how individuals across 3 generations (young, middle-aged, and older) think about the design and use of collaborative health and wellness management technologies and what roles these could take in their lives. Methods Face-to-face semistructured interviews, paper prototype systems, and video skits were used to assess how individuals from 3 age cohorts (young: 18-25 years; middle-aged: 35-50 years; and older: ≥65 years) conceptualize the role that health and wellness computing could take in their lives. Results A total of 21 participants in the 3 age cohorts took part (young: n=7; middle-aged: n=7; and older: n=7). Young adults expected to be able to actively manage the presentation of their health-related information. Middle-aged adults had more nuanced expectations that reflect their engagement with work and other life activities. Older adults questioned the sharing of health information with a larger audience, although they saw the value in 1-way sharing between family members or providing aggregated information. Conclusions Our findings inform our suggestions for improving the design of future collaborative health and wellness applications that target specific age groups. We recommend that collaborative ICT health applications targeting young adults should integrate with existing social networking sites, whereas those targeting middle-aged and older adults should support small social networks that rely on intimate personal relationships. Systems that target middle-aged adults should support episodic needs, such as time-sensitive, perhaps intermittent, goal setting. They should also have a low barrier to entry, allowing individuals who do not normally engage with the Internet to participate with the application for the specific purposes of health engagement. Collaborative ICT health applications targeting older adults should allow discreet 1-way sharing, and also support sharing of information in aggregate with others’ data. These systems should also provide mechanisms to preselect recipients of different kinds of data, or to easily direct specific information to individuals in real time. PMID:23900035

Understanding and managing the effects of battery charger and inverter aging

NASA Astrophysics Data System (ADS)

Gunther, W.; Aggarwal, S.

An aging assessment of battery chargers and inverters was conducted under the auspices of the NRC's Nuclear Plant Aging Research (NPAR) Program. The intentions of this program are to resolve issues related to the aging and service wear of equipment and systems at operating reactor facilities and to assess their impact on safety. Inverters and battery chargers are used in nuclear power plants to perform significant functions related to plant safety and availability. The specific impact of a battery charger or inverter failure varies with plant configuration. Operating experience data have demonstrated that reactor trips, safety injection system actuations, and inoperable emergency core cooling systems have resulted from inverter failures; and dc bus degradation leading to diesel generator inoperability or loss of control room annunication and indication have resulted from battery and battery charger failures. For the battery charger and inverter, the aging and service wear of subcomponents have contributed significantly to equipment failures. This paper summarizes the data and then describes methods that can be used to detect battery charger and inverter degradation prior to failure, as well as methods to minimize the failure effects. In both cases, the managing of battery charger and inverter aging is emphasized.

Patient education self-management during surgical recovery: combining mobile (iPad) and a content management system.

PubMed

Cook, David J; Moradkhani, Anilga; Douglas, Kristin S Vickers; Prinsen, Sharon K; Fischer, Erin N; Schroeder, Darrell R

2014-04-01

The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery. Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.

Development, Dissemination, and Assessment of a Food Safety Systems Management Curriculum for Agribusiness Students in Armenia

ERIC Educational Resources Information Center

Pokharel, Siroj; Marcy, Joseph E.; Neilan, Angela M.; Cutter, Catherine N.

2017-01-01

This study addresses the development, dissemination, and assessment of a Food Safety System Management (FSSM) curriculum offered to college-aged, agribusiness students in Yerevan, Armenia. Prior to beginning the program, demographic data were collected and a paper-based pretest was administered to access the food safety knowledge, behavior, and…

Operations Research techniques in the management of large-scale reforestation programs

Treesearch

Joseph Buongiorno; D.E. Teeguarden

1978-01-01

A reforestation planning system for the Douglas-fir region of the Western United States is described. Part of the system is a simulation model to predict plantation growth and to determine economic thinning regimes and rotation ages as a function of site characteristics, initial density, reforestation costs, and management constraints. A second model estimates the...

Computerized database management system for breast cancer patients.

PubMed

Sim, Kok Swee; Chong, Sze Siang; Tso, Chih Ping; Nia, Mohsen Esmaeili; Chong, Aun Kee; Abbas, Siti Fathimah

2014-01-01

Data analysis based on breast cancer risk factors such as age, race, breastfeeding, hormone replacement therapy, family history, and obesity was conducted on breast cancer patients using a new enhanced computerized database management system. My Structural Query Language (MySQL) is selected as the application for database management system to store the patient data collected from hospitals in Malaysia. An automatic calculation tool is embedded in this system to assist the data analysis. The results are plotted automatically and a user-friendly graphical user interface is developed that can control the MySQL database. Case studies show breast cancer incidence rate is highest among Malay women, followed by Chinese and Indian. The peak age for breast cancer incidence is from 50 to 59 years old. Results suggest that the chance of developing breast cancer is increased in older women, and reduced with breastfeeding practice. The weight status might affect the breast cancer risk differently. Additional studies are needed to confirm these findings.

Complexity in Nature and Society: Complexity Management in the Age of Globalization

NASA Astrophysics Data System (ADS)

Mainzer, Klaus

The theory of nonlinear complex systems has become a proven problem-solving approach in the natural sciences from cosmic and quantum systems to cellular organisms and the brain. Even in modern engineering science self-organizing systems are developed to manage complex networks and processes. It is now recognized that many of our ecological, social, economic, and political problems are also of a global, complex, and nonlinear nature. What are the laws of sociodynamics? Is there a socio-engineering of nonlinear problem solving? What can we learn from nonlinear dynamics for complexity management in social, economic, financial and political systems? Is self-organization an acceptable strategy to handle the challenges of complexity in firms, institutions and other organizations? It is a main thesis of the talk that nature and society are basically governed by nonlinear and complex information dynamics. How computational is sociodynamics? What can we hope for social, economic and political problem solving in the age of globalization?.

Frequency Domain Reflectometry Modeling and Measurement for Nondestructive Evaluation of Nuclear Power Plant Cables

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

Glass, Samuel W.; Fifield, Leonard S.; Jones, Anthony M.

Cable insulation polymers are among the more susceptible materials to age-related degradation within a nuclear power plant. This is recognized by both regulators and utilities, so all plants have developed cable aging management programs to detect damage before critical component failure in compliance with regulatory guidelines. Although a wide range of tools are available to evaluate cables and cable systems, cable aging management programs vary in how condition monitoring and NDE is conducted as utilities search for the most reliable and cost-effective ways to assess cable system condition. Frequency domain reflectometry (FDR) is emerging as one valuable tool to locatemore » and assess damaged portions of a cable system with minimal cost and only requires access in most cases to one of the cable terminal ends. This work examines a physics-based model of a cable system and relates it to FDR measurements for a better understanding of specific damage influences on defect detectability.« less

Adoption of online health management tools among healthy older adults: An exploratory study.

PubMed

Zettel-Watson, Laura; Tsukerman, Dmitry

2016-06-01

As the population ages and chronic diseases abound, overburdened healthcare systems will increasingly require individuals to manage their own health. Online health management tools, quickly increasing in popularity, have the potential to diminish or even replace in-person contact with health professionals, but overall efficacy and usage trends are unknown. The current study explored perceptions and usage patterns among users of online health management tools, and identified barriers and barrier-breakers among non-users. An online survey was completed by 169 computer users (aged 50+). Analyses revealed that a sizable minority (37%) of participants use online health management tools and most users (89%) are satisfied with these tools, but a limited range of tools are being used and usage occurs in relatively limited domains. Improved awareness and education for online health management tools could enhance people's abilities to remain at home as they age, reducing the financial burden on formal assistance programs. © The Author(s) 2014.

Uneven-aged silviculture and management in the eastern United States: Proceedings of an In-Service Workshop; Morgantown, West Virginia; July 15-17, 1975

Treesearch

Warren T. Doolittle; A. P. Mustain; Carter B. Gibbs; David. A. Marquis; Barton M. Blum; Carl H. Tubbs; W. B. Leak; S. F. Gingrich; H. Clay Smith; Paul S. DeBald; LaMont G. Engle; Robert E. Phares

1975-01-01

The workshop, summarized in this Proceedings, represented a joint effort by personnel from Research, National Forest System, and State and Private Forestry, to review the state-of-the-art knowledge about the applicability of uneven-aged silviculture and management in the eastern United States. One major objective of this review was to develop a much better mutual...

Managing aging effects on dry cask storage systems for extended long-term storage and transportation of used fuel - rev. 0

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

Chopra, O.K.; Diercks, D.; Fabian, R.

The cancellation of the Yucca Mountain repository program in the United States raises the prospect of extended long-term storage (i.e., >120 years) and deferred transportation of used fuel at operating and decommissioned nuclear power plant sites. Under U.S. federal regulations contained in Title 10 of the Code of Federal Regulations (CFR) 72.42, the initial license term for an Independent Spent Fuel Storage Installation (ISFSI) must not exceed 40 years from the date of issuance. Licenses may be renewed by the U.S. Nuclear Regulatory Commission (NRC) at the expiration of the license term upon application by the licensee for a periodmore » not to exceed 40 years. Application for ISFSI license renewals must include the following: (1) Time-limited aging analyses (TLAAs) that demonstrate that structures, systems, and components (SSCs) important to safety will continue to perform their intended function for the requested period of extended operation; and (2) a description of the aging management program (AMP) for management of issues associated with aging that could adversely affect SSCs important to safety. In addition, the application must also include design bases information as documented in the most recent updated final safety analysis report as required by 10 CFR 72.70. Information contained in previous applications, statements, or reports filed with the Commission under the license may be incorporated by reference provided that those references are clear and specific. The NRC has recently issued the Standard Review Plan (SRP) for renewal of used-fuel dry cask storage system (DCSS) licenses and Certificates of Compliance (CoCs), NUREG-1927, under which NRC may renew a specific license or a CoC for a term not to exceed 40 years. Both the license and the CoC renewal applications must contain revised technical requirements and operating conditions (fuel storage, surveillance and maintenance, and other requirements) for the ISFSI and DCSS that address aging effects that could affect the safe storage of the used fuel. The information contained in the license and CoC renewal applications will require NRC review to verify that the aging effects on the SSCs in DCSSs/ ISFSIs are adequately managed for the period of extended operation. To date, all of the ISFSIs located across the United States with more than 1,500 dry casks loaded with used fuel have initial license terms of 20 years; three ISFSIs (Surry, H.B. Robinson and Oconee) have received their renewed licenses for 20 years, and two other ISFSIs (Calvert Cliffs and Prairie Island) have applied for license renewal for 40 years. This report examines issues related to managing aging effects on the SSCs in DCSSs/ISFSIs for extended long-term storage and transportation of used fuels, following an approach similar to that of the Generic Aging Lessons Learned (GALL) report, NUREG-1801, for the aging management and license renewal of nuclear power plants. The report contains five chapters and an appendix on quality assurance for aging management programs for used-fuel dry storage systems. Chapter I of the report provides an overview of the ISFSI license renewal process based on 10 CFR 72 and the guidance provided in NUREG-1927. Chapter II contains definitions and terms for structures and components in DCSSs, materials, environments, aging effects, and aging mechanisms. Chapter III and Chapter IV contain generic TLAAs and AMPs, respectively, that have been developed for managing aging effects on the SSCs important to safety in the dry cask storage system designs described in Chapter V. The summary descriptions and tabulations of evaluations of AMPs and TLAAs for the SSCs that are important to safety in Chapter V include DCSS designs (i.e., NUHOMS{reg_sign}, HI-STORM 100, Transnuclear (TN) metal cask, NAC International S/T storage cask, ventilated storage cask (VSC-24), and the Westinghouse MC-10 metal dry storage cask) that have been and continue to be used by utilities across the country for dry storage of used fuel to date. The goal of this report is to help establish the technical basis for extended long-term storage and transportation of used fuel.« less

Patient Education Self-Management During Surgical Recovery: Combining Mobile (iPad) and a Content Management System

PubMed Central

Moradkhani, Anilga; Douglas, Kristin S. Vickers; Prinsen, Sharon K.; Fischer, Erin N.; Schroeder, Darrell R.

2014-01-01

Abstract Objective: The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and “just-in-time” education to older patients following cardiac surgery. Subjects and Methods: Patients were provided with iPad® (Apple®, Cupertino, CA) tablets that delivered educational modules as part of a daily “to do” list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers. Results: A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use. Conclusions: We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and “just-in-time” education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models. PMID:24443928

Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.

PubMed

Buja, Alessandra; Damiani, Gianfranco; Gini, Rosa; Visca, Modesta; Federico, Bruno; Donato, Daniele; Francesconi, Paolo; Marini, Alessandro; Donatini, Andrea; Brugaletta, Salvatore; Baldo, Vincenzo; Donata Bellentani, Maria

2014-01-01

Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group. This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.

Clinical-outcome-based demand management in health services.

PubMed

Brogan, C; Lawrence, D; Mayhew, L

2008-01-01

THE PROBLEM OF MANAGING DEMAND: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure will be at the expense of clinical outcomes and unmet need, which will perpetuate financial crises.

41 CFR 101-26.501-2 - Standardized buying programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA Procurement Programs § 101-26.501-2 Standardized buying programs. Wherever... school age passenger. (4) Sedans and station wagons (based on standardized, consolidated requirements...

The aging nursing workforce: How to retain experienced nurses.

PubMed

Cohen, Jeremye D

2006-01-01

In the face of an anticipated nursing shortage, healthcare organizations must evaluate their culture, operations, and compensation system to ensure that these elements align with organizational efforts to retain nurses who are approaching retirement age. Management should focus on enhancing elements of job satisfaction and job embeddedness that will motivate nurses to remain both in the workforce and with their employer. Although much of this responsibility falls on the nurse manager, nurse managers are often not provided the necessary support by top management and are neither recognized nor held accountable for nurse turnover. Other retention initiatives can include altering working conditions to reduce both physical and mental stress and addressing issues of employee health and safety. As for compensation, organizations may be well-served by offering senior nursing staff flexible working hours, salary structures that reward experience, and benefit programs that hold value for an aging workforce.

Ageing Holocaust survivors in Australia.

PubMed

Paratz, Elizabeth D; Katz, Benny

2011-02-21

In recent years, a phenomenon of "late effects of the Holocaust" has emerged, with impacts on the psychological and physical health of ageing Holocaust survivors. As Holocaust survivors age, they may experience heightened anxiety around normal processes of ageing, worsened post-traumatic stress disorder with cognitive decline, and fear of the medical system. Holocaust survivors are at increased risk of osteoporosis, cardiometabolic disease due to hypothalamic-pituitary-adrenal axis dysfunction, cancer, and sequelae of Nazi medical experiments. From existing medical literature on this topic, practical principles of management are derived to create a framework for sensitive medical management of Holocaust survivors in Australia. The issues discussed are also relevant to the wider geriatric refugee or prisoner-of-war experience.

Information management in Iranian Maternal Mortality Surveillance System.

PubMed

Sadoughi, Farahnaz; Karimi, Afsaneh; Erfannia, Leila

2017-07-01

Maternal mortality is preventable by proper information management and is the main target of the Maternal Mortality Surveillance System (MMSS). This study aimed to determine the status of information management in the Iranian Maternal Mortality Surveillance System (IMMSS). The population of this descriptive and analytical study, which was conducted in 2016, included 96 administrative staff of health and treatment deputies of universities of medical sciences and the Ministry of Health in Iran. Data were gathered by a five-part questionnaire with confirmed validity and reliability. A total of 76 questionnaires were completed, and data were analyzed using SPSS software, version 19, by descriptive and inferential statistics. The relationship between variables "organizational unit" and the four studied axes was studied using Kendall's correlation coefficient test. The status of information management in IMMSS was desirable. Data gathering and storage axis and data processing and compilation axis achieved the highest (2.7±0.46) and the lowest (2.4±0.49) mean scores, respectively. The data-gathering method, control of a sample of women deaths in reproductive age in the universities of medical sciences, use of international classification of disease, and use of this system information by management teams to set resources allocation achieved the lowest mean scores in studied axes. Treatment deputy staff had a more positive attitude toward the status of information management of IMMSS than the health deputy staff (p=0.004). Although the status of information management in IMMSS was desirable, it could be improved by modification of the data-gathering method; creating communication links between different data resources; a periodic sample control of women deaths in reproductive age in the universities of medical sciences; and implementing ICD-MM and integration of its rules on a unified system of death.

Program Manager: Journal of the Defense Systems Management College. Volume 18. Number 6, November-December 1989

DTIC Science & Technology

1989-12-01

program manager was evaluated managers in group one will group two, the "less or no sports at all" by at least one additional rater ). In ad- have... determined that for the 34 evaluating the differences between subhypothesis is based on its respective managers, the total number of years group means, each...things like education, experience, age, sex , personality, in- formed within the context of Air Force program managers dividual values, and a specific

Nondestructive Examination for Nuclear Power Plant Cable Aging Management Programs

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

Glass, Samuel W.; Fifield, Leonard S.

2016-01-01

Degradation of the cable jacket, electrical insulation, and other cable components of installed cables within nuclear power plants (NPPs) is known to occur as a function of age, temperature, radiation, and other environmental factors. System tests verify cable function under normal loads; however, the concern is over cable performance under exceptional loads associated with design-basis events (DBEs). The cable’s ability to perform safely over the initial 40 year planned and licensed life has generally been demonstrated and there have been very few age-related cable failures. With greater than 1000 km of power, control, instrumentation, and other cables typically found inmore » an NPP, replacing all the cables would be a severe cost burden. Justification for life extension to 60 and 80 years requires a cable aging management program (AMP) to justify cable performance under normal operation as well as accident conditions. This paper addresses various NDE technologies that constitute the essence of an acceptable aging management program.« less

Legacy systems: managing evolution through integration in a distributed and object-oriented computing environment.

PubMed

Lemaitre, D; Sauquet, D; Fofol, I; Tanguy, L; Jean, F C; Degoulet, P

1995-01-01

Legacy systems are crucial for organizations since they support key functionalities. But they become obsolete with aging and the apparition of new techniques. Managing their evolution is a key issue in software engineering. This paper presents a strategy that has been developed at Broussais University Hospital in Paris to make a legacy system devoted to the management of health care units evolve towards a new up-to-date software. A two-phase evolution pathway is described. The first phase consists in separating the interface from the data storage and application control and in using a communication channel between the individualized components. The second phase proposes to use an object-oriented DBMS in place of the homegrown system. An application example for the management of hypertensive patients is described.

Influence of selection systems and shelterwood methods on understory plant communities of longleaf pine forests in flatwoods and uplands

Treesearch

Dale G. Brockway; Kenneth W. Outcalt

2015-01-01

Although longleaf pine (Pinus palustris Mill.) forests have mostly been managed with even-aged methods, interest has been rising in uneven-aged systems, as a means of achieving a broader range of stewardship objectives. Selection silviculture has been practiced on a limited scale in longleaf pine, but difficulty of using traditional approaches and...

Managing for Innovation in the Age of Information Technology.

ERIC Educational Resources Information Center

Downes, Robin N.

1987-01-01

Discusses the need for innovative management techniques if integrated library systems are to be implemented successfully, as well as the opportunity the installation process provides to reexamine the organizational structure and objectives of the library and to introduce a creative organizational environment. (CLB)

Instrumental meat quality of veal calves reared under three management systems and color evolution of meat stored in three packaging systems.

PubMed

Ripoll, G; Albertí, P; Casasús, I; Blanco, M

2013-02-01

This study evaluated the meat quality of grazing suckling calves (GR), suckling plus supplemented calves (SUP) and weaned calves finished on concentrates (FIN) and the color evolution of meat packaged in film (FILM), modified atmosphere packaging (MAP) and vacuum packaging (VAC). Intramuscular fat was quite low for all treatments and GR meat had greater percentages of PUFA and lower SFA, MUFA and n6/n3 than SUP and FIN. FIN and SUP meat had more L* and was more tender when aged than GR. GR meat was tough and dark. The packaging system was more influential on meat color than the feeding management. VAC had the lowest values of metmyoglobin when aged. MAP had the greatest L* and hue angle and the lowest redness after 13 d of aging, thus MAP was the packaging with the shortest shelf life. Copyright © 2012 Elsevier Ltd. All rights reserved.

Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

PubMed Central

Torkaman, Ali; Bagherifard, Abolfazl; Mokhatri, Tahmineh; Haghighi, Mohammad Hossein Shabanpour; Monshizadeh, Siamak; Taraz, Hamid; Hasanvand, Amin

2016-01-01

Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements. There were not any significant differences between right and left coracoclavicular, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments. PMID:26894217

Report to the administrator by the NASA Aerospace Safety Advisory Panel on the Skylab program. Volume 1: Summary report. [systems management evaluation and design analysis

NASA Technical Reports Server (NTRS)

1973-01-01

Contractor and NASA technical management for the development and manufacture of the Skylab modules is reviewed with emphasis on the following management controls: configuration and interface management; vendor control; and quality control of workmanship. A review of the modified two-stage Saturn V launch vehicle which focused on modifications to accommodate the Skylab payload; resolution of prior flight anomalies; and changes in personnel and management systems is presented along with an evaluation of the possible age-life and storage problems for the Saturn 1-B launch vehicle. The NASA program management's visibility and control of contractor operations, systems engineering and integration, the review process for the evaluation of design and flight hardware, and the planning process for mission operations are investigated. It is concluded that the technical management system for development and fabrication of the modules, spacecraft, and launch vehicles, the process of design and hardware acceptance reviews, and the risk assessment activities are satisfactory. It is indicated that checkout activity, integrated testing, and preparations for and execution of mission operation require management attention.

Smokey comes of age: Unmanned aerial systems for fire management

USGS Publications Warehouse

Twidwell, Dirac; Allen, Craig R.; Detweiler, Carrick; Higgins, James; Laney, Christian; Elbaum, Sebastian

2016-01-01

During the past century, fire management has focused on techniques both to protect human communities from catastrophic wildfire and to maintain fire-dependent ecological systems. However, despite a large and increasing allocation of resources and personnel to achieve these goals, fire management objectives at regional to global scales are not being met. Current fire management techniques are clearly inadequate for the challenges faced by fire managers, and technological innovations are needed. Advances in unmanned aerial systems (UAS) technology provide opportunities for innovation in fire management and science. In many countries, fire management organizations are beginning to explore the potential of UAS for monitoring fires. We have taken the next step and developed a prototype that can precisely ignite fires as part of wildfire suppression tactics or prescribed fires (fire intentionally ignited within predetermined conditions to reduce hazardous fuels, improve habitat, or mitigate for large wildfires). We discuss the potential for these technologies to benefit fire management activities, while acknowledging the sizeable sociopolitical barriers that prevent their immediate broad application.

Preparing the Workforce for Healthy Aging Programs: The Skills for Healthy Aging Resources and Programs (SHARP) Model

ERIC Educational Resources Information Center

Frank, Janet C.; Altpeter, Mary; Damron-Rodriguez, JoAnn; Driggers, Joann; Lachenmayr, Susan; Manning, Colleen; Martinez, Dana M.; Price, Rachel M.; Robinson, Patricia

2014-01-01

Current public health and aging service agency personnel have little training in gerontology, and virtually no training in evidence-based health promotion and disease management programs for older adults. These programs are rapidly becoming the future of our community-based long-term care support system. The purpose of this project was to develop…

Lake Erie Yellow perch age estimation based on three structures: Precision, processing times, and management implications

USGS Publications Warehouse

Vandergoot, C.S.; Bur, M.T.; Powell, K.A.

2008-01-01

Yellow perch Perca flavescens support economically important recreational and commercial fisheries in Lake Erie and are intensively managed. Age estimation represents an integral component in the management of Lake Erie yellow perch stocks, as age-structured population models are used to set safe harvest levels on an annual basis. We compared the precision associated with yellow perch (N = 251) age estimates from scales, sagittal otoliths, and anal spine sections and evaluated the time required to process and estimate age from each structure. Three readers of varying experience estimated ages. The precision (mean coefficient of variation) of estimates among readers was 1% for sagittal otoliths, 5-6% for anal spines, and 11-13% for scales. Agreement rates among readers were 94-95% for otoliths, 71-76% for anal spines, and 45-50% for scales. Systematic age estimation differences were evident among scale and anal spine readers; less-experienced readers tended to underestimate ages of yellow perch older than age 4 relative to estimates made by an experienced reader. Mean scale age tended to underestimate ages of age-6 and older fish relative to otolith ages estimated by an experienced reader. Total annual mortality estimates based on scale ages were 20% higher than those based on otolith ages; mortality estimates based on anal spine ages were 4% higher than those based on otolith ages. Otoliths required more removal and preparation time than scales and anal spines, but age estimation time was substantially lower for otoliths than for the other two structures. We suggest the use of otoliths or anal spines for age estimation in yellow perch (regardless of length) from Lake Erie and other systems where precise age estimates are necessary, because age estimation errors resulting from the use of scales could generate incorrect management decisions. ?? Copyright by the American Fisheries Society 2008.

Legacy systems: managing evolution through integration in a distributed and object-oriented computing environment.

PubMed Central

Lemaitre, D.; Sauquet, D.; Fofol, I.; Tanguy, L.; Jean, F. C.; Degoulet, P.

1995-01-01

Legacy systems are crucial for organizations since they support key functionalities. But they become obsolete with aging and the apparition of new techniques. Managing their evolution is a key issue in software engineering. This paper presents a strategy that has been developed at Broussais University Hospital in Paris to make a legacy system devoted to the management of health care units evolve towards a new up-to-date software. A two-phase evolution pathway is described. The first phase consists in separating the interface from the data storage and application control and in using a communication channel between the individualized components. The second phase proposes to use an object-oriented DBMS in place of the homegrown system. An application example for the management of hypertensive patients is described. PMID:8563252

Multiaged silviculture of ponderosa pine

Treesearch

Kevin L. O' Hara

2005-01-01

Ponderosa pine (Pinus ponderosa P. & C. Lawson) is highly suitable for management using multiaged systems. This suitability is primarily the result of a frequent, low severity disturbance regime, but also because it naturally occurs at low densities and has a long history of management to promote multiple age classes. Several different stocking...

Effect of pest management system on 'Empire' apple leaf phyllosphere populations

USDA-ARS?s Scientific Manuscript database

The phyllosphere of plant tissues is varied and dynamic. Pest management, time of sampling, proximity to immigration sources, tissue and tissue status such as leaf/fruit age and location within the canopy, and other environmental and biological factors interact to influence the composition and abun...

Carbon stocks across a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands

USGS Publications Warehouse

Powers, Matthew D.; Kolka, Randall K.; Bradford, John B.; Palik, Brian J.; Fraver, Shawn; Jurgensen, Martin F.

2012-01-01

Forests function as a major global C sink, and forest management strategies that maximize C stocks offer one possible means of mitigating the impacts of increasing anthropogenic CO2 emissions. We studied the effects of thinning, a common management technique in many forest types, on age-related trends in C stocks using a chronosequence of thinned and unmanaged red pine (Pinus resinosa) stands ranging from 9 to 306 years old. Live tree C stocks increased with age to a maximum near the middle of the chronosequence in unmanaged stands, and increased across the entire chronosequence in thinned stands. C in live understory vegetation and C in the mineral soil each declined rapidly with age in young stands but changed relatively little in middle-aged to older stands regardless of management. Forest floor C stocks increased with age in unmanaged stands, but forest floor C decreased with age after the onset of thinning around age 40 in thinned stands. Deadwood C was highly variable, but decreased with age in thinned stands. Total ecosystem C increased with stand age until approaching an asymptote around age 150. The increase in total ecosystem C was paralleled by an age-related increase in total aboveground C, but relatively little change in total belowground C. Thinning had surprisingly little impact on total ecosystem C stocks, but it did modestly alter age-related trends in total ecosystem C allocation between aboveground and belowground pools. In addition to characterizing the subtle differences in C dynamics between thinned and unmanaged stands, these results suggest that C accrual in red pine stands continues well beyond the 60–100 year management rotations typical for this system. Management plans that incorporate longer rotations and thinning in some stands could play an important role in maximizing C stocks in red pine forests while meeting other objectives including timber extraction, biodiversity conservation, restoration, and fuel reduction goals.

Sodium chlorate reduces presence of Escherichia coli in feces of lambs and ewes managed in shed-lambing systems

USDA-ARS?s Scientific Manuscript database

Our objective was to establish doses of orally-administered NaClO3 that reduced presence of generic Escherichia coli in intestines of ewes and neonatal lambs managed in a shed-lambing system. Neonatal lambs (n = 32; age = 7.1 ± 1.2 d; BW = 6.8 ± 1.0 kg) and yearling ewes (n = 44; BW = 74.8 ± 5.6 kg)...

Developing Occupation-Based Preventive Programs for Late-Middle-Aged Latino Patients in Safety-Net Health Systems

PubMed Central

Carlson, Mike; Martínez, Jenny; Guzmán, Laura; Mahajan, Anish; Clark, Florence

2015-01-01

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. PMID:26565102

Developing Occupation-Based Preventive Programs for Late-Middle-Aged Latino Patients in Safety-Net Health Systems.

PubMed

Schepens Niemiec, Stacey L; Carlson, Mike; Martínez, Jenny; Guzmán, Laura; Mahajan, Anish; Clark, Florence

2015-01-01

Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos. Copyright © 2015 by the American Occupational Therapy Association, Inc.

RISK ASSESSMENT AND MANAGEMENT OF WATER SUPPLY SYSTEM - INFRASTRUCTURE INITIATIVE FOR THE 21ST CENTURY

EPA Science Inventory

The current problem in the United States is that the water infrastructure is aging and spending has not been adequate to repair, replace, or rehabilitate drinking water distribution systems and wastewater collection systems. The American Society of Civil Engineers Report Card in...

Looking for Trouble

ERIC Educational Resources Information Center

Rice, Mike

2006-01-01

Circuit breakers are the linchpin of an institution's power-distribution system, so it's not surprising that several warning signs of an aging system relate to these devices. When warning signs occur, it's a message to facilities managers and administrators that breakers may need to be upgraded to help the power distribution system meet existing…

24 CFR 572.125 - Replacement reserves.

Code of Federal Regulations, 2010 CFR

2010-04-01

... drawn down under the Cash and Management Information System when specifically needed to assist a... prevent severe financial hardship to families caused by the failure of a major system or component of the... families; and (3) The condition and age of the properties and each of their major systems and components...

Online chemotherapy symptom care and patient management system: an evaluative study.

PubMed

Chan, Moon Fai; Ang, Neo Kim Emily; Cho, Aye Aye; Chow, Ying Leng; Taylor, Beverly

2014-02-01

Health delivery practices are shifting toward home care, because of better possibilities for managing chronic care, controlling health delivery costs, and increasing the quality of life and quality of health services, and the distinct possibility of predicting and thus avoiding serious complications. The study aimed to explore the benefits of an online Symptom Care and Management System in the home for patients receiving chemotherapy. A single-group experimental design was used. Thirty patients aged between 37 and 77 years undergoing their first or commencing a new course of chemotherapy treatment were recruited from November 2010 and December 2012 at a cancer center in Singapore. All patients used the Symptom Care and Management System to send daily symptom reports to the cancer center and received symptom management advice from the oncology nurse via teleconferencing during the first four chemotherapy treatment cycles. Patients' perceptions of the use of the Symptom Care and Management System were evaluated. All participants perceived the Symptom Care and Management System as a user-friendly interface and believed that they felt more involved in their care, and the system made it easier to understand some of the problems they experienced and helped them manage the symptoms more easily during the treatment. In addition, 29 participants (96.7%) felt that the nurse could contact them better via the Symptom Care and Management System, the Symptom Care and Management System helped them explain their symptoms to the nurse, and that it was simple to understand. The results presented in this study suggested that the Symptom Care and Management System has the potential to enhance remote monitoring and provides a feasible and acceptable way for a specific group of cancer patients to manage their symptoms at home.

Use of group-selection and seed-tree cuts by three early-successional migratory species in Arkansas

Treesearch

Lynn E. Alterman; James C. Bednarz; Ronald E. Thill

2005-01-01

Silviculture in the Ouachita National Forest in Arkansas and Oklahoma has shifted in recent years from mostly even-aged management to a mix of even- and uneven-aged regeneration systems, including group-selection. Researchers have described presence/absence of early-successional bird species in forest openings created by even- and uneven-aged silviculture, but few have...

[The model of aged-hearing monitoring under the hospital information system].

PubMed

Bao, Xiao-lin; Xu, Hua; Sun, Qiang; Liu, Ji-hong; Guo, Jia-liang

2013-03-01

To study the oldly people's hearing screening and dynamic monitoring mode, and to discuss the new diseases and health management mode in current information network era. To establish the network connection between the hospital and the communities in the internet through the function expansion of the Hospital Information Systems and to realize "dual systems, double platforms" integrated management modes and establish the audiology workstation. The routine physical examination, pure tone hearing threshold tests and middle ear analysis were performed on four hundred and twenty elderly people from the fourteen communities every three months, and the changes of hearing and related symptoms were observed. Resources sharing was established between the hospital and these fourteen communities. Health records were established for all the aged people, the hearing screening lasted only half a day each time. Fourteen hearing loss cases were found during one year. A statistically significant difference (P < 0.01) were found, the ratio of hearing loss with diabetes, high blood pressure and other diseases were much higher than people without concomitant. The advantage of disease management mode under the Hospital Information System is convenient, the work efficiency and qualities are improved, which is worthy of popularizing.

Effectiveness of neurofeedback therapy for anxiety and stress in adults living with a chronic illness: a systematic review protocol.

PubMed

Blaskovits, Farriss; Tyerman, Jane; Luctkar-Flude, Marian

2017-07-01

The objective of this review is to systematically examine the effectiveness of neurofeedback therapy for managing anxiety and stress in adults living with a chronic illness.The specific objectives are to identify which neurofeedback systems and/or protocols demonstrate effectiveness and determine the level of supporting evidence.The review question is as follows: What is the effectiveness of neurofeedback therapy for managing anxiety and stress in an adult population aged 18 years of age or older living with a chronic illness?

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

PubMed

Wambach, Jennifer A; Young, Lisa R

2014-12-01

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

Some Old Questions Revisited.

ERIC Educational Resources Information Center

Stewart, G. Kent

1985-01-01

Discusses issues to consider in managing school space. Among these are the program-plan-budgeting system (PPBS), deferred maintenance of aging buildings, and state involvement in facility financing. (MLF)

Systematic Age-Related Differences in Chronic Disease Management in a Population-Based Cohort Study: A New Paradigm of Primary Care Is Required

PubMed Central

Buja, Alessandra; Damiani, Gianfranco; Gini, Rosa; Visca, Modesta; Federico, Bruno; Donato, Daniele; Francesconi, Paolo; Marini, Alessandro; Donatini, Andrea; Brugaletta, Salvatore; Baldo, Vincenzo; Donata Bellentani, Maria

2014-01-01

Background Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group. Methods This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. Results The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16–44 year-olds), adults (45–64), and oldest old (+85) than for patients aged 65–74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16–44 y), adults (45–64 y), the very old (75–84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65–74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. Conclusion Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly. PMID:24632818

Competency Management and Learning Organization in a New Clinical Fieldwork Course

ERIC Educational Resources Information Center

Putthinoi, Supawadee; Lersilp, Suchitporn; Chakpitak, Nopasit

2015-01-01

As Thailand transitions into an ageing society, greater demands will be placed on healthcare systems. The concept of competency management and learning organization can be beneficial in continually expanding organizational capacity in order to create response. This study aimed to develop a new clinical fieldwork course in the community by…

Special Education Management System Project Document. 2. Santa Cruz BCP Observation Booklet.

ERIC Educational Resources Information Center

Santa Cruz County Superintendent of Schools, CA.

Presented in booklet and chart form is the Behavioral Characteristics Progression (BCP), part of the Santa Cruz Special Education Management Project, consisting of 2400 observable traits grouped into 50 behavioral strands. The BCP is seen to be a nonstandardized criterion referenced tool which replaces conventional age and disability labels with…

A Management Strategy for the Naval Administrative Telephone System,

DTIC Science & Technology

1985-03-01

story [Ref. 17]: " What the government wants is a one-stop telecommunica- tions company1 operated by a single prime contractor, that can provide and...examines the various system and environmental factor which impact upon a selection of a management strategy, and with- in the constraints imposed by...resolution technique embodied in the age-old adage "divide and conquer." The key premise of this technique is that if a complex ( macro -) problem is

An intelligent decision support system for work zone traffic management and planning.

DOT National Transportation Integrated Search

2004-01-01

Periodic resurfacing, rehabilitation, restoration, and reconstruction work is needed on the aging highway system in the state of Ohio to maintain a desired level of service for the traveling public. However, temporary work zones on highways disrupt t...

The development and evaluation of a nursing information system for caring clinical in-patient.

PubMed

Fang, Yu-Wen; Li, Chih-Ping; Wang, Mei-Hua

2015-01-01

The research aimed to develop a nursing information system in order to simplify the admission procedure for caring clinical in-patient, enhance the efficiency of medical information documentation. Therefore, by correctly delivering patients’ health records, and providing continues care, patient safety and care quality would be effectively improved. The study method was to apply Spiral Model development system to compose a nursing information team. By using strategies of data collection, working environment observation, applying use-case modeling, and conferences of Joint Application Design (JAD) to complete the system requirement analysis and design. The Admission Care Management Information System (ACMIS) mainly included: (1) Admission nursing management information system. (2) Inter-shift meeting information management system. (3) The linkage of drug management system and physical examination record system. The framework contained qualitative and quantitative components that provided both formative and summative elements of the evaluation. System evaluation was to apply information success model, and developed questionnaire of consisting nurses’ acceptance and satisfaction. The results of questionnaires were users’ satisfaction, the perceived self-involvement, age and information quality were positively to personal and organizational effectiveness. According to the results of this study, the Admission Care Management Information System was practical to simplifying clinic working procedure and effective in communicating and documenting admission medical information.

Creating a Knowledge Base for Management of Southern Bottomland Hardwood Ecosystems

Treesearch

John C. Bliss; Stephen B. Jones; John A. Stanturf; Christine M. Hamner

1997-01-01

We describe an interdisciplinary approach to forecasting potential impacts of even-aged and uneven-aged silvicultural treatments upon bottomland hardwood ecosystems in the Southern United States. Our approach involves identifying scientists with expertise in key disciplines: utilizing the Delphi technique to develop consensus among these scientists on important system...

Non-cardiac manifestations of Marfan syndrome

PubMed Central

2017-01-01

Because of the widespread distribution of fibrillin 1 in the body, Marfan syndrome (MFS) affects virtually every system. The expression of this single dominantly inherited gene is variable within a family, and between families. There is some genotype-phenotype correlation which is helpful in guiding long-term prognosis, and management. In general gene mutations have been reported in clusters, with those having mainly ocular manifestations occurring in exons 1 to 15 of this 65-exon gene; those causing cardiac problems often involving cysteine replacement in a calcium binding EGF-like sequence; the most severe mutations occurring in exons 25–32, causing neonatal MFS diagnosed at birth, and severe enough to cause death frequently before the age of 2. Other correlations will certainly be found in future. This condition is progressive, and the manifestations unfold according to age. For example, if the lens is going to dislocate this usually occurs by age 10; scoliosis usually presents itself between the ages of 8 and 15; height should be monitored carefully between the onset of puberty and cessation of growth approximately age 17 or 18. Holistic care should be offered by one doctor who oversees the patient’s welfare. This should be a paediatrician, paediatric cardiologist, or general practitioner in the case of an affected child. Thereafter, the physician in charge of the most seriously affected system should be aware that other systems need to be managed through a referral network. PMID:29270372

System configuration management plan for 101-SY Hydrogen Mitigation Test Project Mini-Data Acquisition and Control System of Tank Waste Remediation System

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

Vargo, G.F. Jr.

1994-10-11

The DOE Standard defines the configuration management program by the five basic program elements of ``program management,`` ``design requirements,`` ``document control,`` ``change control,`` and ``assessments,`` and the two adjunct recovery programs of ``design reconstitution,`` and ``material condition and aging management. The C-M model of five elements and two adjunct programs strengthen the necessary technical and administrative control to establish and maintain a consistent technical relationship among the requirements, physical configuration, and documentation. Although the DOE Standard was originally developed for the operational phase of nuclear facilities, this plan has the flexibility to be adapted and applied to all life-cycle phasesmore » of both nuclear and non-nuclear facilities. The configuration management criteria presented in this plan endorses the DOE Standard and has been tailored specifically to address the technical relationship of requirements, physical configuration, and documentation during the full life-cycle of the 101-SY Hydrogen Mitigation Test Project Mini-Data Acquisition and Control System of Tank Waste Remediation System.« less

An intelligent decision support system for work zone traffic management and planning : executive summary report.

DOT National Transportation Integrated Search

2004-01-01

Problem: Periodic resurfacing, rehabilitation, restoration, and reconstruction work is needed on the aging highway system in the state of Ohio to maintain a desired level of service for the traveling public. However, temporary work zones on highways ...

Loan Stars: ILL Comes of Age.

ERIC Educational Resources Information Center

Jackson, Mary E.

1998-01-01

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

An Assessment of Integrated Health Management (IHM) Frameworks

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

N. Lybeck; M. Tawfik; L. Bond

In order to meet the ever increasing demand for energy, the United States nuclear industry is turning to life extension of existing nuclear power plants (NPPs). Economically ensuring the safe, secure, and reliable operation of aging nuclear power plants presents many challenges. The 2009 Light Water Reactor Sustainability Workshop identified online monitoring of active and structural components as essential to the better understanding and management of the challenges posed by aging nuclear power plants. Additionally, there is increasing adoption of condition-based maintenance (CBM) for active components in NPPs. These techniques provide a foundation upon which a variety of advanced onlinemore » surveillance, diagnostic, and prognostic techniques can be deployed to continuously monitor and assess the health of NPP systems and components. The next step in the development of advanced online monitoring is to move beyond CBM to estimating the remaining useful life of active components using prognostic tools. Deployment of prognostic health management (PHM) on the scale of a NPP requires the use of an integrated health management (IHM) framework - a software product (or suite of products) used to manage the necessary elements needed for a complete implementation of online monitoring and prognostics. This paper provides a thoughtful look at the desirable functions and features of IHM architectures. A full PHM system involves several modules, including data acquisition, system modeling, fault detection, fault diagnostics, system prognostics, and advisory generation (operations and maintenance planning). The standards applicable to PHM applications are indentified and summarized. A list of evaluation criteria for PHM software products, developed to ensure scalability of the toolset to an environment with the complexity of a NPP, is presented. Fourteen commercially available PHM software products are identified and classified into four groups: research tools, PHM system development tools, deployable architectures, and peripheral tools.« less

The effects of gender and age on forensic personal identification from frontal sinus in a Turkish population

PubMed Central

Tatlisumak, Ertugrul; Asirdizer, Mahmut; Bora, Aydin; Hekimoglu, Yavuz; Etli, Yasin; Gumus, Orhan; Keskin, Siddik

2017-01-01

Objectives: To define the dimensions of the frontal sinus in groups standardized for age and gender and to discuss the reasons and the effects of the variations. Methods: Frontal sinus measurements were obtained from paranasal CT scans of 180 males and 180 females in the Radiology Department of Dursun Odabas Medical Center of Yuzuncu Yil University, Van, which is located in Eastern Turkey, between February and March 2016. The width and height of sinuses were measured on a coronal plane, and the anteroposterior length was measured on an axial plane. Volumes were calculated using the Hospital Information Management Systems and Image Archiving and Management System program. The Statistical Package of the Social Science version 13 was used for statistical analyses. Results: We determined differences in the frontal sinus measurements of different age groups in a Turkish adult population. Frontal sinus dimensions were usually higher in females and lower in males after 40-49 years of age than their younger counterparts, but the measurements were lower in females and higher in males in 70≤ years of age group than 60-69 years of age. Left frontal sinus was dominant in young age groups but right frontal sinus was dominant in groups 40-49 years of age or older. Conclusion: We observed crossing of the measurements between the different age groups, which we could not find clear explanations. The results of such studies may affect forensic identification from frontal sinus measurements. PMID:28042629

Designing a model for trauma system management using public health approach: the case of Iran.

PubMed

Tarighi, Payam; Tabibi, Seyed Jamaledin; Motevalian, Seyed Abbas; Tofighi, Shahram; Maleki, Mohammad Reza; Delgoshaei, Bahram; Panahi, Farzad; Masoomi, Gholam Reza

2012-01-01

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

Aging Water Infrastructure and Nutrient Control at WWTPs: U.S. Environmental Protection Agency Research Program

EPA Science Inventory

What are… the effects of major influencing factors (climate change, population dynamics, etc.) on future system demands? the innovative technologies that can cost-effectively improve performance and extend the life of existing systems? the new designs and management approaches...

Forest structure and light regimes following moderate wind storms: implications for multi-cohort management.

PubMed

Hanson, Jacob J; Lorimer, Craig G

2007-07-01

Moderate-severity disturbances appear to be common throughout much of North America, but they have received relatively little detailed study compared to catastrophic disturbances and small gap dynamics. In this study, we examined the immediate impact of moderate-intensity wind storms on stand structure, opening sizes, and light regimes in three hemlock-hardwood forests of northeastern Wisconsin. These were compared to three stands managed by single-tree and group selection, the predominant forest management system for northern hardwoods in the region. Wind storms removed an average of 41% of the stand basal area, compared to 27% removed by uneven-aged harvests, but both disturbances removed trees from a wide range of size classes. The removal of nearly half of the large trees by wind in two old-growth stands caused partial retrogression to mature forest structure, which has been hypothesized to be a major disturbance pathway in the region. Wind storms resulted in residual stand conditions that were much more heterogeneous than in managed stands. Gap sizes ranged from less than 10 m2 up to 5000 m2 in wind-disturbed stands, whereas the largest opening observed in managed stands was only 200 m2. Wind-disturbed stands had, on average, double the available solar radiation at the forest floor compared to managed stands. Solar radiation levels were also more heterogeneous in wind-disturbed stands, with six times more variability at small scales (0.1225 ha) and 15 times more variability at the whole-stand level. Modification of uneven-aged management regimes to include occasional harvests of variable intensity and spatial pattern may help avoid the decline in species diversity that tends to occur after many decades of conventional uneven-aged management. At the same time, a multi-cohort system with these properties would retain a high degree of average crown cover, promote structural heterogeneity typical of old-growth forests, and maintain dominance by late-successional species.

Decision Support Systems in the Public Sector; A Cybernetic Model for the Proactive Organization.

DTIC Science & Technology

1987-05-01

other markets; vandalism protection through indoor parking, and anything else that an ingenious personnel manager can concoct. The variable "age of...variable age - •of the labor force is restored to acceptability, there wi±l have teen a mutual adaptation between the company and the labor force. A

Adaptive Tele-Therapies Based on Serious Games for Health for People with Time-Management and Organisational Problems: Preliminary Results

PubMed Central

Frutos-Pascual, Maite; García Zapirain, Begoña; Méndez Zorrilla, Amaia

2014-01-01

Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decision trees within Django, a high-level Python Web framework. The technologies and techniques used were selected so as to boost user involvement and to enable the system to be easily customised. This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD. To do so, we relied on the collection of parameters and the conduct of surveys for assessing time management skills, as well as measuring system usability and availability. The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively. The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100. The creation of a customisable tool capable of working with different skills, in conjunction with the replication of the current study, may help to understand these users’ needs, as well as boosting time management skills among teenagers with and without ADHD. PMID:24402063

Adaptive tele-therapies based on serious games for health for people with time-management and organisational problems: preliminary results.

PubMed

Frutos-Pascual, Maite; Zapirain, Begoña García; Zorrilla, Amaia Méndez

2014-01-07

Attention Deficit with Hyperactivity Disorder (ADHD) is one of the most prevalent disorders within the child population today. Inattention problems can lead to greater difficulties in completing assignments, as well as problems with time management and prioritisation of tasks. This article presents an intelligent tele-therapy tool based on Serious Games for Health, aimed at the improvement of time management skills and the prioritisation of tasks. This tele-system is based on the use of decision trees within Django, a high-level Python Web framework. The technologies and techniques used were selected so as to boost user involvement and to enable the system to be easily customised. This article shows the preliminary results of the pilot-phase in an experiment performed to evaluate the use of adaptive tele-therapies within a group of typically developing children and adolescents aged between 12 and 19 years old without ADHD. To do so, we relied on the collection of parameters and the conduct of surveys for assessing time management skills, as well as measuring system usability and availability. The results of a time management survey highlighted that the users involved in the trial did not use any specific or effective time management techniques, scoring 1.98 and 2.30 out of 5 points in this area for ages under 15 and over 16 years old, respectively. The final calculations based on the usability questionnaire resulted in an average score of 78.75 out of 100. The creation of a customisable tool capable of working with different skills, in conjunction with the replication of the current study, may help to understand these users' needs, as well as boosting time management skills among teenagers with and without ADHD.

Use of HSM with Relational Databases

NASA Technical Reports Server (NTRS)

Breeden, Randall; Burgess, John; Higdon, Dan

1996-01-01

Hierarchical storage management (HSM) systems have evolved to become a critical component of large information storage operations. They are built on the concept of using a hierarchy of storage technologies to provide a balance in performance and cost. In general, they migrate data from expensive high performance storage to inexpensive low performance storage based on frequency of use. The predominant usage characteristic is that frequency of use is reduced with age and in most cases quite rapidly. The result is that HSM provides an economical means for managing and storing massive volumes of data. Inherent in HSM systems is system managed storage, where the system performs most of the work with minimum operations personnel involvement. This automation is generally extended to include: backup and recovery, data duplexing to provide high availability, and catastrophic recovery through use of off-site storage.

Validity of the Family Asthma Management System Scale with an urban African-American sample.

PubMed

Celano, Marianne; Klinnert, Mary D; Holsey, Chanda Nicole; McQuaid, Elizabeth L

2011-06-01

To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Forty-three children, ages 8-13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample.

Sociodemographic inequalities in barriers to cancer pain management: a report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II).

PubMed

Stein, Kevin D; Alcaraz, Kassandra I; Kamson, Chelsey; Fallon, Elizabeth A; Smith, Tenbroeck G

2016-10-01

Research has increasingly documented sociodemographic inequalities in the assessment and management of cancer-related pain. Most studies have focused on racial/ethnic disparities, while less is known about the impact of other sociodemographic factors, including age and education. We analyzed data from a large, national, population-based study of cancer survivors to examine the influence of sociodemographic factors, and physical and mental health comorbidities on barriers to cancer pain management. The study included data from 4707 cancer survivors in the American Cancer Society's Study of Cancer Survivors-II, who reported experiencing pain from their cancer. A multilevel, socioecological, conceptual framework was used to generate a list of 15 barriers to pain management, representing patient, provider, and system levels. Separate multivariable logistic regressions for each barrier identified sociodemographic and health-related inequalities in cancer pain management, controlling for years since diagnosis, disease stage, and cancer treatment. Two-thirds of survivors reported at least 1 barrier to pain management. While patient-related barriers were most common, the greatest disparities were noted in provider- and system-level barriers. Specifically, inequalities by race/ethnicity, education, age, and physical and mental health comorbidities were observed. Findings indicate survivors who were nonwhite, less educated, older, and/or burdened by comorbidities were most adversely affected. Future efforts in research, clinical practice, and policy should identify and/or implement new strategies to address sociodemographic inequalities in cancer pain management. Copyright © 2016 John Wiley & Sons, Ltd.

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

PubMed

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

2017-01-01

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

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

78 FR 21980 - Aging Management of Internal Surfaces, Service Level III and Other Coatings, Atmospheric Storage...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-12

... NUCLEAR REGULATORY COMMISSION [NRC-2013-0068] Aging Management of Internal Surfaces, Service Level... Interim Staff Guidance (LR-ISG), LR-ISG-2012-02, ``Aging Management of Internal Surfaces, Service Level... proposes to revise NRC staff-recommended aging management programs (AMP) and aging management review (AMR...

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider.

PubMed

Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-04-10

There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

PubMed Central

Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

2017-01-01

Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

The aging of America's reservoirs: In-reservoir and downstream physical changes and habitat implications

USGS Publications Warehouse

Juracek, Kyle E.

2015-01-01

Reservoirs are important for various purposes including flood control, water supply, power generation, and recreation. The aging of America's reservoirs and progressive loss of water storage capacity resulting from ongoing sedimentation, coupled with increasing societal needs, will cause the social, economic, environmental, and political importance of reservoirs to continually increase. The short- and medium-term (<50 years) environmental consequences of reservoir construction and operation are well known and include an altered flow regime, lost connectivity (longitudinal, floodplain), an altered sediment regime, substrate compositional change, and downstream channel degradation. In general, reservoir-related changes have had adverse consequences for the natural ecosystem. Longer term (>50 years) environmental changes as reservoirs enter “old” age are less understood. Additional research is needed to help guide the future management of aging reservoir systems and support the difficult decisions that will have to be made. Important research directions include assessment of climate change effects on aging and determination of ecosystem response to ongoing aging and various management actions that may be taken with the intent of minimizing or reversing the physical effects of aging.

Information technology skills and training needs of health information management professionals in Nigeria: a nationwide study.

PubMed

Taiwo Adeleke, Ibrahim; Hakeem Lawal, Adedeji; Adetona Adio, Razzaq; Adisa Adebisi, AbdulLateef

There is a lack of effective health information management systems in Nigeria due to the prevalence of cumbersome paper-based and disjointed health data management systems. This can make informed healthcare decision making difficult. This study examined the information technology (IT) skills, utilisation and training needs of Nigerian health information management professionals. We deployed a cross-sectional structured questionnaire to determine the IT skills and training needs of health information management professionals who have leadership roles in the nation's healthcare information systems (n=374). It was found that ownership of a computer, level of education and age were associated with knowledge and perception of IT. The vast majority of participants (98.8%) acknowledged the importance and relevance of IT in healthcare information systems and many expressed a desire for further IT training, especially in statistical analysis. Despite this, few (8.1 %) worked in settings where such systems operate and there exists an IT skill gap among these professionals which is not compatible with their roles in healthcare information systems. To rectify this anomaly they require continuing professional development education, especially in the areas of health IT. Government intervention in the provision of IT infrastructure in order to put into practice a computerised healthcare information system would therefore be a worthwhile undertaking.

Unintended adverse consequences of introducing electronic health records in residential aged care homes.

PubMed

Yu, Ping; Zhang, Yiting; Gong, Yang; Zhang, Jiajie

2013-09-01

The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A deterministic computer simulation model of life-cycle lamb and wool production.

PubMed

Wang, C T; Dickerson, G E

1991-11-01

A deterministic mathematical computer model was developed to simulate effects on life-cycle efficiency of lamb and wool production from genetic improvement of performance traits under alternative management systems. Genetic input parameters can be varied for age at puberty, length of anestrus, fertility, precocity of fertility, number born, milk yield, mortality, growth rate, body fat, and wool growth. Management options include mating systems, lambing intervals, feeding levels, creep feeding, weaning age, marketing age or weight, and culling policy. Simulated growth of animals is linear from birth to inflection point, then slows asymptotically to specified mature empty BW and fat content when nutrition is not limiting. The ME intake requirement to maintain normal condition is calculated daily or weekly for maintenance, protein and fat deposition, wool growth, gestation, and lactation. Simulated feed intake is the minimum of availability, DM physical limit, or ME physiological limit. Tissue catabolism occurs when intake is below the requirement for essential functions. Mortality increases when BW is depressed. Equations developed for calculations of biological functions were validated with published and unpublished experimental data. Lifetime totals are accumulated for TDN, DM, and protein intake and for market lamb equivalent output values of empty body or carcass lean and wool from both lambs and ewes. These measures of efficiency for combinations of genetic, management, and marketing variables can provide the relative economic weighting of traits needed to derive optimal criteria for genetic selection among and within breeds under defined industry production systems.

Prediction uncertainty and data worth assessment for groundwater transport times in an agricultural catchment

NASA Astrophysics Data System (ADS)

Zell, Wesley O.; Culver, Teresa B.; Sanford, Ward E.

2018-06-01

Uncertainties about the age of base-flow discharge can have serious implications for the management of degraded environmental systems where subsurface pathways, and the ongoing release of pollutants that accumulated in the subsurface during past decades, dominate the water quality signal. Numerical groundwater models may be used to estimate groundwater return times and base-flow ages and thus predict the time required for stakeholders to see the results of improved agricultural management practices. However, the uncertainty inherent in the relationship between (i) the observations of atmospherically-derived tracers that are required to calibrate such models and (ii) the predictions of system age that the observations inform have not been investigated. For example, few if any studies have assessed the uncertainty of numerically-simulated system ages or evaluated the uncertainty reductions that may result from the expense of collecting additional subsurface tracer data. In this study we combine numerical flow and transport modeling of atmospherically-derived tracers with prediction uncertainty methods to accomplish four objectives. First, we show the relative importance of head, discharge, and tracer information for characterizing response times in a uniquely data rich catchment that includes 266 age-tracer measurements (SF6, CFCs, and 3H) in addition to long term monitoring of water levels and stream discharge. Second, we calculate uncertainty intervals for model-simulated base-flow ages using both linear and non-linear methods, and find that the prediction sensitivity vector used by linear first-order second-moment methods results in much larger uncertainties than non-linear Monte Carlo methods operating on the same parameter uncertainty. Third, by combining prediction uncertainty analysis with multiple models of the system, we show that data-worth calculations and monitoring network design are sensitive to variations in the amount of water leaving the system via stream discharge and irrigation withdrawals. Finally, we demonstrate a novel model-averaged computation of potential data worth that can account for these uncertainties in model structure.

The development of uneven-aged southern pine silviculture before the Crossett Experimental Forest (Arkansas, USA)

Treesearch

Don C. Bragg

2017-01-01

Although the Crossett Experimental Forest (CEF) played a well-publicized role in the development of uneven-aged southern pine silviculture, work on a selection method in Arkansas (USA) did not originate there. In 1925, Leslie Pomeroy and Eugene Connor acquired the Ozark Badger Lumber Company and initiated an expert-driven selection management system compatible with...

Influence of reproduction cutting methods on structure, growth and regeneration of longleaf pine forests in flatwoods and uplands

Treesearch

Dale G. Brockway; Kenneth W. Outcalt

2017-01-01

Though longleaf pine (Pinus palustris Mill.) forests have been primarily managed with even-aged methods, interest is increasing in uneven-aged systems, as a means of achieving a wider range of stewardship goals. Selection silviculture has been practiced on a limited scale in longleaf pine, but difficulty with using traditional approaches and...

Caring for people with chronic disease: is 'muddling through' the best way to handle the multiple complexities?

PubMed

Sturmberg, Joachim P

2012-12-01

It is stated everywhere that chronic care poses one of the biggest challenges for the future of medicine. Critical analysis however suggests that these statements are oversimplistic and based on limited, and at times, spurious assumptions. This paper highlights some basic realities: epidemiology shows that at any time, 80% of people experience 'good enough health', and that only 0.8% require tertiary medical care; most people with chronic conditions experience a stable illness trajectory; 'true' multi-morbidity is a pattern of advanced age; ageing and the physiological decline of our organ systems is a slow and steady process starting at the age of 30; and, as our health declines in a variety of patterns with disease and ageing, our psycho-socio-semiotic care needs increase dramatically. I argue that managing the complexities associated with chronic disease care successfully requires an equally complex management approach, 'muddling through', defined by Lindblom as making decisions based on successive limited comparisons. Our patients - rightly - expect that we make these decisions in their best interest. Individual health care professionals and health care policy makers firmly need to put the patient at the centre of the health care system. © 2012 Blackwell Publishing Ltd.

Residual tree damage during selection cuts using two skidding systems in the Missouri Ozarks

Treesearch

Robert L. Ficklin; John P. Dwyer; Bruce E. Cutter; Tom Draper

1997-01-01

Today, there is an interest in using alternative silvicultural systems like selection and two-aged management, because the public finds these systems more acceptable than clearcutting. However, repeated entries into forest stands to remove timber increase the risk of residual stand damage. Harvest techniques are desirable that (1) reduce the risk of stand damage and (2...

Ageing management program for the Spanish low and intermediate level waste disposal and spent fuel and high-level waste centralised storage facilities

NASA Astrophysics Data System (ADS)

Zuloaga, P.; Ordoñez, M.; Andrade, C.; Castellote, M.

2011-04-01

The generic design of the centralised spent fuel storage facility was approved by the Spanish Safety Authority in 2006. The planned operational life is 60 years, while the design service life is 100 years. Durability studies and surveillance of the behaviour have been considered from the initial design steps, taking into account the accessibility limitations and temperatures involved. The paper presents an overview of the ageing management program set in support of the Performance Assessment and Safety Review of El Cabril low and intermediate level waste (LILW) disposal facility. Based on the experience gained for LILW, ENRESA has developed a preliminary definition of the Ageing Management Plan for the Centralised Interim Storage Facility of spent Fuel and High Level Waste (HLW), which addresses the behaviour of spent fuel, its retrievability, the confinement system and the reinforced concrete structure. It includes tests plans and surveillance design considerations, based on the El Cabril LILW disposal facility.

Immunization Information System and Informatics to Promote Immunizations: Perspective From Minnesota Immunization Information Connection.

PubMed

Muscoplat, Miriam Halstead; Rajamani, Sripriya

2017-01-01

The vision for management of immunization information is availability of real-time consolidated data and services for all ages, to clinical, public health, and other stakeholders. This is being executed through Immunization Information Systems (IISs), which are population-based and confidential computerized systems present in most US states and territories. Immunization Information Systems offer many functionalities, such as immunization assessment reports, client follow-up, reminder/recall feature, vaccine management tools, state-supplied vaccine ordering, comprehensive immunization history, clinical decision support/vaccine forecasting and recommendations, data processing, and data exchange. This perspective article will present various informatics tools in an IIS, in the context of the Minnesota Immunization Information Connection.

Beliefs and Attitudes Associated with ERP Adoption Behaviours: A Grounded Theory Study from IT Manager and End-user Perspectives

NASA Astrophysics Data System (ADS)

Arunthari, Santipat; Hasan, Helen

(1998, p. 121) defines an Enterprise Resource Planning (ERP) system as an enterprise system that promises seamless integration of all information flowing through a company, including financial and accounting information, human resource information, supply chain information, customer information. ERP systems came on the scene in the early 1990s as a response to the proliferation of standalone business applications to service these separate information needs in most large organisations. Enterprise wide projects, such as data warehousing, requiring integrated approaches to organisational operations and information management were inhibited through a proliferation of incompatible off-the-shelf packages, in-house developments and aging legacy systems.

Risk assessment of sewer condition using artificial intelligence tools: application to the SANEST sewer system.

PubMed

Sousa, V; Matos, J P; Almeida, N; Saldanha Matos, J

2014-01-01

Operation, maintenance and rehabilitation comprise the main concerns of wastewater infrastructure asset management. Given the nature of the service provided by a wastewater system and the characteristics of the supporting infrastructure, technical issues are relevant to support asset management decisions. In particular, in densely urbanized areas served by large, complex and aging sewer networks, the sustainability of the infrastructures largely depends on the implementation of an efficient asset management system. The efficiency of such a system may be enhanced with technical decision support tools. This paper describes the role of artificial intelligence tools such as artificial neural networks and support vector machines for assisting the planning of operation and maintenance activities of wastewater infrastructures. A case study of the application of this type of tool to the wastewater infrastructures of Sistema de Saneamento da Costa do Estoril is presented.

Characteristics of Pregnant Teen Substance Abuse Treatment Admissions

MedlinePlus

... Set (TEDS) is an administrative data system providing descriptive information about the national flow of admissions aged ... Management Decisions, Inc., Arlington, VA; and RTI International, Research Triangle Park, NC. Information and data for this ...

A guide to the clinical management of attrition.

PubMed

Rees, J S; Somi, S

2018-03-09

Attrition is an enigmatic condition often found in older individuals and often as a result of bruxism which can take place as a result of either day bruxism, night bruxism or both. Various studies and systemic reviews clearly shown that tooth wear is an age-related phenomena and the last Adult Dental Health Survey showed that 15% of participants showed moderate wear and 3% severe wear with 80% of patients over 50 years of age showing signs of wear. This review examines current theories around the aetiological factors contributing to attrition together with the clinical management of attrition focusing on minimal intervention where possible.

Frequency Domain Reflectometry NDE for Aging Cables in Nuclear Power Plants

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

Glass, Samuel W.; Jones, Anthony M.; Fifield, Leonard S.

Cable insulation polymers are among the more susceptible materials to age-related degradation within a nuclear power plant. This is recognized by both regulators and utilities, so all plants have developed cable aging management programs to detect damage before critical component failure in compliance with regulatory guidelines. Although a wide range of tools are available to evaluate cables and cable systems, cable aging management programs vary in how condition monitoring and nondestructive examinations are conducted as utilities search for the most reliable and cost-effective ways to assess cable system condition. Frequency domain reflectometry (FDR) is emerging as one valuable tool tomore » locate and assess damaged portions of a cable system with minimal cost and only requires access in most cases to one of the cable terminal ends. Since laboratory studies to evaluate the use of FDR for inspection of aged cables can be expensive and data interpretation may be confounded by multiple factors which influence results, a model-based approach is desired to parametrically investigate the effect of insulation material damage in a controlled manner. This work describes development of a physics-based FDR model which uses finite element simulations of cable segments in conjunction with cascaded circuit element simulations to efficiently study a cable system. One or more segments of the cable system model have altered physical or electrical properties which represent the degree of damage and the location of the damage in the system. This circuit model is then subjected to a simulated FDR examination. The modeling approach is verified using several experimental cases and by comparing it to a commercial simulator suitable for simulation of some cable configurations. The model is used to examine a broad range of parameters including defect length, defect profile, degree of degradation, number and location of defects, FDR bandwidth, and addition of impedance-matched extensions to minimize the end-shadow effect.« less

Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review.

PubMed

Pinazo-Durán, María D; Zanón-Moreno, Vicente; García-Medina, José J; Arévalo, J Fernando; Gallego-Pinazo, Roberto; Nucci, Carlo

2016-01-01

Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients.

Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review

PubMed Central

Zanón-Moreno, Vicente; García-Medina, José J.; Arévalo, J. Fernando; Gallego-Pinazo, Roberto; Nucci, Carlo

2016-01-01

Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients. PMID:27051666

Silvicultural systems and cutting methods for ponderosa pine forests in the Front Range of the central Rocky Mountains

Treesearch

Robert R. Alexander

1986-01-01

Guidelines are provided to help forest managers and silviculturists develop even- and/or uneven-aged cutting practices needed to convert old-growth and mixed ponderosa pine forests in the Front Range into managed stands for a variety of resource needs. Guidelines consider stand conditions, and insect and disease susceptibility. Cutting practices are designed to...

Effects of basal area on survival and growth of longleaf pine when practicing selection silviculture

Treesearch

Ferhat Kara; Edward F. Loewenstein; Dale G. Brockway

2017-01-01

Aim of study: Uneven-aged (UEA) management systems can achieve multiple-use objectives, however, use of UEA techniques to manage longleaf pine (Pinus palustris Mill.) forests are still open to question, because of the species’ intolerance of competition. It was our aim to examine the influence of different levels (9.2, 13.8 and...

How to Implement the Ways of Knowing through the Realms of Meaning in Human Resource Management: Ten Recommendations for Selecting Campus Administrators

ERIC Educational Resources Information Center

Jacobs, Karen Dupre; Kritsonis, William Allan

2006-01-01

Human resource management in education is a vital function of hiring, developing, nurturing, and sustaining highly-qualified personnel for the school system. In an age where strong accountability measures are in place, school districts across America must become aware of the types of teachers and administrative staff being selected and retained…

[Stress management for office workers].

PubMed

Hayashi, Takeshi

2002-09-01

The environment which surrounds office workers has undergone a big transformation with the collapse of lifetime employment, the shift from the long employment principle to meritocracy, the results principle, the introduction of flexible work hours, outsourcing and dispatch work. Today's office worker stressor include 1. VDT work, 2. meritocracy, 3. management by objective, 4. excessive load on the middle and advanced age generations, 5. the collapse of the lifetime employment system and 6. non-employee changes. (1) VDT work management, (2) the use of Information technology, (3) Improvement of office environments, (4) Management of long overtime work and (5) Support of superiors and colleagues are thought as stress management.

Intra-abdominal solid organ injuries: an enhanced management algorithm.

PubMed

Kokabi, Nima; Shuaib, Waqas; Xing, Minzhi; Harmouche, Elie; Wilson, Kenneth; Johnson, Jamlik-Omari; Khosa, Faisal

2014-11-01

The organ injury scale grading system proposed by the American Association for the Surgery of Trauma provides guidelines for operative versus nonoperative management in solid organ injuries; however, major shortcomings of the American Association for the Surgery of Trauma injury scale may become apparent with low-grade injuries, in which conservative management may fail. Nonoperative management of common intra-abdominal solid organ injuries relies increasingly on computed tomographic findings and other clinical factors, including patient age, presence of concurrent injuries, and serial clinical assessments. Familiarity with characteristic imaging features is essential for the prompt diagnosis and appropriate treatment of blunt abdominal trauma. In this pictorial essay, the spectrum of the American Association for the Surgery of Trauma organ injury scale grading system is illustrated, and a multidisciplinary management algorithm for common intra-abdominal solid organ injuries is proposed. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Benefits of information technology-enabled diabetes management.

PubMed

Bu, Davis; Pan, Eric; Walker, Janice; Adler-Milstein, Julia; Kendrick, David; Hook, Julie M; Cusack, Caitlin M; Bates, David W; Middleton, Blackford

2007-05-01

To determine the financial and clinical benefits of implementing information technology (IT)-enabled disease management systems. A computer model was created to project the impact of IT-enabled disease management on care processes, clinical outcomes, and medical costs for patients with type 2 diabetes aged >25 years in the U.S. Several ITs were modeled (e.g., diabetes registries, computerized decision support, remote monitoring, patient self-management systems, and payer-based systems). Estimates of care process improvements were derived from published literature. Simulations projected outcomes for both payer and provider organizations, scaled to the national level. The primary outcome was medical cost savings, in 2004 U.S. dollars discounted at 5%. Secondary measures include reduction of cardiovascular, cerebrovascular, neuropathy, nephropathy, and retinopathy clinical outcomes. All forms of IT-enabled disease management improved the health of patients with diabetes and reduced health care expenditures. Over 10 years, diabetes registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer-centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million, and integrated provider-patient systems saved $16.9 billion. IT-enabled diabetes management has the potential to improve care processes, delay diabetes complications, and save health care dollars. Of existing systems, provider-centered technologies such as diabetes registries currently show the most potential for benefit. Fully integrated provider-patient systems would have even greater potential for benefit. These benefits must be weighed against the implementation costs.

Integrated software system for low level waste management

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

Worku, G.

1995-12-31

In the continually changing and uncertain world of low level waste management, many generators in the US are faced with the prospect of having to store their waste on site for the indefinite future. This consequently increases the set of tasks performed by the generators in the areas of packaging, characterizing, classifying, screening (if a set of acceptance criteria applies), and managing the inventory for the duration of onsite storage. When disposal sites become available, it is expected that the work will require re-evaluating the waste packages, including possible re-processing, re-packaging, or re-classifying in preparation for shipment for disposal undermore » the regulatory requirements of the time. In this day and age, when there is wide use of computers and computer literacy is at high levels, an important waste management tool would be an integrated software system that aids waste management personnel in conducting these tasks quickly and accurately. It has become evident that such an integrated radwaste management software system offers great benefits to radwaste generators both in the US and other countries. This paper discusses one such approach to integrated radwaste management utilizing some globally accepted radiological assessment software applications.« less

The Utility of Discriminant Analysis for Predicting Farmers' Intentions to Participate in Farmer-Managed Irrigation Systems in Iran

NASA Astrophysics Data System (ADS)

Zarafshani, Kiumars; Hossien Alibaygi, Amir; Afshar, Nasrin

Participatory irrigation management has been problematic in most parts of the world and Iran has been no exception. The purpose of this study was to assess farmers' intentions to participate in irrigation management based on selected variables using discriminant analysis. A survey questionnaire was used to collect information from a sample of Water Cooperatives in Javanrood Townships using stratified random sampling (n = 106). Results indicated that age, educational level, attitude towards PIM, irrigation performance, landholding size, agricultural and non-agricultural income affected farmers' intentions to participate in irrigation management.

A Metasynthesis of Factors Affecting Self-Management of Chronic Illness

PubMed Central

SCHULMAN-GREEN, Dena; JASER, Sarah S.; PARK, Chorong; WHITTEMORE, Robin

2015-01-01

Aim To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis. Background Self-management is an individuals’ active management of a chronic illness in collaboration with their family members and clinicians. Design Qualitative metasynthesis. Data Sources We analyzed studies (N=53) published between January 2000–May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness. Review Methods Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis; and synthesis of findings. Results Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes (N=28) and cardiovascular disease (N=20). Participants included men and women (mean age=57, range 18–94) from twenty countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier). Conclusion Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals’ needs and improve health outcomes. PMID:26781649

Imaging informatics-based multimedia ePR system for data management and decision support in rehabilitation research

NASA Astrophysics Data System (ADS)

Wang, Ximing; Verma, Sneha; Qin, Yi; Sterling, Josh; Zhou, Alyssa; Zhang, Jeffrey; Martinez, Clarisa; Casebeer, Narissa; Koh, Hyunwook; Winstein, Carolee; Liu, Brent

2013-03-01

With the rapid development of science and technology, large-scale rehabilitation centers and clinical rehabilitation trials usually involve significant volumes of multimedia data. Due to the global aging crisis, millions of new patients with age-related chronic diseases will produce huge amounts of data and contribute to soaring costs of medical care. Hence, a solution for effective data management and decision support will significantly reduce the expenditure and finally improve the patient life quality. Inspired from the concept of the electronic patient record (ePR), we developed a prototype system for the field of rehabilitation engineering. The system is subject or patient-oriented and customized for specific projects. The system components include data entry modules, multimedia data presentation and data retrieval. To process the multimedia data, the system includes a DICOM viewer with annotation tools and video/audio player. The system also serves as a platform for integrating decision-support tools and data mining tools. Based on the prototype system design, we developed two specific applications: 1) DOSE (a phase 1 randomized clinical trial to determine the optimal dose of therapy for rehabilitation of the arm and hand after stroke.); and 2) NEXUS project from the Rehabilitation Engineering Research Center(RERC, a NIDRR funded Rehabilitation Engineering Research Center). Currently, the system is being evaluated in the context of the DOSE trial with a projected enrollment of 60 participants over 5 years, and will be evaluated by the NEXUS project with 30 subjects. By applying the ePR concept, we developed a system in order to improve the current research workflow, reduce the cost of managing data, and provide a platform for the rapid development of future decision-support tools.

A Comparative Study of Major OPACs in Selected Academic Libraries for Developing Countries: User Study and Subjective User Evaluation.

ERIC Educational Resources Information Center

Park, Iljong

1997-01-01

A study of five Texas academic libraries provided information on OPAC use by Korean college students to assist system managers select OPACs. The study determined that academic level and age influence preference for the type of OPAC system, that more specific search instructions are needed, and that system menus were the most commonly used source…

78 FR 21623 - Public Housing Assessment System (PHAS): Capital Fund Final Scoring Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... PHAs from making improvements to the nation's aging stock and unfairly punishes PHAs for well-managed... that PHAs with active and on-schedule construction contracts should be able to exclude vacancies for...

Prognostics for Electronics Components of Avionics Systems

NASA Technical Reports Server (NTRS)

Celaya, Jose R.; Saha, Bhaskar; Wysocki, Philip F.; Goebel, Kai F.

2009-01-01

Electronics components have and increasingly critical role in avionics systems and for the development of future aircraft systems. Prognostics of such components is becoming a very important research filed as a result of the need to provide aircraft systems with system level health management. This paper reports on a prognostics application for electronics components of avionics systems, in particular, its application to the Isolated Gate Bipolar Transistor (IGBT). The remaining useful life prediction for the IGBT is based on the particle filter framework, leveraging data from an accelerated aging tests on IGBTs. The accelerated aging test provided thermal-electrical overstress by applying thermal cycling to the device. In-situ state monitoring, including measurements of the steady-state voltages and currents, electrical transients, and thermal transients are recorded and used as potential precursors of failure.

Electronic data collection and management system for global adult tobacco survey.

PubMed

Pujari, Sameer J; Palipudi, Krishna M; Morton, Jeremy; Levinsohn, Jay; Litavecz, Steve; Green, Michael

2012-01-01

Portable handheld computers and electronic data management systems have been used for national surveys in many high-income countries, however their use in developing countries has been challenging due to varying geographical, economic, climatic, political and cultural environments. In order to monitor and measure global adult tobacco use, the World Health Organization and the US Centers for Disease Control and Prevention initiated the Global Adult Tobacco Survey, a nationally representative household survey of adults, 15 years of age or older, using a standard core questionnaire, sample design, and data collection and management procedures. The Survey has been conducted in 14 low- and middle-income countries, using an electronic data collection and management system. This paper describes implementation of the electronic data collection system and associated findings. The Survey was based on a comprehensive data management protocol, to enable standardized, globally comparable high quality data collection and management. It included adaptation to specific country needs, selection of appropriate handheld hardware devices, use of open source software, and building country capacity and provide technical support. In its first phase, the Global Adult Tobacco Survey was successfully conducted between 2008 and 2010, using an electronic data collection and management system for interviews in 302,800 households in 14 countries. More than 2,644 handheld computers were fielded and over 2,634 fieldworkers, supervisors and monitors were trained to use them. Questionnaires were developed and programmed in 38 languages and scripts. The global hardware failure rate was < 1% and data loss was almost 0%. Electronic data collection and management systems can be used effectively for conducting nationally representative surveys, particularly in low- and middle-income countries, irrespective of geographical, climatic, political and cultural environments, and capacity-building at the country level is an important vehicle for Health System Strengthening.

Technology assessment and requirements analysis: a process to facilitate decision making in picture archiving and communications system implementation.

PubMed

Radvany, M G; Chacko, A K; Richardson, R R; Grazdan, G W

1999-05-01

In a time of decreasing resources, managers need a tool to manage their resources effectively, support clinical requirements, and replace aging equipment in order to ensure adequate clinical care. To do this successfully, one must be able to perform technology assessment and capital equipment asset management. The lack of a commercial system that adequately performed technology needs assessment and addressed the unique needs of the military led to the development of an in-house Technology Assessment and Requirements Analysis (TARA) program. The TARA is a tool that provides an unbiased review of clinical operations and the resulting capital equipment requirements for military hospitals. The TARA report allows for the development of acquisition strategies for new equipment, enhances personnel management, and improves and streamlines clinical operations and processes.

Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review.

PubMed

Dwyer, Drew

2011-12-01

The phenomenon of an ageing population is being experienced globally, as countries struggle to change and improve residential models of care and provide services to the elderly. The role of the registered nurse (RN) is considered crucial to the clinical governance and management of care given. To date, however, no systematic review has examined the RN's experience in leadership and management. The objective of this review is to critically appraise, synthesise and present best available evidence on the experiences of RNs as clinical leaders and managers in residential aged care facilities. This review considered qualitative research papers that addressed the experiences of RNs as clinical leaders and managers in residential aged care facilities. Participants of interest were RNs, nurse leaders, nurses holding registration and or regulation under a board of nursing, nurses working in residential aged care and long-term care facilities. The diversity and use of language to describe nurses' roles and models of care for the elderly care environment were considered in the review. The search strategy sought to find both published studies and papers, limited to the English language and published between January 1997 and February 2011. An initial limited search was done in Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature databases to identify the key words contained in the title or abstract and index terms used to describe the relevant terms in the article. A second extensive search was undertaken and extended to other relevant databases using all identified keywords and index terms. The third step involved searching reference lists and bibliographies of chosen articles for additional studies. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appropriate critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information package. As both reviewers were in agreement on all studies included, a third reviewer was not required. A final total of eight papers, qualitative in nature, were included in the review. The majority of papers examined the experiences of nurses' leadership styles and the management characteristics within their organisations. The qualitative papers were analysed using The Joanna Briggs Institute-Qualitative Assessment and Review Instrument.The process of meta-synthesis embodied in this programme involves the aggregation or synthesis of findings or conclusions. Five syntheses were derived with key themes related to education, professional nursing development, positive attitudes to aged care and the need for a supportive environment. Nurses that work in the aged care environment show a strong motivation to work in care and provide the best outcomes in nursing the elderly. Geriatric nursing is considered a specialised and complex area of healthcare by the nursing profession. Nurses experience a lack of professional support and collaboration from allied health and medical colleagues. There is a lack of specific education that is focused in clinical leadership and health team management. There is no current structured pathway of learning and development for nursing careers in aged care. Nurses identify with their leadership role in residential aged care, and experience paradoxical feelings of being valued by the clients and devalued by the system at the same time. Organisational barriers are strong in preventing continuing education and skills development for nurse leaders in aged care environments. Overall the themes presented in the review reported the negative experiences of nurses in residential aged care and geriatrics. Nurses will continue to be devalued if there is no professional identity and support for their roles and need to have a career pathway when making the decision to enter into aged and geriatric practice. Clinical leadership training is needed for nurses to transition through practice into specialised roles such as the RN team leader and Geriatric Nurse Practitioner (GNP). Providing a career structure and choice in the industry for the nurse to become a clinical leader or a manager of health services will improve recruitment and retention. IMPLICATION FOR RESEARCH: More research is needed to identify the skills gaps experienced by nurses in aged care and geriatric care. This research could lead to the design and implementation of a skills audit to identify candidates for specialised courses so that clinical leadership and governance in aged care are improved. More research is needed for role construction and the professional development of the GNP. Organisations can benefit from research currently being conducted on the role of the RN in aged care and geriatrics, by mapping the skills mix of candidate RNs to the key performance indicators in the role. Organisations must change their perception and value of RNs as clinical leaders in care teams. 2011 The Author. International Journal of Evidence-Based Healthcare. 2011 The Joanna Briggs Institute.

Total Quality Management: A Guide to Implementation

DTIC Science & Technology

1989-08-01

Kaizen. New York: Random House. 1986. Ishikawa , Kaoru . Guide to Quality Control. Asian Productivity Organization. 1984. Ishikawa , Kaoru . What is Total...with the problems and the new management principles are based on the complexities of the new Systems Age. The theories of Deming, Juran, Ishikawa , and...Progress. Jun 1985. Miller, Jeffery G. and Thomas E. Vollmann. "The Hidden Factory." Harvard Business Review. Sep-Oct 1985. Shimoyamada, Kaoru . "The

75 FR 7212 - Definition of “Reasonable Factors Other Than Age” Under the Age Discrimination in Employment Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-18

...' were ubiquitous components of `systems for making personnel decisions' ''), vacated and remanded, 128 S... discrimination by lower-level managers given unchecked discretion to engage in subjective decision making needs... system of subjective decision-making' '') (quoting Stout v. Potter, 276 F.3d 118, 1124 (9th Cir. 2002...

Nurses' experiences of practice and political reform in long-term aged care in Australia: implications for the retention of nursing personnel.

PubMed

Venturato, Lorraine; Kellett, Ursula; Windsor, Carol

2007-01-01

The aim of the study was to explore registered nurses' experiences in long-term aged care in light of the political reform of aged care services in Australia. In Australia, the aged care industry has undergone a lengthy period of political and structural reform. Despite reviews into various aspects of these reforms, there has been little consideration of the effect these are having on the practice experiences and retention of nursing staff in long-term care. In this critical hermeneutic study, 14 nurses from long-term care facilities in Australia were interviewed about their experiences during the reform period. The data revealed a sense of tension and conflict between nurses' traditional values, roles and responsibilities and those supported by the reforms. Nurses struggled to re-negotiate both their practice roles and values as the reforms were implemented and the system evolved. Nursing management support was an important aspect in mediating the effect of reforms on nursing staff. This research highlights both the tensions experienced by nurses in long-term aged care in Australia and the need to re-negotiate nursing roles, responsibilities and values within an evolving care system. This research supports a role for sensitive and proactive nursing management during periods of industry reform as a retention strategy for qualified nursing personnel.

Factors affecting the sustainability of solid waste management system-the case of Palestine.

PubMed

Al-Khateeb, Ammar J; Al-Sari, Majed I; Al-Khatib, Issam A; Anayah, Fathi

2017-02-01

Understanding the predictors of sustainability in solid waste management (SWM) systems can significantly contribute to eliminate many waste management problems. In this paper, the sustainability elements of SWM systems of interest are (1) attitudes toward separation at the source, (2) behaviour regarding reuse and/or recycling and (3) willingness to pay for an improved service of SWM. The predictors affecting these three elements were studied in two Palestinian cities: Ramallah and Jericho. The data were collected via structured questionnaires and direct interviews with the respondents, and the analysis utilized a logistic regression model. The results showed that the place of residence and dwelling premises are the significant factors influencing attitudes toward separation at the source; the place of residence and age are the significant factors explaining behaviour regarding reuse and/or recycling; while the dwelling premises, gender, level of education and being received education on waste management are the significant factors affecting willingness to pay for an improved service of SWM.

Validity of the Family Asthma Management System Scale with an Urban African-American Sample

PubMed Central

Klinnert, Mary D.; Holsey, Chanda Nicole; McQuaid, Elizabeth L.

2011-01-01

Objective To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Methods Forty-three children, ages 8–13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. Results The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. Conclusions The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample. PMID:19776230

Water Infrastructure Asset Management Primer (WERF Report INFR9SG09b)

EPA Science Inventory

Abstract: Water infrastructure systems are essential for sustaining societal quality of life. However, they face a variety of challenges and potential threats to sustained performance, including aging, deterioration, underfunding, disruptive events, and population growth, among ...

77 FR 41457 - Aging Management Associated With Wall Thinning Due to Erosion Mechanisms

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-13

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0170] Aging Management Associated With Wall Thinning Due... management program (AMP) in NUREG-1801, Revision 2, ``Generic Aging Lessons Learned (GALL) Report,'' and the NRC staff's aging management review procedure and acceptance criteria contained in NUREG-1800...

KEY ITEMS OF INNOVATION MANAGEMENT IN THE PRIMARY HEALTHCARE CENTRES CASE STUDY: FINLAND.

PubMed

Aslani, Alireza; Zolfagharzadeh, Mohammad Mahdi; Naaranoja, Marja

2015-09-01

Trends such as aging populations, excess costs, rising public expectations, and progress in medical science and technologies point out the necessity of adaptation and development of innovation in the healthcare systems particularly in developed countries. The main objective of this article is to review diffusion of innovation in the healthcare sector. Different types of innovation, diffusion characteristics, and adoption mechanisms are the subjects that are discussed in the selected case study, Finland. Finally, the key items of innovation management in the Finnish health system are introduced. The results can be implemented in other countries as well.

Intelligent assistant carer for active aging

NASA Astrophysics Data System (ADS)

Bizjak, Jani; Gradišek, Anton; Stepančič, Luka; Gjoreski, Hristijan; Gams, Matjaž

2017-12-01

We present the concept of an Intelligent Assistant Carer system for the elderly, designed to help with active aging and to facilitate the interactions with carers. The system is modular, allowing the users to choose the appropriate functions according to their needs, and is built on an open platform in order to make it compatible with third-party products and services. Currently, the system consists of a wearable device (a smartwatch) and an internet portal that manages the data and takes care of the interactions between the user, the carers, and the support services. We present in detail one of the modules, i.e., fall detection, and the results of a pilot study for the system on 150 users over the course of 3 months.

77 FR 27815 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0256] Aging Management of Stainless Steel Structures and... Guidance (LR-ISG), LR-ISG-2011-01, ``Aging Management of Stainless Steel Structures and Components in...) Report for the aging management of stainless steel structures and components exposed to treated borated...

77 FR 74883 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water; Revision 1

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-18

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0256] Aging Management of Stainless Steel Structures and..., ``Aging Management of Stainless Steel Structures and Components in Treated Borated Water,'' which was... Staff Guidance LR-ISG-2011-01, ``Aging Management of Stainless Steel Structures and Components in...

mHealth For Aging China: Opportunities and Challenges.

PubMed

Sun, Jing; Guo, Yutao; Wang, Xiaoning; Zeng, Qiang

2016-01-01

The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries.

Cluster Randomized Controlled Trial of An Aged Care Specific Leadership and Management Program to Improve Work Environment, Staff Turnover, and Care Quality.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Li, Zhicheng; Cunich, Michelle M; Thomas, Tamsin H; Chenoweth, Lynn; Kendig, Hal L

2015-07-01

To evaluate the effectiveness of a leadership and management program in aged care. Double-blind cluster randomized controlled trial. Twelve residential and community-aged care sites in Australia. All care staff employed for 6 months or longer at the aged care sites were invited to participate in the surveys at 3 time points: baseline (time 1), 9 months from baseline (time 2), and 9 months after completion of time 2 (time 3) from 2011 to 2013. At each time point, at least 500 care staff completed a survey. At baseline (N = 503) the largest age group was 45 to 54 years (37%), and the majority of care staff were born in Australia (70%), spoke English (94%), and had at least completed secondary education (57%). A 12-month Clinical Leadership in Aged Care (CLiAC) program for middle managers, which aimed to further develop their leadership and management skills in creating positive workplace relationships and in enabling person-centered, evidence-based care. The primary outcomes were care staff ratings of the work environment, care quality and safety, and staff turnover rates. Secondary outcomes were care staff's intention to leave their employer and profession, workplace stress, job satisfaction, and cost-effectiveness of implementing the program. Absenteeism was excluded due to difficulty in obtaining reliable data. Managers' self-rated knowledge and skills in leadership and management are not included in this article, which focuses on care staff perceptions only. At 6 months after its completion, the CLiAC program was effective in improving care staff's perception of management support [mean difference 0.61, 95% confidence interval (CI) 0.04-1.18; P = .04]. Compared with the control sites, care staff at the intervention sites perceived their managers' leadership styles as more transformational (mean difference 0.30, 95% CI 0.09-0.51; P = .005), transactional (mean difference 0.22, 95% CI 0.05-0.39; P = .01), and less passive avoidant (mean difference 0.30, 95% CI 0.07-0.52; P = .01); and were rated higher on the overall leadership outcomes (mean difference 0.35, 95% CI 0.13-0.56; P = .001) as well as individual manager outcomes: extra effort (P = .004), effectiveness (P = .001), and satisfaction (P = .01). There was no evidence that CLiAC was effective in reducing staff turnover, or improving patient care quality and safety. While the CLiAC leadership program had direct impact on the primary process outcomes (management support, leadership actions, behaviors, and effects), this was insufficient to change the systems required to support care service quality and client safety. Nevertheless, the findings send a strong message that leadership and management skills in aged care managers can be nurtured and used to change leadership behaviors at a reasonable cost. Copyright © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

NASA C-17 Usage Overview

NASA Technical Reports Server (NTRS)

Miller, Christopher R.

2008-01-01

The usage and integrated vehicle health management of the NASA C-17. Propulsion health management flight objectives for the aircraft include mapping of the High Pressure Compressor in order to calibrate a Pratt and Whitney engine model and the fusion of data collected from existing sensors and signals to develop models, analysis methods and information fusion algorithms. An additional health manage flight objective is to demonstrate that the Commercial Modular Aero-Propulsion Systems Simulation engine model can successfully execute in real time onboard the C-17 T-1 aircraft using engine and aircraft flight data as inputs. Future work will address aircraft durability and aging, airframe health management, and propulsion health management research in the areas of gas path and engine vibration.

Global sensitivity analysis of water age and temperature for informing salmonid disease management

NASA Astrophysics Data System (ADS)

Javaheri, Amir; Babbar-Sebens, Meghna; Alexander, Julie; Bartholomew, Jerri; Hallett, Sascha

2018-06-01

Many rivers in the Pacific Northwest region of North America are anthropogenically manipulated via dam operations, leading to system-wide impacts on hydrodynamic conditions and aquatic communities. Understanding how dam operations alter abiotic and biotic variables is important for designing management actions. For example, in the Klamath River, dam outflows could be manipulated to alter water age and temperature to reduce risk of parasite infections in salmon by diluting or altering viability of parasite spores. However, sensitivity of water age and temperature to the riverine conditions such as bathymetry can affect outcomes from dam operations. To examine this issue in detail, we conducted a global sensitivity analysis of water age and temperature to a comprehensive set of hydraulics and meteorological parameters in the Klamath River, California, where management of salmonid disease is a high priority. We applied an analysis technique, which combined Latin-hypercube and one-at-a-time sampling methods, and included simulation runs with the hydrodynamic numerical model of the Lower Klamath. We found that flow rate and bottom roughness were the two most important parameters that influence water age. Water temperature was more sensitive to inflow temperature, air temperature, solar radiation, wind speed, flow rate, and wet bulb temperature respectively. Our results are relevant for managers because they provide a framework for predicting how water within 'high infection risk' sections of the river will respond to dam water (low infection risk) input. Moreover, these data will be useful for prioritizing the use of water age (dilution) versus temperature (spore viability) under certain contexts when considering flow manipulation as a method to reduce risk of infection and disease in Klamath River salmon.

Using nursing intervention classification in an advance practice registered nurse-led preventive model for adults aging with developmental disabilities.

PubMed

Hahn, Joan Earle

2014-09-01

To describe the most frequently reported and the most central nursing interventions in an advance practice registered nurse (APRN)-led in-home preventive intervention model for adults aging with developmental disabilities using the Nursing Intervention Classification (NIC) system. A descriptive data analysis and a market basket analysis were conducted on de-identified nominal nursing intervention data from two home visits conducted by nurse practitioners (NPs) from October 2010 to June 2012 for 80 community-dwelling adults with developmental disabilities, ages 29 to 68 years. The mean number of NIC interventions was 4.7 in the first visit and 6.0 in the second visit and last visit. NPs reported 45 different intervention types as classified using a standardized language, with 376 in Visit One and 470 in Visit Two. Approximately 85% of the sample received the Health education intervention. The market basket analysis revealed common pairs, triples, and quadruple sets of interventions in this preventive model. The NIC nursing interventions that occurred together repeatedly were: Health education, Weight management, Nutrition management, Health screening, and Behavior management. Five NIC interventions form the basis of an APRN-led preventive intervention model for individuals aging with lifelong disability, with health education as the most common intervention, combined with interventions to manage weight and nutrition, promote healthy behaviors, and encourage routine health screening. Less frequently reported NIC interventions suggest the need to tailor prevention to individual needs, whether acute or chronic. APRNs employing prevention among adults aging with developmental disabilities must anticipate the need to focus on health education strategies for health promotion and prevention as well as tailor and target a patient-centered approach to support self-management of health to promote healthy aging in place. These NIC interventions serve not only as a guide for planning preventive interventions, but for designing nursing curricula to reduce health disparities among people with varying learning needs. © 2014 Sigma Theta Tau International.

Meeting the challenges--the role of medical informatics in an ageing society.

PubMed

Koch, Sabine

2006-01-01

The objective of this paper is to identify trends and new technological developments that appear due to an ageing society and to relate them to current research in the field of medical informatics. A survey of the current literature reveals that recent technological advances have been made in the fields of "telecare and home-monitoring", "smart homes and robotics" and "health information systems and knowledge management". Innovative technologies such as wearable devices, bio- and environmental sensors and mobile, humanoid robots do already exist and ambient assistant living environments are being created for an ageing society. However, those technologies have to be adapted to older people's self-care processes and coping strategies, and to support new ways of healthcare delivery. Medical informatics can support this process by providing the necessary information infrastructure, contribute to standardisation, interoperability and security issues and provide modelling and simulation techniques for educational purposes. Research fields of increasing importance with regard to an ageing society are, moreover, the fields of knowledge management, ubiquitous computing and human-computer interaction.

Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective

PubMed Central

Johnson, Robert W.; Alvarez-Pasquin, Marie-José; Bijl, Marc; Franco, Elisabetta; Gaillat, Jacques; Clara, João G.; Labetoulle, Marc; Michel, Jean-Pierre; Naldi, Luigi; Sanmarti, Luis S.; Weinke, Thomas

2015-01-01

Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed. PMID:26478818

Automated Age-related Macular Degeneration screening system using fundus images.

PubMed

Kunumpol, P; Umpaipant, W; Kanchanaranya, N; Charoenpong, T; Vongkittirux, S; Kupakanjana, T; Tantibundhit, C

2017-07-01

This work proposed an automated screening system for Age-related Macular Degeneration (AMD), and distinguishing between wet or dry types of AMD using fundus images to assist ophthalmologists in eye disease screening and management. The algorithm employs contrast-limited adaptive histogram equalization (CLAHE) in image enhancement. Subsequently, discrete wavelet transform (DWT) and locality sensitivity discrimination analysis (LSDA) were used to extract features for a neural network model to classify the results. The results showed that the proposed algorithm was able to distinguish between normal eyes, dry AMD, or wet AMD with 98.63% sensitivity, 99.15% specificity, and 98.94% accuracy, suggesting promising potential as a medical support system for faster eye disease screening at lower costs.

Age-0 Shovelnose Sturgeon prey consumption in the Lower Missouri River

USGS Publications Warehouse

Gosch, N.J.C.; Miller, M.L.; Gemeinhardt, T.R.; Starks, Trevor A.; Civiello, A.P.; Long, James M.; Bonneau, J.L.

2016-01-01

A lack of nutritious food during the first year of life is a hypothesized factor that may limit survival of endangered pallid sturgeonScaphirhynchus albus in the lower Missouri River (LMOR). Unfortunately, information for age-0 pallid sturgeon diets remains limited, but diet analyses for age-0 Scaphirhynchus spp. (sturgeon hereafter) have occurred. Little information, however, exists on age-0 sturgeon diets in the LMOR; thus, our primary objective was to document age-0 sturgeon diets in this system. We examined guts contents from 30 individuals, which were genetically identified as shovelnose sturgeon Scaphirhynchus platorynchus, and three stomachs were empty. The remaining age-0 shovelnose sturgeon consumed chironomid larvae almost exclusively (>98% of prey items consumed). Our results were similar to studies conducted in other systems, and it appears unlikely that a lack of nutritious food was a major factor affecting the individuals captured during this study. This effort provides important information to help guide ongoing adaptive management efforts in the LMOR.

White Paper on Condition Assessment of Wastewater Collection Systems

EPA Science Inventory

The Office of Research and Development’s National Risk Management Research Laboratory has published this report in support of the Aging Water Infrastructure (AWI) Research Program, which directly supports the Office of Water’s Sustainable Water Infrastructure Initiative. Scienti...

The role of social values in the management of ecological systems.

PubMed

Ives, Christopher D; Kendal, Dave

2014-11-01

The concept of value is central to the practice and science of ecological management and conservation. There is a well-developed body of theory and evidence that explores concepts of value in different ways across different disciplines including philosophy, economics, sociology and psychology. Insight from these disciplines provides a robust and sophisticated platform for considering the role of social values in ecological conservation, management and research. This paper reviews theories of value from these disciplines and discusses practical tools and instruments that can be utilised by researchers and practitioners. A distinction is highlighted between underlying values that shape people's perception of the world (e.g. altruistic or biospheric value orientations), and the values that people assign to things in the world (e.g. natural heritage, money). Evidence from numerous studies has shown that there are multiple pathways between these values and attitudes, beliefs and behaviours relevant to ecological management and conservation. In an age of increasing anthropogenic impacts on natural systems, recognising how and why people value different aspects of ecological systems can allow ecological managers to act to minimise conflict between stakeholders and promote the social acceptability of management activities. A series of practical guidelines are provided to enable social values to be better considered in ecosystem management and research. Copyright © 2014 Elsevier Ltd. All rights reserved.

Accelerated Aging Experiments for Capacitor Health Monitoring and Prognostics

NASA Technical Reports Server (NTRS)

Kulkarni, Chetan S.; Celaya, Jose Ramon; Biswas, Gautam; Goebel, Kai

2012-01-01

This paper discusses experimental setups for health monitoring and prognostics of electrolytic capacitors under nominal operation and accelerated aging conditions. Electrolytic capacitors have higher failure rates than other components in electronic systems like power drives, power converters etc. Our current work focuses on developing first-principles-based degradation models for electrolytic capacitors under varying electrical and thermal stress conditions. Prognostics and health management for electronic systems aims to predict the onset of faults, study causes for system degradation, and accurately compute remaining useful life. Accelerated life test methods are often used in prognostics research as a way to model multiple causes and assess the effects of the degradation process through time. It also allows for the identification and study of different failure mechanisms and their relationships under different operating conditions. Experiments are designed for aging of the capacitors such that the degradation pattern induced by the aging can be monitored and analyzed. Experimental setups and data collection methods are presented to demonstrate this approach.

Model forest landscape change in the Missouri Ozarks under alternative management practices

Treesearch

Stephen R. Shifley; Frank R. Thompson; David R. Larsen; William D. Dijak

2000-01-01

We used a spatially explicit landscape model, LANDIS, to simulate the effects of five management alternatives on a 3216 ha forest landscape in southeast Missouri, USA. We compared management alternatives among two intensities of even-aged management with clearcutting, uneven-aged management with group selection harvest, a mixture of even- and uneven-aged management,...

Comparison of Routine Health Management Information System Versus Enhanced Inpatient Malaria Surveillance for Estimating the Burden of Malaria Among Children Admitted to Four Hospitals in Uganda

PubMed Central

Mpimbaza, Arthur; Miles, Melody; Sserwanga, Asadu; Kigozi, Ruth; Wanzira, Humphrey; Rubahika, Denis; Nasr, Sussann; Kapella, Bryan K.; Yoon, Steven S.; Chang, Michelle; Yeka, Adoke; Staedke, Sarah G.; Kamya, Moses R.; Dorsey, Grant

2015-01-01

The primary source of malaria surveillance data in Uganda is the Health Management Information System (HMIS), which does not require laboratory confirmation of reported malaria cases. To improve data quality, an enhanced inpatient malaria surveillance system (EIMSS) was implemented with emphasis on malaria testing of all children admitted in select hospitals. Data were compared between the HMIS and the EIMSS at four hospitals over a period of 12 months. After the implementation of the EIMSS, over 96% of admitted children under 5 years of age underwent laboratory testing for malaria. The HMIS significantly overreported the proportion of children under 5 years of age admitted with malaria (average absolute difference = 19%, range = 8–27% across the four hospitals) compared with the EIMSS. To improve the quality of the HMIS data for malaria surveillance, the National Malaria Control Program should, in addition to increasing malaria testing rates, focus on linking laboratory test results to reported malaria cases. PMID:25422396

Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness.

PubMed

Whiteman, Karen L; Lohman, Matthew C; Gill, Lydia E; Bruce, Martha L; Bartels, Stephen J

2017-08-01

To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using an adaptive systems engineering framework and user-centered design. First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing. We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application. Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study.

PubMed

Jeon, Yun-Hee; Conway, Jane; Chenoweth, Lynn; Weise, Janelle; Thomas, Tamsin Ht; Williams, Anna

2015-04-01

To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. A Delphi method. Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. © 2014 John Wiley & Sons Ltd.

77 FR 22337 - Privacy Act of 1974; Amendment to an Existing System of Records, Inventory Management System Also...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-13

... or before this period which would result in a contrary determination. Comments Due Date: May 14, 2012... of whether or not the family is or has participated in the Family Self-sufficiency (FSS) program..., middle initial, date of birth, age on effective date of action, sex, relationship to head of household...

Computer Assisted Diagnostic Prescriptive Program in Reading and Mathematics. An Exemplary Micro-Computer Program and a Developer/Demonstrator Project, National Diffusion Network.

ERIC Educational Resources Information Center

Roberson, E. Wayne; Glowinski, Debra J.

The Computer Assisted Diagnostic Prescriptive Program (CADPP) is a customized databased curriculum management system which permits the user to load the following into a filing/retrieval software system: (1) learning characteristics of individual students (e.g., age, instructional level, learning modality); (2) skill-oriented characteristics of…

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

Noel, Claudel, E-mail: claudelnoel@gmail.co

The solid waste management industry in Haiti is comprised of a formal and an informal sector. Many basic activities in the solid waste management sector are being carried out within the context of profound poverty, which exposes the failure of the socioeconomic and political system to provide sufficient job opportunities for the urban population. This paper examines the involvement of workers in the solid waste management industry in Greater Port-au-Prince and the implications for livelihood strategies. The findings revealed that the Greater Port-au-Prince solid waste management system is very inclusive with respect to age, while highly segregated with regard tomore » gender. In terms of earning capacity, the results showed that workers hired by the State agencies were the most economically vulnerable group as more than 50% of them fell below the official nominal minimum wage. This paper calls for better salary scales and work compensation for the solid waste workers.« less

Human judgment vs. quantitative models for the management of ecological resources.

PubMed

Holden, Matthew H; Ellner, Stephen P

2016-07-01

Despite major advances in quantitative approaches to natural resource management, there has been resistance to using these tools in the actual practice of managing ecological populations. Given a managed system and a set of assumptions, translated into a model, optimization methods can be used to solve for the most cost-effective management actions. However, when the underlying assumptions are not met, such methods can potentially lead to decisions that harm the environment and economy. Managers who develop decisions based on past experience and judgment, without the aid of mathematical models, can potentially learn about the system and develop flexible management strategies. However, these strategies are often based on subjective criteria and equally invalid and often unstated assumptions. Given the drawbacks of both methods, it is unclear whether simple quantitative models improve environmental decision making over expert opinion. In this study, we explore how well students, using their experience and judgment, manage simulated fishery populations in an online computer game and compare their management outcomes to the performance of model-based decisions. We consider harvest decisions generated using four different quantitative models: (1) the model used to produce the simulated population dynamics observed in the game, with the values of all parameters known (as a control), (2) the same model, but with unknown parameter values that must be estimated during the game from observed data, (3) models that are structurally different from those used to simulate the population dynamics, and (4) a model that ignores age structure. Humans on average performed much worse than the models in cases 1-3, but in a small minority of scenarios, models produced worse outcomes than those resulting from students making decisions based on experience and judgment. When the models ignored age structure, they generated poorly performing management decisions, but still outperformed students using experience and judgment 66% of the time. © 2016 by the Ecological Society of America.

Adapting Dry Cask Storage for Aging at a Geologic Repository

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

C. Sanders; D. Kimball

2005-08-02

A Spent Nuclear Fuel (SNF) Aging System is a crucial part of operations at the proposed Yucca Mountain repository in the United States. Incoming commercial SNF that does not meet thermal limits for emplacement will be aged on outdoor pads. U.S. Department of Energy SNF will also be managed using the Aging System. Proposed site-specific designs for the Aging System are closely based upon designs for existing dry cask storage (DCS) systems. This paper evaluates the applicability of existing DCS systems for use in the SNF Aging System at Yucca Mountain. The most important difference between existing DCS facilities andmore » the Yucca Mountain facility is the required capacity. Existing DCS facilities typically have less than 50 casks. The current design for the aging pad at Yucca Mountain calls for a capacity of over 2,000 casks (20,000 MTHM) [1]. This unprecedented number of casks poses some unique problems. The response of DCS systems to off-normal and accident conditions needs to be re-evaluated for multiple storage casks. Dose calculations become more complicated, since doses from multiple or very long arrays of casks can dramatically increase the total boundary dose. For occupational doses, the geometry of the cask arrays and the order of loading casks must be carefully considered in order to meet ALARA goals during cask retrieval. Due to the large area of the aging pad, skyshine must also be included when calculating public and worker doses. The expected length of aging will also necessitate some design adjustments. Under 10 CFR 72.236, DCS systems are initially certified for a period of 20 years [2]. Although the Yucca Mountain facility is not intended to be a storage facility under 10 CFR 72, the operational life of the SNF Aging System is 50 years [1]. Any cask system selected for use in aging will have to be qualified to this design lifetime. These considerations are examined, and a summary is provided of the adaptations that must be made in order to use DCS technologies successfully at a geologic repository.« less

Ecological Factors Predict Transition Readiness/Self-Management in Youth With Chronic Conditions.

PubMed

Javalkar, Karina; Johnson, Meredith; Kshirsagar, Abhijit V; Ocegueda, Sofia; Detwiler, Randal K; Ferris, Maria

2016-01-01

Health care transition readiness or self-management among adolescents and young adults (AYA) with chronic conditions may be influenced by factors related to their surrounding environment. Study participants were AYA diagnosed with a chronic condition and evaluated at pediatric- and adult-focused subspecialty clinics at the University of North Carolina Hospital Systems. All participants were administered a provider-administered self-management/transition-readiness tool, the UNC TRxANSITION Scale. Geographic area and associated characteristics (ecological factors) were identified for each participant's ZIP code using the published U.S. Census data. The Level 1 model of the hierarchical linear regression used individual-level predictors of transition readiness/self-management. The Level 2 model incorporated the ecological factors. We enrolled 511 AYA with different chronic conditions aged 12-31 years with the following characteristics: mean age of 20± 4 years, 45% white, 42% black, and 54% female. Participants represented 214 ZIP codes in or around North Carolina, USA. The Level 1 model showed that age, gender, and race were significant predictors of transition readiness/self-management. On adding the ecological factors in the Level 2 model, race was no longer significant. Participants from a geographic area with a greater percentage of females (β = .114, p = .005) and a higher median income (β = .126, p = .002) had greater overall transition readiness. Ecological factors also predicted subdomains of transition readiness/self-management. In this cohort of adolescents and young adults with different chronic conditions, ecological disparities such as sex composition, median income, and language predict self-management/transition readiness. It is important to take ecological risk factors into consideration when preparing patients for health self-management or transition. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

76 FR 60937 - Draft License Renewal Interim Staff Guidance LR-ISG-2011-02; Aging Management Program for Steam...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

...-2011-02; Aging Management Program for Steam Generators AGENCY: Nuclear Regulatory Commission. ACTION... License Renewal Interim Staff Guidance (LR-ISG), LR-ISG-2011-02, ``Aging Management Program for Steam... using Revision 3 of NEI 97-06 to manage steam generator aging. The Draft LR-ISG revises the NRC staff's...

Influence of descriptive terminology on management of atypical thyroid fine-needle aspirates.

PubMed

Vivero, Marina; Renshaw, Andrew A; Krane, Jeffrey F

2014-03-01

The Bethesda System category of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is used to classify a variety of mild abnormalities in thyroid FNAs. Modifying terminology is often added to FNA reports, but it is unknown whether specific phrases affect clinical management. To answer this question, the authors correlated treatment of patients who had initial AUS/FLUS diagnoses from Baptist Hospital (Miami, Fla) (BH) and Brigham and Women's Hospital (Boston, Mass) (BWH) with the language used in pathology reports. In total, 146 FNAs from BH, including 115 women and 31 men with a median age of 53 years (range, 21-79 years), and 300 FNAs from BWH, including 241 women and 59 men with a median age of 66 years (range, 10-85 years), were included. FNA reports were evaluated for predetermined descriptive phrases and were correlated with subsequent management. More patients with available follow-up underwent excision at BH than at BWH (86% vs 8%; P < .001), and fewer underwent a repeat biopsy (14% vs 92%; P < .001). Qualifiers associated with differing malignancy risk affected patient management (P < .05) at BH, but not at BWH. Reports indicating a scant or limited specimen increased rebiopsy rates at BH (100% vs 4.8%; P < .05), but not at BWH (93% vs 91%; P = .67), as did explicit recommendation for rebiopsy at BH (35% vs 14%; P = .03). No other phrases affected patient management (P > .05). In practice settings that follow The Bethesda System management guidelines, descriptive report terminology does not modify patient treatment. In less standardized settings, terminology associated with differing risk of malignancy on subsequent excision, pathologist recommendations, and phrases indicative of limited sampling significantly alter patient management. © 2013 American Cancer Society.

Bulk Electrical Cable Non-Destructive Examination Methods for Nuclear Power Plant Cable Aging Management Programs

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

Glass, Samuel W.; Jones, Anthony M.; Fifield, Leonard S.

This Pacific Northwest National Laboratory milestone report describes progress to date on the investigation of nondestructive test methods focusing particularly on bulk electrical test methods that provide key indicators of cable aging and damage. The work includes a review of relevant literature as well as hands-on experimental verification of inspection capabilities. As nuclear power plants consider applying for second, or subsequent, license renewal to extend their operating period from 60 years to 80 years, it is important to understand how the materials installed in plant systems and components will age during that time and develop aging management programs to assuremore » continued safe operation under normal and design basis events (DBE). Normal component and system tests typically confirm the cables can perform their normal operational function. The focus of the cable test program, however, is directed toward the more demanding challenge of assuring the cable function under accident or DBE. The industry has adopted 50% elongation at break (EAB) relative to the un-aged cable condition as the acceptability standard. All tests are benchmarked against the cable EAB test. EAB, however, is a destructive test so the test programs must apply an array of other nondestructive examination (NDE) tests to assure or infer the overall set of cable’s system integrity. Assessment of cable integrity is further complicated in many cases by vendor’s use of dissimilar material for jacket and insulation. Frequently the jacket will degrade more rapidly than the underlying insulation. Although this can serve as an early alert to cable damage, direct test of the cable insulation without violating the protective jacket becomes problematic. This report addresses the range of bulk electrical NDE cable tests that are or could be practically implemented in a field-test situation with a particular focus on frequency domain reflectometry (FDR). The FDR test method offers numerous advantages over many other bulk electrical tests. Two commercial FDR systems plus a laboratory vector network analyzer are used to test an array of aged and un-aged cables under identical conditions. Several conclusions are set forth, and a number of knowledge gaps are identified.« less

Population Health Management and the Second Golden Age of Arab Medicine: Promoting Health, Localizing Knowledge Industries, and Diversifying Economies in the GCC Countries.

PubMed

Mattke, Soeren; Hunter, Lauren E; Magnuson, Madeline; Arifkhanova, Aziza

2015-07-15

Over the past half-century, the Gulf Cooperation Council (GCC) countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates-have experienced rapid economic growth and, with it, dramatic lifestyle changes. Low levels of physical activity and calorie-dense diets have led to an increase in the prevalence of chronic disease, most prominently diabetes. After having successfully controlled communicable diseases and made advanced acute care accessible locally, the GCC countries now face the challenge of orienting their health care systems toward prevention and treatment of chronic diseases. In this study, Dr. Mattke and his colleagues argue that this challenge presents GCC countries with a historic opportunity to reestablish the thought leadership role that Arab medicine had in the Islamic Golden Age. They propose that GCC countries could apply their considerable wealth to design and implement innovative health care systems based on population health management principles and sophisticated health information technology. Taking this path would not only improve prevention and management of chronic disease in the GCC countries but also contribute to the diversification of their economies and localization of knowledge industries.

Titan II. Reliability and Aging Surveillance Program (RASP) Management Plan

DTIC Science & Technology

1974-12-02

following organizations: SAC OGDEN ALC * LGBT *MMER XPQM *MMCO BM MMCP V DEFS MMCR DOKM MMCT DOTM MMEW ~- V -~ -DOXX S • ,. _ X PQ T * Indicates...age and service on the Titan II Weapon System. This responsibility includes publication and dissemina- tion of reports and information. CINCSAC/ LGBT ...semiannually by the scheduling subcommittee composed of CINCSAC/ LGBT and Ogden ALC/ MMCO and MMER. LGBT will have primary responsibility for scheduling

NASA's Earth Observing Data and Information System - Near-Term Challenges

NASA Technical Reports Server (NTRS)

Behnke, Jeanne; Mitchell, Andrew; Ramapriyan, Hampapuram

2018-01-01

NASA's Earth Observing System Data and Information System (EOSDIS) has been a central component of the NASA Earth observation program since the 1990's. EOSDIS manages data covering a wide range of Earth science disciplines including cryosphere, land cover change, polar processes, field campaigns, ocean surface, digital elevation, atmosphere dynamics and composition, and inter-disciplinary research, and many others. One of the key components of EOSDIS is a set of twelve discipline-based Distributed Active Archive Centers (DAACs) distributed across the United States. Managed by NASA's Earth Science Data and Information System (ESDIS) Project at Goddard Space Flight Center, these DAACs serve over 3 million users globally. The ESDIS Project provides the infrastructure support for EOSDIS, which includes other components such as the Science Investigator-led Processing systems (SIPS), common metadata and metrics management systems, specialized network systems, standards management, and centralized support for use of commercial cloud capabilities. Given the long-term requirements, and the rapid pace of information technology and changing expectations of the user community, EOSDIS has evolved continually over the past three decades. However, many challenges remain. Challenges addressed in this paper include: growing volume and variety, achieving consistency across a diverse set of data producers, managing information about a large number of datasets, migration to a cloud computing environment, optimizing data discovery and access, incorporating user feedback from a diverse community, keeping metadata updated as data collections grow and age, and ensuring that all the content needed for understanding datasets by future users is identified and preserved.

Age synthesis and estimation via faces: a survey.

PubMed

Fu, Yun; Guo, Guodong; Huang, Thomas S

2010-11-01

Human age, as an important personal trait, can be directly inferred by distinct patterns emerging from the facial appearance. Derived from rapid advances in computer graphics and machine vision, computer-based age synthesis and estimation via faces have become particularly prevalent topics recently because of their explosively emerging real-world applications, such as forensic art, electronic customer relationship management, security control and surveillance monitoring, biometrics, entertainment, and cosmetology. Age synthesis is defined to rerender a face image aesthetically with natural aging and rejuvenating effects on the individual face. Age estimation is defined to label a face image automatically with the exact age (year) or the age group (year range) of the individual face. Because of their particularity and complexity, both problems are attractive yet challenging to computer-based application system designers. Large efforts from both academia and industry have been devoted in the last a few decades. In this paper, we survey the complete state-of-the-art techniques in the face image-based age synthesis and estimation topics. Existing models, popular algorithms, system performances, technical difficulties, popular face aging databases, evaluation protocols, and promising future directions are also provided with systematic discussions.

Cultivar and Year Rather than Agricultural Practices Affect Primary and Secondary Metabolites in Apple Fruit

PubMed Central

Renard, Catherine M. G. C.; Plenet, Daniel; Gautier, Hélène; Touloumet, Line; Girard, Thierry; Simon, Sylvaine

2015-01-01

Many biotic and abiotic parameters affect the metabolites involved in the organoleptic and health value of fruits. It is therefore important to understand how the growers' decisions for cultivar and orchard management can affect the fruit composition. Practices, cultivars and/or year all might participate to determine fruit composition. To hierarchize these factors, fruit weight, dry matter, soluble solids contents, titratable acidity, individual sugars and organics acids, and phenolics were measured in three apple cultivars (‘Ariane’, ‘Melrose’ and ‘Smoothee’) managed under organic, low-input and conventional management. Apples were harvested at commercial maturity in the orchards of the cropping system experiment BioREco at INRA Gotheron (Drôme, 26) over the course of three years (2011, 2012 and 2013). The main factors affecting primary and secondary metabolites, in both apple skin and flesh, were by far the cultivar and the yearly conditions, while the management system had a very limited effect. When considering the three cultivars and the year 2011 to investigate the effect of the management system per se, only few compounds differed significantly between the three systems and in particular the total phenolic content did not differ significantly between systems. Finally, when considering orchards grown in the same pedoclimatic conditions and of the same age, instead of the usual organic vs. conventional comparison, the effect of the management system on the apple fruit quality (Fruit weight, dry matter, soluble solids content, titratable acidity, individual sugars, organic acids, and phenolics) was very limited to non-significant. The main factors of variation were the cultivar and the year of cropping rather than the cropping system. More generally, as each management system (e.g. conventional, organic…) encompasses a great variability of practices, this highlights the importance of accurately documenting orchard practices and design beside the generic type of management in such studies. PMID:26618711

Hospital Management Between The Modern Image And Aging

NASA Astrophysics Data System (ADS)

Dadulescu, Ana-Maria

2015-09-01

Hospital management has experienced significant progress with the evolution of the Romanian health system reform, it has made strides in terms of resource allocation and cost control, new systems for classification, evaluation and monitoring (DRGs, SIUI, CaPeSaRo) were implemented, some taken from other countries and adapted to local conditions, but not always integrated with the other components and sometimes incompletely implemented and developed. This material does not offer definite solutions to current problems. It only briefly addresses the main aspects of hospital activity, and points out some failures with whom hospital managers are presently faced. Once the problems are identified it creates prerequisites for solving them, it opens channels of research and development of new methodologies or correlation of the existing deficient workflows that can be corrected.

Frequency domain reflectometry modeling for nondestructive evaluation of nuclear power plant cables

NASA Astrophysics Data System (ADS)

Glass, S. W.; Fifield, L. S.; Jones, A. M.; Hartman, T. S.

2018-04-01

Cable insulation polymers are among the more susceptible materials to age-related degradation within a nuclear power plant. This is recognized by both regulators and utilities, so all plants have developed cable aging management programs to detect damage before critical component failure in compliance with regulatory guidelines. Although a wide range of tools are available to evaluate cables and cable systems, cable aging management programs vary in how condition monitoring and nondestructive examinations are conducted as utilities search for the most reliable and cost-effective ways to assess cable system condition. Frequency domain reflectometry (FDR) is emerging as one valuable tool to locate and assess damaged portions of a cable system with minimal cost and only requires access in most cases to one of the cable terminal ends. Since laboratory studies to evaluate the use of FDR for inspection of aged cables can be expensive and data interpretation may be confounded by multiple factors which influence results, a model-based approach is desired to parametrically investigate the effect of insulation material damage in a controlled manner. This work describes development of a physics-based FDR model which uses finite element simulations of cable segments in conjunction with cascaded circuit element simulations to efficiently study a cable system. One or more segments of the cable system model have altered physical or electrical properties which represent the degree of damage and the location of the damage in the system. This circuit model is then subjected to a simulated FDR examination. The modeling approach is verified using several experimental cases and by comparing it to a commercial simulator suitable for simulation of some cable configurations. The model is used to examine a broad range of parameters including defect length, defect profile, degree of degradation, number and location of defects, FDR bandwidth, and addition of impedance-matched extensions to minimize the end-shadow effect.

Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

PubMed

Decker, Sandra L; Jamoom, Eric W; Sisk, Jane E

2012-05-01

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

Medical mall founders' satisfaction and integrated management requirements.

PubMed

Ito, Atsushi

2017-10-01

Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision-making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision-making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

Health Information Management System for Elderly Health Sector: A Qualitative Study in Iran

PubMed Central

Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin

2016-01-01

Background: There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. Objectives: The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. Materials and Methods: This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. Results: The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. Conclusions: It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran. PMID:27186383

Health Information Management System for Elderly Health Sector: A Qualitative Study in Iran.

PubMed

Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin

2016-02-01

There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran.

Configuration management plan for waste tank farms and the 242-A evaporator of tank waste remediation system

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

Laney, T.

The configuration management architecture presented in this Configuration Management Plan is based on the functional model established by DOE-STD-1073-93, ``Guide for Operational Configuration Management Program.`` The DOE Standard defines the configuration management program by the five basic program elements of ``program management,`` ``design requirements,`` ``document control,`` ``change control,`` and ``assessments,`` and the two adjunct recovery programs of ``design reconstitution,`` and ``material condition and aging management.`` The CM model of five elements and two adjunct programs strengthen the necessary technical and administrative control to establish and maintain a consistent technical relationship among the requirements, physical configuration, and documentation. Although the DOEmore » Standard was originally developed for the operational phase of nuclear facilities, this plan has the flexibility to be adapted and applied to all life-cycle phases of both nuclear and non-nuclear facilities. The configuration management criteria presented in this plan endorses the DOE Standard and has been tailored specifically to address the technical relationship of requirements, physical configuration, and documentation during the full life cycle of the Waste Tank Farms and 242-A Evaporator of Tank Waste Remediation System.« less

Preparing the workforce for healthy aging programs: the Skills for Healthy Aging Resources and Programs (SHARP) model.

PubMed

Frank, Janet C; Altpeter, Mary; Damron-Rodriguez, JoAnn; Driggers, Joann; Lachenmayr, Susan; Manning, Colleen; Martinez, Dana M; Price, Rachel M; Robinson, Patricia

2014-10-01

Current public health and aging service agency personnel have little training in gerontology, and virtually no training in evidence-based health promotion and disease management programs for older adults. These programs are rapidly becoming the future of our community-based long-term care support system. The purpose of this project was to develop and test a model community college career technical education program, Skills for Healthy Aging Resources and Programs (SHARP), for undergraduate college students, current personnel in aging service and community organizations, and others interested in retraining. A multidisciplinary cross-sector team from disciplines of public health, sociology, gerontology and nursing developed four competency-based courses that focus on healthy aging, behavior change strategies, program management, an internship, and an option for leader training in the Chronic Disease Self-Management Program. To enhance implementation and fidelity, intensive faculty development training was provided to all instructors and community agency partners. Baseline and postprogram evaluation of competencies for faculty and students was conducted. Process evaluation for both groups focused on satisfaction with the curricula and suggestions for program improvement. SHARP has been piloted five times at two community colleges. Trainees (n = 113) were primarily community college students (n = 108) and current aging service personnel (n = 5). Statistically significant improvements in all competencies were found for both faculty and students. Process evaluation outcomes identified the needed logical and component adaptations to enhance the feasibility of program implementation, dissemination, and student satisfaction. The SHARP program provides a well-tested, evidence-based effective model for addressing workforce preparation in support of healthy aging service program expansion and delivery. © 2014 Society for Public Health Education.

SPI/U3.2. Security Profile Inspector for UNIX Systems

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

Bartoletti, A.

1994-08-01

SPI/U3.2 consists of five tools used to assess and report the security posture of computers running the UNIX operating system. The tools are: Access Control Test: A rule-based system which identifies sequential dependencies in UNIX access controls. Binary Authentication Tool: Evaluates the release status of system binaries by comparing a crypto-checksum to provide table entries. Change Detection Tool: Maintains and applies a snapshot of critical system files and attributes for purposes of change detection. Configuration Query Language: Accepts CQL-based scripts (provided) to evaluate queries over the status of system files, configuration of services and many other elements of UNIX systemmore » security. Password Security Inspector: Tests for weak or aged passwords. The tools are packaged with a forms-based user interface providing on-line context-sensistive help, job scheduling, parameter management and output report management utilities. Tools may be run independent of the UI.« less

Analysis of System Training Impact for Major Defense Acquisition Programs (MDAPs): Training Systems Acquisition

DTIC Science & Technology

2012-07-01

Background The Patriot system began because of the need to replace an aging and limited air defense system in the 1970s, the Nike -Hercules, and...1980s by Bolt, Beranek & Newman Inc . that overlaid student performance and expert solutions in a real-time simulation, with feedback from an...Interaction and Interface Design Team at Aptima, Inc . In this role she managed and led the work-centered development of a variety of military and

Underlying risk factors for prescribing errors in long-term aged care: a qualitative study.

PubMed

Tariq, Amina; Georgiou, Andrew; Raban, Magdalena; Baysari, Melissa Therese; Westbrook, Johanna

2016-09-01

To identify system-related risk factors perceived to contribute to prescribing errors in Australian long-term care settings, that is, residential aged care facilities (RACFs). The study used qualitative methods to explore factors that contribute to unsafe prescribing in RACFs. Data were collected at three RACFs in metropolitan Sydney, Australia between May and November 2011. Participants included RACF managers, doctors, pharmacists and RACF staff actively involved in prescribing-related processes. Methods included non-participant observations (74 h), in-depth semistructured interviews (n=25) and artefact analysis. Detailed process activity models were developed for observed prescribing episodes supplemented by triangulated analysis using content analysis methods. System-related factors perceived to increase the risk of prescribing errors in RACFs were classified into three overarching themes: communication systems, team coordination and staff management. Factors associated with communication systems included limited point-of-care access to information, inadequate handovers, information storage across different media (paper, electronic and memory), poor legibility of charts, information double handling, multiple faxing of medication charts and reliance on manual chart reviews. Team factors included lack of established lines of responsibility, inadequate team communication and limited participation of doctors in multidisciplinary initiatives like medication advisory committee meetings. Factors related to staff management and workload included doctors' time constraints and their accessibility, lack of trained RACF staff and high RACF staff turnover. The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Stream biogeochemical resilience in the age of Anthropocene

NASA Astrophysics Data System (ADS)

Dong, H.; Creed, I. F.

2017-12-01

Recent evidence indicates that biogeochemical cycles are being pushed beyond the tolerance limits of the earth system in the age of the Anthropocene placing terrestrial and aquatic ecosystems at risk. Here, we explored the question: Is there empirical evidence of global atmospheric changes driving losses in stream biogeochemical resilience towards a new normal? Stream biogeochemical resilience is the process of returning to equilibrium conditions after a disturbance and can be measured using three metrics: reactivity (the highest initial response after a disturbance), return rate (the rate of return to equilibrium condition after reactive changes), and variance of the stationary distribution (the signal to noise ratio). Multivariate autoregressive models were used to derive the three metrics for streams along a disturbance gradient - from natural systems where global drivers would dominate, to relatively managed or modified systems where global and local drivers would interact. We observed a loss of biogeochemical resilience in all streams. The key biogeochemical constituent(s) that may be driving loss of biogeochemical resilience were identified from the time series of the stream biogeochemical constituents. Non-stationary trends (detected by Mann-Kendall analysis) and stationary cycles (revealed through Morlet wavelet analysis) were removed, and the standard deviation (SD) of the remaining residuals were analyzed to determine if there was an increase in SD over time that would indicate a pending shift towards a new normal. We observed that nitrate-N and total phosphorus showed behaviours indicative of a pending shift in natural and managed forest systems, but not in agricultural systems. This study provides empirical support that stream ecosystems are showing signs of exceeding planetary boundary tolerance levels and shifting towards a "new normal" in response to global changes, which can be exacerbated by local management activities. Future work will consider the potential for cascading effects on downstream systems.

Cutaneous infectious diseases: Kids are not just little people.

PubMed

Admani, Shehla; Jinna, Sphoorthi; Friedlander, Sheila Fallon; Sloan, Brett

2015-01-01

The changes in immune response that occur with age play a significant role in disease presentation and patient management. Evolution of the innate and adaptive immune systems throughout life, influenced partly by hormonal changes associated with puberty, plays a role in the differences between pediatric and adult response to disease. We review a series of manifestations of dermatologic infectious diseases spanning bacterial, viral, and fungal origins that can be seen in both pediatric and adult age groups and highlight similarities and differences in presentation and disease course. Therapeutic options are also discussed for these infectious diseases, with particular attention to variations in management between these population subgroups, given differences in pharmacokinetics and side effect profiles. Published by Elsevier Inc.

Surgical management of abnormal uterine bleeding in fertile age women.

PubMed

Finco, Andrea; Centini, Gabriele; Lazzeri, Lucia; Zupi, Errico

2015-07-01

Abnormal uterine bleeding is a common gynecological disease and represents one of the most frequent reasons for hospital admission to a specialist unit, often requiring further surgical treatment. Following the so-called PALM-COEIN system we will attempt to further clarify the surgical treatments available today. The first group (PALM) is characterized by structural lesions, which may be more appropriately treated by means of surgical management. Although hysterectomy remains the definitive and decisive choice, there are many alternative techniques available. These minimally invasive procedures offer the opportunity for a more conservative approach. Precise and accurate counseling facilitates better patient selection, based on the patient's desires, age and disease type, allowing treatment to be individually tailored to each woman.

Large increase in opportunistic testing for chlamydia during a pilot project in a primary health organisation.

PubMed

Azariah, Sunita; McKernon, Stephen; Werder, Suzanne

2013-06-01

The Auckland chlamydia pilot project was one of three funded by the Ministry of Health to trial implementation of the 2008 Chlamydia Management Guidelines. Chlamydia is the most commonly notified sexually transmitted infection in New Zealand. To increase opportunistic testing in under-25-year-olds and to improve documentation of partner notification in primary care. A four-month pilot was initiated in Total Healthcare Otara using a nurse-led approach. Laboratory testing data was analysed to assess whether the pilot had any impact on chlamydia testing volumes in the target age-group. Data entered in the practice management system was used to assess follow-up and management of chlamydia cases. During the pilot there was a 300% increase in the number of chlamydia tests in the target age group from 812 to 2410 and the number of male tests increased by nearly 500%. Twenty-four percent of people tested were positive for chlamydia, with no significant difference in prevalence by ethnicity. The pilot resulted in better documentation of patient follow-up in the patient management system. There was a large increase in chlamydia testing during the pilot with a high prevalence found in the population tested. Chlamydia remains an important health problem in New Zealand. The cost benefit of increased chlamydia screening at a population level has yet to be established.

Analysis of intrinsic and extrinsic factors influencing the dynamics of bovine Eimeria spp. from central-eastern Poland.

PubMed

Tomczuk, Krzysztof; Grzybek, Maciej; Szczepaniak, Klaudiusz; Studzińska, Maria; Demkowska-Kutrzepa, Marta; Roczeń-Karczmarz, Monika; Klockiewicz, Maciej

2015-11-30

Eimeria infections are common in cattle worldwide, however, little is known about the invasion dynamics of this unicellular parasite. Therefore, the aim of this study was to analyze intrinsic (host age) and extrinsic (herd size and management system) factors influencing the dynamics of Eimeria spp. found in calves from CE Poland. Fecal samples were collected from 356 calves from different types of management systems and from different herd sizes. Flotation and McMaster method were used for parasitological investigation. Oocysts were differentiated on the basis of morphological criteria. Eight Eimeria species were identified and mean species richness (MSR) was significantly affected by host age. The highest MSR was noted for middle age animals. There was an association between species, with a highly significant co-occurrence of Eimeria bovis with Eimeria zuernii. The presence of E. bovis significantly increased the percentage of individuals carrying E. zuernii. The presence of E. bovis significantly increased the percentage of individuals carrying Eimeria canadensis. The overall prevalence of Eimeria spp. reached 52.8% and was significantly affected by the age of cows, with the highest prevalence in animals between 5-10 months old. The most prevalent species were E. bovis (37.4%), E. zuernii (19.9%) and E. canadensis (12.1%). The prevalence of E. bovis was affected by host age (the highest prevalence in age class 2 animals) and management type (the highest prevalence in individuals raised in groups). The prevalence of E. zuernii was affected by age (the lowest prevalence was noted in the oldest individuals) and herd size (individuals infected were present only in the middle and large size herds), whereas the prevalence of E. canadensis was affected by all three factors. Overall, mean OPG of the combined Eimeria spp. was 458.84 (37.93) and differed significantly between age classes. Mean OPGs were generally low for young and mature animals but high for middle age class animals. There was no significant influence of extrinsic factors on OPG. Taking into consideration the presented results, it is necessary to underline the role of intrinsic and extrinsic factors affecting the prevalence and abundance of Eimeria spp. in calves. Understanding the dynamics of Eimeria infections in calves may help to overcome this most common bovine parasite. Copyright © 2015 Elsevier B.V. All rights reserved.

[Health care for aged victims of accidents and violence: analysis of SUS health services in Recife (PE, Brazil)].

PubMed

de Lima, Maria Luiza Carvalho; de Souza, Edinilsa Ramos; de Lima, Maria Luiza Lopes Timóteo; Barreira, Alice Kelly; Bezerra, Eduardo Duque; Acioli, Raquel Moura Lins

2010-09-01

A situational diagnosis of the health services regarding the care of aged victims of accidents and violence (AVAV) was carried out in Recife, Pernambuco, Brazil. The National Policy for Reducing Accident and Violence Related Morbidity and Mortality and the National Policy for the Aged People Health were used as references. The methodology was based on the triangulation method, with both quantitative and qualitative approaches. Questionnaires and interviews were answered by managers and health staff of hospital, prehospital and rehabilitation services; and local aged health policy managers. In 2006, only the Family Health Program reported prehospital care for AVAV, 31 cases were due to violence and 18 to accidents. The hospital care for aged people was 7.2% of the total care, 27% from accidents and 10% from violence. In the same year, there was no record of rehabilitation care of AVAV. The directives of the policies studied are only partially followed. The health care is deficient in several aspects, such as: clinical protocols; notification devices; support to the aged, caregivers and aggressors; and also continuous training. This analysis can be such a contribution to the reorganization of the local health system, recognizing the aged person as vulnerable to accidents and violence.

Organizational entrepreneurship and administrators of hospitals: case study of Iran.

PubMed

Raadabadi, Mehdi; Fayaz-Bakhsh, Ahmad; Nazari, Aslan; Mousavi, Seyed Masood; Fayaz-Bakhsh, Mohammadali

2014-04-11

Due to rapid changes of technology and scientific advances in health systems and need for fast planning in health care, entrepreneurial spirit among employers and employees is a crucial element. According to the field of entrepreneurship research has not been solved and where learning and innovation for healthcare organizations due to the nature of the work required. This study aims to examine the entrepreneurial activities within the hospitals affiliated to Tehran University of Medical Sciences, Iran. To achieve the aim of the study, a questionnaire containing 29 items regarding the areas of innovation, creative behavior, flexibility, empowerment, rewarding systems and the management support was distributed among the hospitals' managers. Establishment of a culture of entrepreneurship in healthcare organizations led to the development unit controlled, changing the culture of the hospital. The analysis of the data showed that the majority of the managers agreed with all five areas of entrepreneurship namely the existence of innovation and innovative behavior, flexibility, decision making, rewarding and encouraging system, as well as management supportive system of personnel's new ideas. In fact, the managers generally had positive attitude towards entrepreneurship in their organizations The Pearson correlation test also showed that there is a significant relationship between the areas of entrepreneurship and the managers' age as well as their working experience (P<0.05). Entrepreneurial activities in healthcare can be improved through providing a suitable environment, adjusting reward and encouragement systems, giving more authority to subordinates, promoting awareness and education, and mobilizing managers to attract appropriate opportunities for organization. Further active involvement of employees, more stable in front of changes and increased ability managers to capture opportunities in domestic and foreign situation.

Postweaning nutritional programming of ovarian development in beef heifers

USDA-ARS?s Scientific Manuscript database

From weaning to breeding, nutritional management of replacement females is critical to their lifetime productivity. Traditionally, cereal grains have been used to develop replacement heifers to enter the breeding system at a younger age. Overfeeding heifers decreases the number of calves weaned, w...

Post-weaning nutritional programming of ovarian development in beef heifers

USDA-ARS?s Scientific Manuscript database

From weaning to breeding, the nutritional management of replacement females is critical to their lifetime productivity. Traditionally, cereal grains have been used to develop replacement heifers to enter the breeding system at a younger age. However, overfeeding heifers decreased number of calves ...

Do social networks influence small-scale fishermen's enforcement of sea tenure?

PubMed

Stevens, Kara; Frank, Kenneth A; Kramer, Daniel B

2015-01-01

Resource systems with enforced rules and strong monitoring systems typically have more predictable resource abundance, which can confer economic and social benefits to local communities. Co-management regimes demonstrate better social and ecological outcomes, but require an active role by community members in management activities, such as monitoring and enforcement. Previous work has emphasized understanding what makes fishermen comply with rules. This research takes a different approach to understand what influences an individual to enforce rules, particularly sea tenure. We conducted interviews and used multiple regression and Akaike's Information Criteria model selection to evaluate the effect of social networks, food security, recent catch success, fisherman's age and personal gear investment on individual's enforcement of sea tenure. We found that fishermen's enforcement of sea tenure declined between the two time periods measured and that social networks, age, food security, and changes in gear investment explained enforcement behavior across three different communities on Nicaragua's Atlantic Coast, an area undergoing rapid globalization.

Proportional basal area method for implementing selection silviculture systems in longleaf pine forests

Treesearch

Dale G. Brockway; Edward F. Loewenstein; Kenneth W. Outcalt

2014-01-01

Proportional basal area (Pro-B) was developed as an accurate, easy-to-use method for making uneven-aged silviculture a practical management option. Following less than 3 h of training, forest staff from a range of professional backgrounds used Pro-B in an operational-scale field study to apply single-tree selection and group selection systems in longleaf pine (Pinus...

Learning in the Age of Global Information Technology: Development of a Generic Architecture for an Advanced Learning Management System

ERIC Educational Resources Information Center

Watson, Jason; Ahmed, Pervaiz K.

2004-01-01

This paper briefly introduces the trends towards e-learning and amplifies some examples of state of the art systems, pointing out that all of these are, to date, limited by adaptability and shareability of content and that it is necessary for industry to develop and use an inter-operability standard. Uses SCORM specifications to specify the…

Health-care district management information system plan: Review of operations analysis activities during calendar year 1975 and plan for continued research and analysis activities

NASA Technical Reports Server (NTRS)

Nielson, G. J.; Stevenson, W. G.

1976-01-01

Operations research activities developed to identify the information required to manage both the efficiency and effectiveness of the Veterans Administration (VA) health services as these services relate to individual patient care are reported. The clinical concerns and management functions that determine this information requirement are discussed conceptually. Investigations of existing VA data for useful management information are recorded, and a diagnostic index is provided. The age-specific characteristics of diseases and lengths of stay are explored, and recommendations for future analysis activities are articulated. The effect of the introduction of new technology to health care is also discussed.

Electronic Data Collection and Management System for Global Adult Tobacco Survey

PubMed Central

Pujari, Sameer J; Palipudi, Krishna M; Morton, Jeremy; Levinsohn, Jay; Litavecz, Steve; Green, Michael

2012-01-01

Introduction: Portable handheld computers and electronic data management systems have been used for national surveys in many high-income countries, however their use in developing countries has been challenging due to varying geographical, economic, climatic, political and cultural environments. In order to monitor and measure global adult tobacco use, the World Health Organization and the US Centers for Disease Control and Prevention initiated the Global Adult Tobacco Survey, a nationally representative household survey of adults, 15 years of age or older, using a standard core questionnaire, sample design, and data collection and management procedures. The Survey has been conducted in 14 low- and middle-income countries, using an electronic data collection and management system. This paper describes implementation of the electronic data collection system and associated findings. Methods: The Survey was based on a comprehensive data management protocol, to enable standardized, globally comparable high quality data collection and management. It included adaptation to specific country needs, selection of appropriate handheld hardware devices, use of open source software, and building country capacity and provide technical support. Results: In its first phase, the Global Adult Tobacco Survey was successfully conducted between 2008 and 2010, using an electronic data collection and management system for interviews in 302,800 households in 14 countries. More than 2,644 handheld computers were fielded and over 2,634 fieldworkers, supervisors and monitors were trained to use them. Questionnaires were developed and programmed in 38 languages and scripts. The global hardware failure rate was < 1% and data loss was almost 0%. Conclusion: Electronic data collection and management systems can be used effectively for conducting nationally representative surveys, particularly in low- and middle-income countries, irrespective of geographical, climatic, political and cultural environments, and capacity-building at the country level is an important vehicle for Health System Strengthening. PMID:23569638

Management of advanced colon cancer in a community hospital--impact of age on clinical management and survival.

PubMed

Mogili, Sujatha; Yousaf, Mobeen; Nadaraja, Nagendra; Woodlock, Timothy

2012-09-01

Colon cancer is more common in the elderly than in younger and middle-aged people. Cancer clinical trials focus more on younger patients and the management of elderly patients with advanced disease is still unclear. We studied all patients presenting with colon adenocarcinoma metastasis to liver at a community teaching hospital from Dec 2000 through Dec 2007 by a retrospective review of Tumor Registry data and patient chart review with focus on age, clinical management, decision making, and survival. Sixty-seven patients with a median age of 69 and a male to female ratio of 31:36 were identified. The patients with obstructive symptoms and Eastern Cooperative Oncology Group performance status on presentation though varied little by age, smaller proportion of elderly patients underwent resection of the primary bowel tumor in the presence of liver metastases with ten of 16 (63%) aged 80 or greater being managed without surgery. The percentage of patient's preference to physician's preference for patients not undergoing the primary bowel resection increased for older age group. Median survival decreased significantly with age (p < 0.05). Age-related clinical management, decision-making autonomy, and survival are apparent in this study, and there was an increasing trend of patient's involvement in decision making as the age increases and, thus, affecting the age-related clinical management.

Soil carbon under perennial pastures; benchmarking the influence of pasture age and management

NASA Astrophysics Data System (ADS)

Orgill, Susan E.; Spoljaric, Nancy; Kelly, Georgina

2015-07-01

This paper reports baseline soil carbon stocks from a field survey of 19 sites; 8 pairs/triplet in the Monaro region of New South Wales. Site comparisons were selected by the Monaro Farming Systems group to demonstrate the influence of land management on soil carbon, and included: nutrient management, liming, pasture age and cropping history. Soil carbon stocks varied with parent material and with land management. The fertilised (phosphorus) native perennial pasture had a greater stock of soil carbon compared with the unfertilised site; 46.8 vs 40.4 Mg.C.ha to 0.50 m. However, the introduced perennial pasture which had been limed had a lower stock of soil carbon compared with the unlimed site; 62.8 vs 66.7 Mg.C.ha to 0.50 m. There was a greater stock of soil carbon under two of the three younger (<10 yr old) perennial pastures compared with older (>35 yr old) pastures. Cropped sites did not have lower soil carbon stocks at all sites; however, this survey was conducted after three years of above average annual rainfall and most sites had been cropped for less than three years. At all sites more than 20% of the total carbon stock to 0.50 m was in the 0.30 to 0.50 m soil layer highlighting the importance of considering this soil layer when investigating the implications of land management on soil carbon. Our baseline data indicates that nutrient management may increase soil carbon under perennial pastures and highlights the importance of perennial pastures for soil carbon sequestration regardless of age.

Proceedings of the Annual Military Librarians Workshop (33rd) Held in San Antonio, Texas on 18-20 October 1989

DTIC Science & Technology

1992-12-01

Revolution," ONLINE (1989 July):75. 6. Ibid., 76. 7. Ibid., 77. 17 HYPERMEDIA: INTERFACING IN THE INFORMATION AGE J . Wesley Regian Air Force Human...Resources Laboratory (AFSC) Brooks Air Force Base, Texas 19 HYPERMEDIA: INTERFACING IN THE INFORMATION AGE J . Wesley Regian Air Force Human Resources...AUTOMATION SYSTEM DISTRIBUTED INFORMATION ACCESS: RETRIEVAL DATABASE INTERFACE MANAGEMENT James J . Young, President Ann R Tinker Sirsi Corporation Huntsville

mHealth For Aging China: Opportunities and Challenges

PubMed Central

Sun, Jing; Guo, Yutao; Wang, Xiaoning; Zeng, Qiang

2016-01-01

The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries. PMID:26816664

Validation of a new classification system for interprosthetic femoral fractures.

PubMed

Pires, Robinson Esteves Santos; Silveira, Marcelo Peixoto Sena; Resende, Alessandra Regina da Silva; Junior, Egidio Oliveira Santana; Campos, Tulio Vinicius Oliveira; Santos, Leandro Emilio Nascimento; Balbachevsky, Daniel; Andrade, Marco Antônio Percope de

2017-07-01

Interprosthetic femoral fracture (IFF) incidence is gradually increasing as the population is progressively ageing. However, treatment remains challenging due to several contributing factors, such as poor bone quality, patient comorbidities, small interprosthetic fragment, and prostheses instability. An effective and specific classification system is essential to optimize treatment management, therefore diminishing complication rates. This study aims to validate a previously described classification system for interprosthetic femoral fractures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Outreach pharmacy service in old age homes: a Hong Kong experience.

PubMed

Lau, Wai-Man; Chan, Kit; Yung, Tsz-Ho; Lee, Anna See-Wing

2003-06-01

To explore drug-related problems in old age homes in Hong Kong through outreach pharmacy service. A standard form was used by outreach pharmacists to identify drug-related problems at old age homes. Homes were selected through random sampling, voluntary participation or adverse selection. Initial observation and assessment were performed in the first and second weeks. Appropriate advice and recommendations were given upon assessment and supplemented by a written report. Educational talks were provided to staff of the homes in addition to other drug information materials. At week 7 to 9, evaluations were carried out. Eighty-five homes were assessed and identified to have problems in the drug management system. These problems could generally be classified into physical storage (8.8%), quality of storage (19.2%), drug administration system (13.3%), documentation (16.4%), and drug knowledge of staff of homes (42.2%). Quality of drug storage was the most common problem found, followed by documentation and drug knowledge (73%, 50% and 44% of points assessed with problems, respectively). Apart from lack of drug knowledge and unawareness of potential risks by staff, minimal professional standards unmet may be fundamentally related to lack of professional input and inadequacy in legislation. Most homes demonstrated significant improvements upon simple interventions, from a majority of homes with more than 10 problems to a majority with less than 5 problems. Diverse problems in drug management are common in old age homes, which warrants attention and professional inputs. Simple interventions and education by pharmacists are shown to be effective in improving the quality of drug management and hence care to residents. While future financing of old age home service can be reviewed within the social context to provide incentives for improvement, review of regulatory policy with enforcement may be more fundamental and effective in upholding the service standard.

76 FR 69292 - Aging Management of Stainless Steel Structures and Components in Treated Borated Water

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... NUCLEAR REGULATORY COMMISSION [NRC-2011-0256] Aging Management of Stainless Steel Structures and... Stainless Steel Structures and Components in Treated Borated Water.'' This LR-ISG revises the guidance in...) and Generic Aging Lessons Learned (GALL) Report for the aging management of stainless steel structures...

Clinical Presentation of Soft-tissue Infections and its Management: A Study of 100 Cases.

PubMed

Singh, Baldev; Singh, Sukha; Khichy, Sudhir; Ghatge, Avinash

2017-01-01

Soft-tissue infections vary widely in their nature and severity. A clear approach to the management must allow their rapid identification and treatment as they can be life-threatening. Clinical presentation of soft-tissue infections and its management. A prospective study based on 100 patients presenting with soft-tissue infections was done. All the cases of soft-tissue infections were considered irrespective of age, sex, etiological factors, or systemic disorders. The findings were evaluated regarding the pattern of soft-tissue infections in relation to age and sex, clinical presentation, complications, duration of hospital stay, management, and mortality. The most commonly involved age group was in the range of 41-60 years with male predominance. Abscess formation (45%) was the most common clinical presentation. Type 2 diabetes mellitus was the most common associated comorbid condition. Staphylococcus aureus was the most common culture isolate obtained. The most common complication seen was renal failure. Patients with surgical site infections had maximum duration of stay in the hospital. About 94% of the cases of soft-tissue infections were managed surgically. Mortality was mostly encountered in the cases of complications of cellulitis. Skin and soft-tissue infections are among the most common infections encountered by the emergency physicians. Ignorance, reluctance to treatment, economic constraints, and illiteracy delay the early detection and the initiation of proper treatment. Adequate and timely surgical intervention in most of the cases is of utmost importance to prevent the complications and reduce the mortality.

[Healthy life style as part of strategy of active longevity].

PubMed

Golubeva, E Iu; Danilova, R I

2011-01-01

The contemporary approaches to the conception of healthy aging are discussed. The insufficient propaganda of healthy style of life of elderly population results in non-satisfaction of own health in old age; lack of information about opportunities to strengthen the health in the system of social services managing is also a problem. Weak skills and motivation of elder generation for taking care of the own health are registered. Gender and age features of health self-evaluation have been considered. Low meaning of spending spare time to use physical culture activity for strengthening health have been determinated.

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

Bartoletti, T.

SPI/U3.1 consists of five tools used to assess and report the security posture of computers running the UNIX operating system. The tools are: Access Control Test: A rule-based system which identifies sequential dependencies in UNIX access controls. Binary Inspector Tool: Evaluates the release status of system binaries by comparing a crypto-checksum to provide table entries. Change Detection Tool: Maintains and applies a snapshot of critical system files and attributes for purposes of change detection. Configuration Query Language: Accepts CQL-based scripts (provided) to evaluate queries over the status of system files, configuration of services and many other elements of UNIX systemmore » security. Password Security Inspector: Tests for weak or aged passwords. The tools are packaged with a forms-based user interface providing on-line context-sensistive help, job scheduling, parameter management and output report management utilities. Tools may be run independent of the UI.« less

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

Bartoletti, Tony

SPI/U3.2 consists of five tools used to assess and report the security posture of computers running the UNIX operating system. The tools are: Access Control Test: A rule-based system which identifies sequential dependencies in UNIX access controls. Binary Authentication Tool: Evaluates the release status of system binaries by comparing a crypto-checksum to provide table entries. Change Detection Tool: Maintains and applies a snapshot of critical system files and attributes for purposes of change detection. Configuration Query Language: Accepts CQL-based scripts (provided) to evaluate queries over the status of system files, configuration of services and many other elements of UNIX systemmore » security. Password Security Inspector: Tests for weak or aged passwords. The tools are packaged with a forms-based user interface providing on-line context-sensistive help, job scheduling, parameter management and output report management utilities. Tools may be run independent of the UI.« less

How to Program the Principal's Office for the Computer Age.

ERIC Educational Resources Information Center

Frankel, Steven

1983-01-01

Explains why principals' offices need computers and discusses the characteristics of inexpensive personal business computers, including their operating systems, disk drives, memory, and compactness. Reviews software available for word processing, accounting, database management, and communications, and compares the Kaypro II, Morrow, and Osborne I…

41 CFR 101-8.723 - Remedial action by recipient.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 8-NONDISCRIMINATION IN PROGRAMS RECEIVING FEDERAL FINANCIAL ASSISTANCE 8.7-Discrimination Prohibited on the Basis of Age § 101-8.723 Remedial action... remedial action that GSA may require to overcome the effects of the discrimination. If another recipient...

41 CFR 101-8.723 - Remedial action by recipient.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS GENERAL 8-NONDISCRIMINATION IN PROGRAMS RECEIVING FEDERAL FINANCIAL ASSISTANCE 8.7-Discrimination Prohibited on the Basis of Age § 101-8.723 Remedial action... remedial action that GSA may require to overcome the effects of the discrimination. If another recipient...

Age Management and Sustainable Careers for the Improvement of the Quality of Ageing at Work.

PubMed

Marcaletti, Francesco

2014-01-01

Prolonging working careers by increasing the statutory age for retirement has become compulsory in most Western societies in order to tackle the shrinking of the labour force, preserve economic productivity, foster knowledge transfer and reduce the risks of financial imbalances in social security systems. This imperative currently results in working careers that already exceed 40 years and come to an end after the age of 65 (e.g. in Italy). Over the next few decades, both career length and retirement age are expected to rise. Thus, creating more inclusive workplaces by increasing their quality is the precondition of a win-win situation for both employers and employees, regardless of age. A request for support in the development of sustainable careers from both private and public labour organisations has led to innovating the mainstream methodologies and research tools in the field of age management. Based on the key elements of the mainstream "work ability concept" - i.e. health, competencies, motivation and work organisation - the Quality of Ageing at Work questionnaire (QAW-q), developed by a team from the WWELL Research Centre, broadens its perspective by surveying elements bridging intra-organisational dimensions and which affect employees' conditions and external socio-institutional constraints: i.e. work-life balance, economic stability, professional identity and relationships in the workplace. The QAW-q is designed to analyse the influence of the different meanings of age (chronological age, seniority within the company and in the labour market) and correlate them with the different dimensions at individual and organisational levels; all these dimensions are weighted by the effect exerted by the passage of time. The results of the QAW-q survey, taken by employees of both private and public companies, serve as a basis for the implementation of measures addressing all the relevant dimensions of the human resource management cycle.

Implementation and evaluation of an integrated computerized asthma management system in a pediatric emergency department: a randomized clinical trial.

PubMed

Dexheimer, Judith W; Abramo, Thomas J; Arnold, Donald H; Johnson, Kevin; Shyr, Yu; Ye, Fei; Fan, Kang-Hsien; Patel, Neal; Aronsky, Dominik

2014-11-01

The use of evidence-based guidelines can improve the care for asthma patients. We implemented a computerized asthma management system in a pediatric emergency department (ED) to integrate national guidelines. Our objective was to determine whether patient eligibility identification by a probabilistic disease detection system (Bayesian network) combined with an asthma management system embedded in the workflow decreases time to disposition decision. We performed a prospective, randomized controlled trial in an urban, tertiary care pediatric ED. All patients 2-18 years of age presenting to the ED between October 2010 and February 2011 were screened for inclusion by the disease detection system. Patients identified to have an asthma exacerbation were randomized to intervention or control. For intervention patients, asthma management was computer-driven and workflow-integrated including computer-based asthma scoring in triage, and time-driven display of asthma-related reminders for re-scoring on the electronic patient status board combined with guideline-compliant order sets. Control patients received standard asthma management. The primary outcome measure was the time from triage to disposition decision. The Bayesian network identified 1339 patients with asthma exacerbations, of which 788 had an asthma diagnosis determined by an ED physician-established reference standard (positive predictive value 69.9%). The median time to disposition decision did not differ among the intervention (228 min; IQR=(141, 326)) and control group (223 min; IQR=(129, 316)); (p=0.362). The hospital admission rate was unchanged between intervention (25%) and control groups (26%); (p=0.867). ED length of stay did not differ among intervention (262 min; IQR=(165, 410)) and control group (247 min; IQR=(163, 379)); (p=0.818). The control and intervention groups were similar in regards to time to disposition; the computerized management system did not add additional wait time. The time to disposition decision did not change; however the management system integrated several different information systems to support clinicians' communication. Copyright © 2014. Published by Elsevier Ireland Ltd.

Mean age distribution of inorganic soil-nitrogen

NASA Astrophysics Data System (ADS)

Woo, Dong K.; Kumar, Praveen

2016-07-01

Excess reactive nitrogen in soils of intensively managed landscapes causes adverse environmental impact, and continues to remain a global concern. Many novel strategies have been developed to provide better management practices and, yet, the problem remains unresolved. The objective of this study is to develop a model to characterize the "age" of inorganic soil-nitrogen (nitrate, and ammonia/ammonium). We use the general theory of age, which provides an assessment of the time elapsed since inorganic nitrogen has been introduced into the soil system. We analyze a corn-corn-soybean rotation, common in the Midwest United States, as an example application. We observe two counter-intuitive results: (1) the mean nitrogen age in the topsoil layer is relatively high; and (2) mean nitrogen age is lower under soybean cultivation compared to corn although no fertilizer is applied for soybean cultivation. The first result can be explained by cation-exchange of ammonium that retards the leaching of nitrogen, resulting in an increase in the mean nitrogen age near the soil surface. The second result arises because the soybean utilizes the nitrogen fertilizer left from the previous year, thereby removing the older nitrogen and reducing mean nitrogen age. Estimating the mean nitrogen age can thus serve as an important tool to disentangle complex nitrogen dynamics by providing a nuanced characterization of the time scales of soil-nitrogen transformation and transport processes.

Patterns of Carbon Storage and Greenhouse Gas Losses in Urban Residential Lawns

NASA Astrophysics Data System (ADS)

Contosta, A.; Varner, R.; Xiao, J.

2017-12-01

Population density and housing age are two factors believed to impact carbon (C) storage and greenhouse gas emissions in one of the most extensively managed landscapes in the U.S.: the urban lawn. Previous research focusing on either above- or below-ground C dynamics has also not explicitly considered how they interact to affect the net carbon balance in urban residential areas. We addressed this knowledge gap by quantifying both soil and vegetative C stocks and greenhouse gas fluxes across an urban gradient in Manchester, NH, USA that included 34 lawns comprising three population density categories, five housing age classes, and the interaction between them. Using a combination of both weekly, manual measurements and continuous, automated estimates, we also sampled emissions of CH4, CO2, and N2O within a subset of these lawns that represented a range of citywide population density and housing age characteristics and management practices. We found that neither above- nor below-ground C storage varied with population density, but both differed among housing age classes. Soil C storage increased with housing age and was highest in the oldest lawns sampled. By contrast, C stocks in aboveground, woody biomass was highest at intermediate ages and lowest in older and new parcels. Unlike C stocks, soil greenhouse gas emissions did not change among population density categories, housing age classes, or with irrigation and fertilization management, but instead followed temporal trends in soil moisture and temperature. Overall, our results suggest that drivers of C storage and greenhouse gas losses in urban residential areas may not be uniform and their accurate representation in Earth system models may require a variety of approaches.

Record completeness and data concordance in an anesthesia information management system using context-sensitive mandatory data-entry fields.

PubMed

Avidan, Alexander; Weissman, Charles

2012-03-01

Use of an anesthesia information management system (AIMS) does not insure record completeness and data accuracy. Mandatory data-entry fields can be used to assure data completeness. However, they are not suited for data that is mandatory depending on the clinical situation (context sensitive). For example, information on equal breath sounds should be mandatory with tracheal intubation, but not with mask ventilation. It was hypothesized that employing context-sensitive mandatory data-entry fields can insure high data-completeness and accuracy while maintaining usability. A commercial off-the-shelf AIMS was enhanced using its built-in VBScript programming tool to build event-driven forms with context-sensitive mandatory data-entry fields. One year after introduction of the system, all anesthesia records were reviewed for data completeness. Data concordance, used as a proxy for accuracy, was evaluated using verifiable age-related data. Additionally, an anonymous satisfaction survey on general acceptance and usability of the AIMS was performed. During the initial 12 months of AIMS use, 12,241 (99.6%) of 12,290 anesthesia records had complete data. Concordances of entered data (weight, size of tracheal tubes, laryngoscopy blades and intravenous catheters) with patients' ages were 98.7-99.9%. The AIMS implementation was deemed successful by 98% of the anesthesiologists. Users rated the AIMS usability in general as very good and the data-entry forms in particular as comfortable. Due to the complexity and the high costs of implementation of an anesthesia information management system it was not possible to compare various system designs (for example with or without context-sensitive mandatory data entry-fields). Therefore, it is possible that a different or simpler design would have yielded the same or even better results. This refers also to the evaluation of usability, since users did not have the opportunity to work with different design approaches or even different computer programs. Using context-sensitive mandatory fields in an anesthesia information management system was associated with high record completeness rate and data concordance. In addition, the system's usability was rated as very good by its users. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Regeneration results using two-aged management

Treesearch

Arlyn W. Perkey; Gary W. Miller; Thomas M. Schuler

1999-01-01

Two-aged management is receiving increasing consideration by central Appalachian hardwood managers as a tool to accomplish multiple landowner goals. On non-industrial private forests where aesthetics are often important, two-aged management has the attribute of retaining some relatively large trees on the area at all times. For many landowners this is critical....

Uneven-aged management of longleaf pine forests: a scientist and manager dialogue

Treesearch

Dale G. Brockway; Kenneth W. Outcalt; James M. Guldin; William D. Boyer; Joan L. Walker; D. Craig Rudolph; Robert B. Rummer; James P. Barnett; Shibu Jose; Jarek Nowak

2005-01-01

Interest in appropriate management approaches for sustaining longleaf pine (Pinus palustris Mill.) forests has increased substantially during the recent decade. Although long-leaf pine can be managed using even-aged techniques, interest in uneven-aged methods has grown significantly as a result of concern for sustaining the wide range of ecological...

Impact of Hydrologic and Micro-topographic Variabilities on Spatial Distribution of Mean Soil-Nitrogen Age

NASA Astrophysics Data System (ADS)

Woo, D.; Kumar, P.

2015-12-01

Excess reactive nitrogen in soils of intensively managed agricultural fields causes adverse environmental impact, and continues to remain a global concern. Many novel strategies have been developed to provide better management practices and, yet, the problem remains unresolved. The objective of this study is to develop a 3-dimensional model to characterize the spatially distributed ``age" of soil-nitrogen (nitrate and ammonia-ammonium) across a watershed. We use the general theory of age, which provides an assessment of the elapsed time since nitrogen is introduced into the soil system. Micro-topographic variability incorporates heterogeneity of nutrient transformations and transport associated with topographic depressions that form temporary ponds and produce prolonged periods of anoxic conditions, and roadside agricultural ditches that support rapid surface movement. This modeling effort utilizes 1-m Light Detection and Ranging (LiDAR) data. We find a significant correlation between hydrologic variability and mean nitrate age that enables assessment of preferential flow paths of nitrate leaching. The estimation of the mean nitrogen age can thus serve as a tool to disentangle complex nitrogen dynamics by providing the analysis of the time scales of soil-nitrogen transformation and transport processes without introducing additional parameters.

Impact of Aging and Exercise on Mitochondrial Quality Control in Skeletal Muscle

PubMed Central

Kim, Yuho; Triolo, Matthew

2017-01-01

Mitochondria are characterized by its pivotal roles in managing energy production, reactive oxygen species, and calcium, whose aging-related structural and functional deteriorations are observed in aging muscle. Although it is still unclear how aging alters mitochondrial quality and quantity in skeletal muscle, dysregulation of mitochondrial biogenesis and dynamic controls has been suggested as key players for that. In this paper, we summarize current understandings on how aging regulates muscle mitochondrial biogenesis, while focusing on transcriptional regulations including PGC-1α, AMPK, p53, mtDNA, and Tfam. Further, we review current findings on the muscle mitochondrial dynamic systems in aging muscle: fusion/fission, autophagy/mitophagy, and protein import. Next, we also discuss how endurance and resistance exercises impact on the mitochondrial quality controls in aging muscle, suggesting possible effective exercise strategies to improve/maintain mitochondrial health. PMID:28656072

Managing Age Discrimination: An Examination of the Techniques Used when Seeking Employment

ERIC Educational Resources Information Center

Berger, Ellie D.

2009-01-01

Purpose: This article examines the age-related management techniques used by older workers in their search for employment. Design and Methods: Data are drawn from interviews with individuals aged 45-65 years (N = 30). Results: Findings indicate that participants develop "counteractions" and "concealments" to manage perceived age discrimination.…

Experimental stocking of sport fish in the regulated Tallapoosa River to determine critical periods for recruitment

USGS Publications Warehouse

Lloyd, M. Clint; Lai, Quan; Sammons, Steve; Irwin, Elise R.

2017-01-01

The stocking of fish in riverine systems to re-establish stocks for conservation and management appears limited to a few species and often occurs in reaches impacted by impoundments. Stocking of sport fish species such as centrarchids and ictalurids is often restricted to lentic environments, although stocking in lotic environments is feasible with variable success. R. L. Harris Dam on the Tallapoosa River, Alabama is the newest and uppermost dam facility on the river (operating since 1983); flows from the dam have been managed adaptively for multiple stakeholder objectives since 2005. One of the stakeholders’ primary objectives is to provide quality sport fisheries in the Tallapoosa River in the managed area below the dam. Historically, ictalurids and cyprinids dominated the river above Lake Martin. However, investigations after Harris Dam closed have detected a shift in community structure to domination by centrarchids. Flow management (termed the Green Plan) has been occurring since March 2005; however, sport fish populations as measured by recruitment of age-1 sport fishes below the dam has not responded adequately to flow management. The objectives of this research were to: (1) determine if stocking Channel Catfish Ictalurus punctatus and Redbreast Sunfish Lepomis auritus influences year-class strength; (2) estimate vital rates (i.e. growth, mortality, and recruitment) for Channel Catfish populations for use in an age-based population model; and (3) identify age-specific survivorship and fecundity rates contributing to Channel Catfish population stability. No marked Redbreast Sunfish were recaptured due to poor marking efficacy and therefore no further analysis was conducted with this species. Stocked Channel Catfish, similarly, were not recaptured, leaving reasons for non-recapture unknown. Matrix models exploring vital rates illustrated survival to age-1 for Channel Catfish to be less than 0.03% and that survival through ages 2 – 4 had equal contribution to overall population growth, indicating recruitment limitation may impact population size and stability. Results from this study indicate stock enhancement of sport fish populations below Harris Dam may not be an effective management technique at this time.

[How management teams use information and control systems to manage hospitals].

PubMed

Naranjo-Gil, David

2016-01-01

To analyze the relationship between the characteristics of top management teams and the different use of management information and control systems (MICS) to implement policies that encourage cooperation and activity coordination in public hospitals. Data were collected through a questionnaire sent to each member of the top management teams of 231 Spanish public hospitals (chief executive director, medical director, nursing director and director for financial and social issues). A total of 457 valid questionnaires were returned, composing 86 full top management teams (37.23%). Top management team diversity was positively related to the interactive use of MICS. Management teams composed of younger members and members with longer service used MICS interactively. Top management teams with a predominantly clinical education and experience used MICS interactively, while top teams with a predominantly administrative education and experience used MICS diagnostically. The results also showed that cooperation and coordination in hospitals were positively related to the interactive use of MICS and were negatively related to the diagnostic use of MICS. The interactive use of MICS is an important mediator in the relationship between top team diversity and policies focused on hospital decentralization. Top management teams with diverse characteristics (e.g. age, length of service, education and experience) use management information interactively to enhance activity coordination and resource allocation in hospitals. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Emerging Computer Media: On Image Interaction

NASA Astrophysics Data System (ADS)

Lippman, Andrew B.

1982-01-01

Emerging technologies such as inexpensive, powerful local computing, optical digital videodiscs, and the technologies of human-machine interaction are initiating a revolution in both image storage systems and image interaction systems. This paper will present a review of new approaches to computer media predicated upon three dimensional position sensing, speech recognition, and high density image storage. Examples will be shown such as the Spatial Data Management Systems wherein the free use of place results in intuitively clear retrieval systems and potentials for image association; the Movie-Map, wherein inherently static media generate dynamic views of data, and conferencing work-in-progress wherein joint processing is stressed. Application to medical imaging will be suggested, but the primary emphasis is on the general direction of imaging and reference systems. We are passing the age of simple possibility of computer graphics and image porcessing and entering the age of ready usability.

Cloud-based BP system integrated with CPOE improves self-management of the hypertensive patients: A randomized controlled trial.

PubMed

Lee, Peisan; Liu, Ju-Chi; Hsieh, Ming-Hsiung; Hao, Wen-Rui; Tseng, Yuan-Teng; Liu, Shuen-Hsin; Lin, Yung-Kuo; Sung, Li-Chin; Huang, Jen-Hung; Yang, Hung-Yu; Ye, Jong-Shiuan; Zheng, He-Shun; Hsu, Min-Huei; Syed-Abdul, Shabbir; Lu, Richard; Nguyen, Phung-Anh; Iqbal, Usman; Huang, Chih-Wei; Jian, Wen-Shan; Li, Yu-Chuan Jack

2016-08-01

Less than 50% of patients with hypertensive disease manage to maintain their blood pressure (BP) within normal levels. The aim of this study is to evaluate whether cloud BP system integrated with computerized physician order entry (CPOE) can improve BP management as compared with traditional care. A randomized controlled trial done on a random sample of 382 adults recruited from 786 patients who had been diagnosed with hypertension and receiving treatment for hypertension in two district hospitals in the north of Taiwan. Physicians had access to cloud BP data from CPOE. Neither patients nor physicians were blinded to group assignment. The study was conducted over a period of seven months. At baseline, the enrollees were 50% male with a mean (SD) age of 58.18 (10.83) years. The mean sitting BP of both arms was no different. The proportion of patients with BP control at two, four and six months was significantly greater in the intervention group than in the control group. The average capture rates of blood pressure in the intervention group were also significantly higher than the control group in all three check-points. Cloud-based BP system integrated with CPOE at the point of care achieved better BP control compared to traditional care. This system does not require any technical skills and is therefore suitable for every age group. The praise and assurance to the patients from the physicians after reviewing the Cloud BP records positively reinforced both BP measuring and medication adherence behaviors. Copyright © 2016. Published by Elsevier Ireland Ltd.

Surgical approach for systemic-pulmonary shunt in neonates with functionally univentricular heart: comparison between sternotomy and thoracotomy.

PubMed

Sasaki, Takashi; Takeda, Yuko; Ohnakatomi, Yasuko; Asou, Toshihide

2016-09-01

The preferred surgical approach for systemic-pulmonary shunts has changed from thoracotomy to sternotomy in our institution, to concomitantly manage the ductus arteriosus during surgery. The purpose of this study was to compare the outcomes of systemic-pulmonary shunts for neonates with functionally univentricular hearts based on surgical approach. Fifty-two neonates with functionally univentricular hearts underwent systemic-pulmonary shunt via sternotomy (n = 28) or thoracotomy (n = 24). Patient characteristics, achievement rates of right heart bypass, and survival rates were compared for the different approaches. Prenatal diagnosis was made more common in the sternotomy group (p = 0.006). The shunt was placed more centrally in the sternotomy group. The ductus arteriosus was ligated or banded in most patients in the sternotomy group (26/28) and in a few patients in the thoracotomy group (6/24). Frequency of ductal management in the early postoperative phase was not different between the groups (21 vs 25 %), but three new incisions had to be made in the thoracotomy group. No differences were seen in the achievement rates of bidirectional cavopulmonary shunts (86 vs 87 % at 10 months of age) and total cavopulmonary connection (81 vs 81 % at 2 years of age), or in the survival rates (92 vs 96 % at 8 years). There were no differences in short- and long-term outcomes between the groups. The sternotomy approach might be preferable in the current era of prenatal diagnosis, to allow simultaneous duct management during systemic-pulmonary shunt surgery, particularly in patients with large ducts associated with functionally univentricular hearts.

Evaluating User Perceptions of Mobile Medication Management Applications With Older Adults: A Usability Study

PubMed Central

Gates, Allison

2014-01-01

Background Medication nonadherence has a significant impact on the health and wellbeing of individuals with chronic disease. Several mobile medication management applications are available to help users track, remember, and read about their medication therapy. Objective The objective of this study was to explore the usability and usefulness of existing medication management applications for older adults. Methods We recruited 35 participants aged 50 and over to participate in a 2-hour usability session. The average age ranged from 52-78 years (mean 67 years) and 71% (25/35) of participants were female. Each participant was provided with an iPad loaded with four medication management applications: MyMedRec, DrugHub, Pillboxie, and PocketPharmacist. These applications were evaluated using the 10 item System Usability Scale (SUS) and visual analog scale. An investigator-moderated 30-minute discussion followed, and was recorded. We used a grounded theory (GT) approach to analyze qualitative data. Results When assessing mobile medication management applications, participants struggled to think of a need for the applications in their own lives. Many were satisfied with their current management system and proposed future use only if cognition and health declined. Most participants felt capable of using the applications after a period of time and training, but were frustrated by their initial experiences with the applications. The early experiences of participants highlighted the benefits of linear navigation and clear wording (eg, “undo” vs “cancel”) when designing for older users. While there was no order effect, participants attributed their poor performance to the order in which they tried the applications. They also described being a part of a technology generation that did not encounter the computer until adulthood. Of the four applications, PocketPharmacist was found to be the least usable with a score of 42/100 (P<.0001) though it offered a drug interaction feature that was among the favorite features of participants. The usability scores for MyMedRec (56/100), DrugHub (57/100), and Pillboxie (52/100) were not significantly different and participants preferred MyMedRec and DrugHub for their simple, linear interfaces. Conclusions With training, adults aged 50 and over can be capable and interested in using mHealth applications for their medication management. However, in order to adopt such technology, they must find a need that their current medication management system cannot fill. Interface diversity and multimodal reminder methods should be considered to increase usability for older adults. Lastly, regulation or the involvement of older adults in development may help to alleviate generation bias and mistrust for applications. PMID:25099993

Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system.

PubMed

Ryan, F; Byrne, S; O'Shea, S

2009-08-01

Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT. A prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms. One hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001). The use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management.

Organizational Entrepreneurship and Administrators of Hospitals: Case Study of Iran

PubMed Central

Raadabadi, Mehdi; Fayaz-Bakhsh, Ahmad; Nazari, Aslan; Mousavi, Seyed Masood; Fayaz-Bakhsh, MohammadAli

2014-01-01

Due to rapid changes of technology and scientific advances in health systems and need for fast planning in health care, entrepreneurial spirit among employers and employees is a crucial element. According to the field of entrepreneurship research has not been solved and where learning and innovation for healthcare organizations due to the nature of the work required. This study aims to examine the entrepreneurial activities within the hospitals affiliated to Tehran University of Medical Sciences, Iran. To achieve the aim of the study, a questionnaire containing 29 items regarding the areas of innovation, creative behavior, flexibility, empowerment, rewarding systems and the management support was distributed among the hospitals’ managers. Establishment of a culture of entrepreneurship in healthcare organizations led to the development unit controlled, changing the culture of the hospital. The analysis of the data showed that the majority of the managers agreed with all five areas of entrepreneurship namely the existence of innovation and innovative behavior, flexibility, decision making, rewarding and encouraging system, as well as management supportive system of personnel’s new ideas. In fact, the managers generally had positive attitude towards entrepreneurship in their organizations The Pearson correlation test also showed that there is a significant relationship between the areas of entrepreneurship and the managers’ age as well as their working experience (P<0.05). Entrepreneurial activities in healthcare can be improved through providing a suitable environment, adjusting reward and encouragement systems, giving more authority to subordinates, promoting awareness and education, and mobilizing managers to attract appropriate opportunities for organization. Further active involvement of employees, more stable in front of changes and increased ability managers to capture opportunities in domestic and foreign situation. PMID:24762370

Iterative Design and Usability Testing of the Imhere System for Managing Chronic Conditions and Disability

PubMed Central

FAIRMAN, ANDREA D.; YIH, ERIKA T.; MCCOY, DANIEL F.; LOPRESTI, EDMUND F.; MCCUE, MICHAEL P.; PARMANTO, BAMBANG; DICIANNO, BRAD E.

2016-01-01

A novel mobile health platform, Interactive Mobile Health and Rehabilitation (iMHere), is being developed to support wellness and self-management among people with chronic disabilities. The iMHere system currently includes a smartphone app with six modules for use by persons with disabilities and a web portal for use by medical and rehabilitation professionals or other support personnel. Our initial clinical research applying use of this system provides insight into the feasibility of employing iMHere in the development of self-management skills in young adults (ages 18–40 years) with spina bifida (SB) (Dicianno, Fairman, et al., 2015). This article describes the iterative design of the iMHere system including usability testing of both the app modules and clinician portal. Our pilot population of persons with SB fostered the creation of a system appropriate for people with a wide variety of functional abilities and needs. As a result, the system is appropriate for use by persons with various disabilities and chronic conditions, not only SB. In addition, the diversity of professionals and support personnel involved in the care of persons with SB also enabled the design and implementation of the iMHere system to meet the needs of an interdisciplinary team of providers who treat various conditions. The iMHere system has the potential to foster communication and collaboration among members of an interdisciplinary healthcare team, including individuals with chronic conditions and disabilities, for a client-centered approach to support self-management skills. PMID:27563387

Conceptualisation of ageing in relation to factors of importance for extending working life - a review.

PubMed

Nilsson, Kerstin

2016-07-01

The aim of this study was to explore and understand the complexity of ageing in relation to factors of importance for extending working life. Discourse analysis of documents was used in an integrative review including 128 articles. Four different conceptualisation of ageing are shown to affect older workers' ability to extend their working life: (a) biological ageing people's health in relation to their physical and mental work environment, their pace of work and recuperation needs; (b) chronological ageing statutory retirement age and policies and economic incentives devised for older workers by society, unions and organisations/enterprises; (c) social ageing inclusion in different social groups, the attitude of managers, organisations and family members, the leisure activities and surrounding environment; and (d) mental/cognitive ageing self-crediting, motivating and meaningful activities, competence and skills in working life. CONCLUSIONS SOCIETIES TODAY FOCUS MOSTLY ON CHRONOLOGICAL AGEING AND ARE LOOKING TO INCREASE THE RETIREMENT AGE WITH REGARD TO STATUTORY PENSION SYSTEMS, EG BEYOND 65 YEARS OF AGE THE INTER-RELATIONSHIPS BETWEEN CHRONOLOGICAL, MENTAL, BIOLOGICAL AND SOCIAL AGEING AND THE NINE AREAS IDENTIFIED AS BEING IMPORTANT TO OLDER WORKERS IN THESE RESPECTS NEED TO BE CONSIDERED WHEN AIMING TO PROVIDE A SUSTAINABLE WORKING LIFE FOR THE INCREASING NUMBERS OF OLDER WORKERS IN MODERN SOCIETY THE THEORETICAL MODEL DEVELOPED IS A CONTRIBUTION TO THE CRITICAL DEBATE THAT CAN BE APPLIED BY SOCIETIES, EMPLOYERS AND MANAGERS IN ORDER TO PROVIDE OLDER WORKERS WITH AN INCLUSIVE AND SUSTAINABLE EXTENDED WORKING LIFE. © 2016 the Nordic Societies of Public Health.

The coping strategies of front-line health workers in the context of user fee exemptions in Niger

PubMed Central

2015-01-01

When user fee exemptions were introduced for children under five years of age in Niger, front-line staff in the health system were not consulted in advance, and various obstacles seriously hindered the policy's implementation. Health workers developed two types of coping strategies. The first dealt with shortcomings of the policy implementation process related to management tools, drug stocks, co-existence of the fee exemption and cost recovery systems, and, above all, supply management for medicines (ordering from private companies, issuing makeshift prescriptions). The second involved clientelism, circumvention of regulations, and misappropriation of resources. Adverse effects have arisen due to both the failings of the health system and the practices of health workers. These include a focus on the commercial management of patients, the most 'costly' of whom sometimes find themselves being refused treatment, patients roaming in search of medicines and treatment, and a decline in quality of care. PMID:26558816

[Systemic lupus erythematosus in the pregnant patient. Implications for anesthesia].

PubMed

Pastor Tomás, E; Guillén Antón, J; Vaquerizo Gareta, A; Lirola Grajales, P; Martínez García, R; Cuartero Lobera, J

2001-03-01

A 28-year-old woman with systemic lupus erythematosus and a history of aseptic meningitis, digestive bleeding due to thrombopenia and deep venous thrombosis underwent elective cesarean for transverse presentation at 35 weeks. Preoperative blood work-up showed an antinuclear antibody titre that was slightly positive and steroid treatment was started. Surgery operation was performed with general anesthesia. The outcome was satisfactory even though serious complications can develop during the management of anesthesia in such patients. Systemic lupus erythematosus is a chronic, multisystemic disease that mainly affects women of childbearing age. Antibodies and immunocomplexes play a fundamental role. Given the multiorgan involvement in this disease, preoperative study of the lupus patient should assess all such involvement, including maternal-fetal risk, as well as consider the drug and anesthetic management to be applied. Among the clinical signs that can affect management of anesthesia are the following: aseptic meningitis, high blood pressure, pericarditis, pneumonitis and recurrent venous thrombosis. Anemia, thrombopenia and significantly altered coagulation events are common.

Role of mitochondrial dysfunction and altered autophagy in cardiovascular aging and disease: from mechanisms to therapeutics

PubMed Central

Marzetti, Emanuele; Csiszar, Anna; Dutta, Debapriya; Balagopal, Gauthami; Calvani, Riccardo

2013-01-01

Advanced age is associated with a disproportionate prevalence of cardiovascular disease (CVD). Intrinsic alterations in the heart and the vasculature occurring over the life course render the cardiovascular system more vulnerable to various stressors in late life, ultimately favoring the development of CVD. Several lines of evidence indicate mitochondrial dysfunction as a major contributor to cardiovascular senescence. Besides being less bioenergetically efficient, damaged mitochondria also produce increased amounts of reactive oxygen species, with detrimental structural and functional consequences for the cardiovascular system. The age-related accumulation of dysfunctional mitochondrial likely results from the combination of impaired clearance of damaged organelles by autophagy and inadequate replenishment of the cellular mitochondrial pool by mitochondriogenesis. In this review, we summarize the current knowledge about relevant mechanisms and consequences of age-related mitochondrial decay and alterations in mitochondrial quality control in the cardiovascular system. The involvement of mitochondrial dysfunction in the pathogenesis of cardiovascular conditions especially prevalent in late life and the emerging connections with neurodegeneration are also illustrated. Special emphasis is placed on recent discoveries on the role played by alterations in mitochondrial dynamics (fusion and fission), mitophagy, and their interconnections in the context of age-related CVD and endothelial dysfunction. Finally, we discuss pharmacological interventions targeting mitochondrial dysfunction to delay cardiovascular aging and manage CVD. PMID:23748424

Incontinence and sexuality in later life.

PubMed

Garrett, Dawne; Tomlin, Karen

2015-07-01

This article explores the interrelated aspects of incontinence and sexuality in older age. It describes the physiological changes that may have an effect on sexual function and the genitourinary system as people age. The enduring importance of sexual intimacy is discussed. Treatments for incontinence and to improve sexual function are explored. The authors conclude that nurses, particularly those involved in continence management, have a role in ensuring sensitive assessment and access to treatment, which can support many older people to maintain fulfilling sexual activity.

Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

PubMed Central

2010-01-01

Background The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care. Methods Using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis) of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations. Results • Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs. • The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment). • There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills. • Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However, little is known regarding how appropriate and effective they are for the aged care sector. Conclusions There is an urgent need for a national strategy that promotes a common approach to aged care leadership and management development, one that is sector-appropriate and congruent with the philosophy of person-centred care now predominant in the sector. The onus is on aged care industries as a whole and various levels of Government to make a concerted effort to establish relevant regulation, legislation and funding. PMID:20602798

How IHI Promotes Learning Systems and Knowledge Management

DTIC Science & Technology

2011-01-26

promote social gatherings for individuals with similar age, etc. Early discharge planning 1.Flu/ Influenza -H1N1 Programs 2.Silver Sneakers Shared...Spread Aim: Prevent Ventilator Associated Pneumonia  Spread What: Ventilator Bundle  Target Goals: Zero Cases of VAP  Spread to Whom: All ICUs in

Wastewater Collection System Toolbox | Eliminating Sanitary ...

EPA Pesticide Factsheets

2017-04-10

Communities across the United States are working to find cost-effective, long-term approaches to managing their aging wastewater infrastructure and preventing the problems that lead to sanitary sewer overflows. The Toolbox is an effort by EPA New England to provide examples of programs and educational efforts from New England and beyond.

Linking a modified EPIC-based growth model (UPGM) with a component-based watershed model (AGES-W)

USDA-ARS?s Scientific Manuscript database

Agricultural models and decision support systems (DSS) for assessing water use and management are increasingly being applied to diverse geographic regions at different scales. This requires models that can simulate different crops, however, very few plant growth models are available that “easily” ...

Nursing in Crisis

ERIC Educational Resources Information Center

Fulcher, Roxanne

2007-01-01

Both the nation's health-care and nursing education systems are in crisis. While the care provided by registered nurses (RNs) is essential to patients' recovery from acute illness and to the effective management of their chronic conditions, the United States is experiencing a nursing shortage that is anticipated to increase as baby boomers age and…

24 CFR 576.57 - Other Federal requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... particular race, color, religion, sex, age, national origin, familial status, or disability who may qualify... proceeds thereunder, either for him or herself or for those with whom he or she has family or business ties...) Audit. The financial management systems used by a State, formula city or county, governmental entity, or...

Career and Vocational Education. Concepts of Health Management System.

ERIC Educational Resources Information Center

Larson, Curtis G.; Fiedler, Beatrice

This curriculum guide is designed to assist students in developing the ability to understand the many aspects of personal/social/mental health. It emphasizes student performance objectives in physical well-being, disease, reproduction, heredity, mental health and aging. It is also designed to assist the local teacher with organization and…

Alcohol and Tobacco Sales to Underage Buyers in Dutch Supermarkets: Can the Use of Age Verification Systems Increase Seller's Compliance?

PubMed

Roodbeen, Ruud T J; Schelleman-Offermans, Karen; Lemmens, Paul H H M

2016-06-01

Age limits are effective in reducing alcohol- and tobacco-related harm, however, their effectiveness depends on the extent to which they are complied with. This study aimed to investigate the effectiveness of different age verification systems (AVSs) implemented by 400 Dutch supermarkets on requesting a valid age verification (ID) and on sellers' compliance. A mixed method design was used. Compliance was measured by 800 alcohol and tobacco purchase attempts by 17-year-old mystery shoppers. To analyze the effectiveness of AVSs, logistic regression analyses were performed. Insight into facilitating and hindering factors in the purchase process was obtained by 13 interviews with supermarket managers. Only a tendency toward a positive effect of the presence of the keying-on-date-of-birth AVS or ID swiper/checker was found on ID request for both alcohol and tobacco purchase attempts. The use of the keying-on-date-of-birth AVS or ID swiper/checker significantly increased the odds for compliance after an ID was requested, for both alcohol and tobacco purchase attempts. Managers indicated that ID requests and compliance could be facilitated by providing cashiers with sufficient managerial support, technical support, and regular training about the purchase process and use of the AVS. The usage of AVSs calculating and confirming whether the customer reached the legal purchase age for cashiers significantly increases the odds for cashiers to comply with age limits of alcohol and tobacco. Future research should gain insight into how usage of effective AVSs can be improved and explore the feasibility of implementation and effectiveness in other outlets. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Legionella Risk Management and Control in Potable Water Systems: Argument for the Abolishment of Routine Testing.

PubMed

Whiley, Harriet

2016-12-24

Legionella is an opportunistic pathogen of public health significance. One of the main sources of Legionella is potable water systems. As a consequence of aging populations there is an increasing demographic considered at high risk for Legionellosis and, as such, a review of the guidelines is required. Worldwide, Legionella has been detected from many potable water sources, suggesting it is ubiquitous in this environment. Previous studies have identified the limitations of the current standard method for Legionella detection and the high possibility of it returning both false negative and false positive results. There is also huge variability in Legionella test results for the same water sample when conducted at different laboratories. However, many guidelines still recommend the testing of water systems. This commentary argues for the removal of routine Legionella monitoring from all water distribution guidelines. This procedure is financially consuming and false negatives may result in managers being over-confident with a system or a control mechanism. Instead, the presence of the pathogen should be assumed and focus spent on managing appropriate control measures and protecting high-risk population groups.

Legionella Risk Management and Control in Potable Water Systems: Argument for the Abolishment of Routine Testing

PubMed Central

Whiley, Harriet

2016-01-01

Legionella is an opportunistic pathogen of public health significance. One of the main sources of Legionella is potable water systems. As a consequence of aging populations there is an increasing demographic considered at high risk for Legionellosis and, as such, a review of the guidelines is required. Worldwide, Legionella has been detected from many potable water sources, suggesting it is ubiquitous in this environment. Previous studies have identified the limitations of the current standard method for Legionella detection and the high possibility of it returning both false negative and false positive results. There is also huge variability in Legionella test results for the same water sample when conducted at different laboratories. However, many guidelines still recommend the testing of water systems. This commentary argues for the removal of routine Legionella monitoring from all water distribution guidelines. This procedure is financially consuming and false negatives may result in managers being over-confident with a system or a control mechanism. Instead, the presence of the pathogen should be assumed and focus spent on managing appropriate control measures and protecting high-risk population groups. PMID:28029126

Personal Retirement Accounts and Saving†

PubMed Central

Aguila, Emma

2017-01-01

Aging populations are leading countries worldwide to social security reforms. Many countries are moving from pay-as-you-go to personal retirement account (PRA) systems because of their financial sustainability and positive impact on private savings. PRA systems boost private savings at a macro level by converting a government liability into financial wealth managed by private fund managers. However, at a micro level, changes in retirement wealth affect individuals' saving and consumption patterns through their working lives. Retirement wealth increased for lower-income workers after Mexico introduced PRAs, crowding out saving, increasing consumption, and offsetting some of the PRA effect on private savings. (JEL D14, E21, H55, J26, O16) PMID:28286607

Medical mall founders' satisfaction and integrated management requirements

PubMed Central

2016-01-01

Summary Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision‐making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision‐making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd PMID:27218206

Adopted children and education: the experiences of a specialist CAMHS team.

PubMed

Barratt, Sara

2012-01-01

The education system makes special provision for "looked after children". However, once adopted these children become invisible. Adopted children are often placed in their new families when they are already of school age. School is yet another transition alongside that of home, food, language and social milieu which an adopted child has to manage together the pain of the loss of the biological family and its culture. This article focuses on the importance for CAMHS practitioners to work closely with schools and adoptive parents to help children manage their lives in school. Alongside the difficulties they face in learning, many adopted children need help in managing friendships and in concentrating on what is required of them in school. Adults may be ignorant of the day to day experiences of racism and questions about mothers, fathers, brothers and sisters that can throw an adopted child into confusion. This chapter draws on clinical experience to describe some of the difficulties that arise for parents and children in managing the education system.

An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study

PubMed Central

Schrader, Geoffrey; Harris, Melanie; Newman, Lareen; Lynn, Sarah; Peterson, Leigh; Battersby, Malcolm

2014-01-01

Background eHealth facilitation of chronic disease management has potential to increase engagement and effectiveness and extend access to care in rural areas. Objective The objective of this study was to demonstrate the feasibility and acceptability of an eHealth system for the management of chronic conditions in a rural setting. Methods We developed an online management program which incorporated content from the Flinders Chronic Condition Management Program (Flinders Program) and used an existing software platform (goACT), which is accessible by patients and health care workers using either Web-enabled mobile phone or Internet, enabling communication between patients and clinicians. We analyzed the impact of this eHealth system using qualitative and simple quantitative methods. Results The eHealth system was piloted with 8 recently hospitalized patients from rural areas, average age 63 (SD 9) years, each with an average of 5 chronic conditions and high level of psychological distress with an average K10 score of 32.20 (SD 5.81). Study participants interacted with the eHealth system. The average number of logins to the eHealth system by the study participants was 26.4 (SD 23.5) over 29 weeks. The login activity was higher early in the week. Conclusions The pilot demonstrated the feasibility of implementing and delivering a chronic disease management program using a Web-based patient-clinician application. A qualitative analysis revealed burden of illness and low levels of information technology literacy as barriers to patient engagement. PMID:24927511

An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study.

PubMed

Schrader, Geoffrey; Bidargaddi, Niranjan; Harris, Melanie; Newman, Lareen; Lynn, Sarah; Peterson, Leigh; Battersby, Malcolm

2014-06-12

eHealth facilitation of chronic disease management has potential to increase engagement and effectiveness and extend access to care in rural areas. The objective of this study was to demonstrate the feasibility and acceptability of an eHealth system for the management of chronic conditions in a rural setting. We developed an online management program which incorporated content from the Flinders Chronic Condition Management Program (Flinders Program) and used an existing software platform (goACT), which is accessible by patients and health care workers using either Web-enabled mobile phone or Internet, enabling communication between patients and clinicians. We analyzed the impact of this eHealth system using qualitative and simple quantitative methods. The eHealth system was piloted with 8 recently hospitalized patients from rural areas, average age 63 (SD 9) years, each with an average of 5 chronic conditions and high level of psychological distress with an average K10 score of 32.20 (SD 5.81). Study participants interacted with the eHealth system. The average number of logins to the eHealth system by the study participants was 26.4 (SD 23.5) over 29 weeks. The login activity was higher early in the week. The pilot demonstrated the feasibility of implementing and delivering a chronic disease management program using a Web-based patient-clinician application. A qualitative analysis revealed burden of illness and low levels of information technology literacy as barriers to patient engagement.

Evaluation of Effectiveness and Cost‐Effectiveness of a Clinical Decision Support System in Managing Hypertension in Resource Constrained Primary Health Care Settings: Results From a Cluster Randomized Trial

PubMed Central

Anchala, Raghupathy; Kaptoge, Stephen; Pant, Hira; Di Angelantonio, Emanuele; Franco, Oscar H.; Prabhakaran, D.

2015-01-01

Background Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. Methods and Results We performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart‐based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was −6.59 mm Hg (95% confidence interval: −12.18 to −1.42; P=0.021). The cost‐effective ratio for CBS and DSS groups was $96.01 and $36.57 per mm of SBP reduction, respectively. Conclusion Clinical DSS are effective and cost‐effective in the management of HTN in resource‐constrained PHC settings. Clinical Trial Registration URL: http://www.ctri.nic.in. Unique identifier: CTRI/2012/03/002476. PMID:25559011

Incontinence Treatment: Newer Treatment Options

MedlinePlus

... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ... Living with Incontinence Incontinence and Relationships Incontinence and Aging Managing Incontinence Managing Incontinence: A Survey The Patient's ...

Clinical requirements for closed-loop control systems.

PubMed

Clarke, William L; Renard, Eric

2012-03-01

Closed-loop (CL) therapy systems should be safe, efficacious, and easily manageable for type 1 diabetes mellitus patient use. For the first two clinical requirements, noninferiority and superiority criteria must be determined based on current conventional and intensive therapy outcomes. Current frequencies of hypoglycemia and diabetic ketoacidosis are reviewed and safety expectations for CL therapy systems are proposed. Glycosylated hemoglobin levels lower than current American Diabetes Association recommendations for different age groups are proposed as superiority criteria. Measures of glycemic variability are described and the recording of blood glucose levels as percentages within, above, and below a target range are suggested as reasonable alternatives to sophisticated statistical analyses. It is also suggested that Diabetes Quality of Life and Fear of Hypoglycemia surveys should be used to track psychobehavioral outcomes. Manageability requirements for safe and effective clinical management of CL systems are worth being underscored. The weakest part of the infusion system remains the catheter, which is exposed to variable and under-delivery incidents. Detection methods are needed to warn both the system and the patient about altered insulin delivery, including internal pressure and flow alarms. Glucose monitor sensor accuracy is another requirement; it includes the definition of conditions that lead to capillary glucose measurement, eventually followed by sensor recalibration or replacement. The crucial clinical requirement will be a thorough definition of the situations when the patient needs to move from CL to manual management of insulin delivery, or inversely can switch back to CL after a requested interruption. Instructions about these actions will constitute a major part of the education process of the patients before using CL systems and contribute to the manageability of these systems. © 2012 Diabetes Technology Society.

Oral manifestations of gastrointestinal diseases in children. Part 1: General introduction.

PubMed

Mantegazza, C; Crippa, R; Zuccotti, G V

2016-03-01

Alterations of the oral cavity are common in children: 22% of children aged less than 4 years and 44% of those aged more than 12 develop dental erosion, 9-95% of children in Europe and in North America develop gingivitis, with adolescents showing a prevalence of more than 60% (Linee guida - Ministero della Salute 2013). Alterations within the oral cavity can be the first sign of systemic diseases and may thus allow for an early diagnosis and treatment. In particular, being the oral cavity a part of the gastrointestinal system, oral alterations can be an expression of a gastrointestinal disease. A prompt recognition of sYstemic diseases through a careful examination of the oral cavity could allow the child to have appropriate investigations and to be managed in a timely fashion.

Optimising the management of severe Traumatic Brain Injury in the military maritime environment.

PubMed

Edgar, I A; Hadjipavlou, G; Smith, J E

2014-01-01

Severe Traumatic Brain Injury (sTBI) is a devastating cause of morbidity and mortality, especially among those aged less than 45 years. Advances in clinical practice continue to focus on preventing primary injury through developing ballistic head and eye protection, and through minimising secondary brain injury (secondary prevention). Managing sTBI is challenging in well-developed, well-resourced healthcare systems. Achieving management aims in the military maritime environment poses even greater challenges. Strategies for the management of sTBI in the maritime environment should be in keeping with current best evidence. Provision of specialist interventions for sTBI in military maritime environments may require alternative approaches matched to the skills of the staff and environmental restrictions.

Horse infection with intestinal helminths in relation to age, sex, access to grass and farm system.

PubMed

Kornaś, S; Cabaret, J; Skalska, M; Nowosad, B

2010-12-15

A 11-year survey on helminth intestinal infection of horses was done in seven provinces of southern Poland. 21,641 faecal samples were collected from horses of different age, sex, breed and management system originating from 84 farms. Age was the major factor influencing the cyathostome egg excretion, the maximum being observed in yearlings and second year horses. Parascaris was found mostly in foals and yearlings. The main factor for Anoplocephala was the access to pasture. The level of cyathostome egg shedding (EPG) could be related to sex (geldings had higher values of EPG), breed (Thoroughbred had higher EPG than other breeds), and type of farm (large farms had higher EPG than others). The change during the survey of anthelmintic treatment (from benzimidazole or pyrantel embonate to avermectins) was associated with lower cyathostome EPG, and this was probably due to partial resistance to benzimidazole. The seasonality of egg shedding (lowest from November to January included) was due to management (leaving the pasture to stable, anthelmintic treatment in October). The influence of climate on EPG was significant but small, annual rainfalls and average temperature being associated negatively and positively, respectively, with high cyathostome EPG. Copyright © 2010 Elsevier B.V. All rights reserved.

Implementing a pilot work injury management program in Hong Kong.

PubMed

Lai, Hon-Sun; Chan, Chetwyn C H

2007-12-01

This paper reports the results of implementing a pilot case management system for work injuries in Hong Kong. The case management approach was characterized by use of a case manager who worked closely with each of the reported injury cases. The case manager undertook the roles of assessor, referral agent, counselor, work-site liaison, and return-to-work (RTW) expert. A quasi-experimental study design was used. The study compared the RTW and workers' compensation outcomes in injured workers in a cleaning company in a case management group (n = 296) and a conventional rehabilitation group (n = 137). Outcomes of the intervention were followed up at 6 months. The results indicated that the RTW rate was 97.0% and 94.2% for the case management and conventional rehabilitation groups respectively, with no significant differences between them. Participants in the case management group had significantly fewer days of sick leave (mean = 27.5 and 41.6 days, respectively) and lower compensation costs (mean = HK$7,212.2 and $20,617.3, respectively) than those in the comparison group. Age of the participants was found to influence the outcomes with those who were between 41 and 50 years old and received case management intervention had shorter sick leave and lower cost of compensation than their conventional rehabilitation counterpart. The majority of the participants who had returned to work in both the case management (95.8%) and the conventional rehabilitation (96.2%) groups were found to maintain their work status 6 months after the intervention. The findings suggested that applying the case management approach to the Hong Kong workers' compensation system was more effective overall. Nevertheless, the inherent problems associated with implementing such an approach within the existing system, which focuses on compensation and medical interventions, remained unresolved.

New public management in Iran's health complex: a management framework for primary health care system.

PubMed

Tabrizi, Jafar Sadegh; HaghGoshayie, Elaheh; Doshmangir, Leila; Yousefi, Mahmood

2018-05-01

New public management (NPM) was developed as a management reform to improve the efficiency and effectiveness in public organizations, especially in health sector. Using the features of private sector management, the managers of health organizations may try to implement the elements of NPM with the hope to improve the performance of their systems.AimsOur aim in the present study was to identify the elements and infrastructures suitable for implementing NPM in the Iranian health complex. In this qualitative study with conventional content analysis approach, we tried to explore the NPM elements and infrastructures in Iranian public health sector. A series of semi-structured interviews (n=48) were conducted in 2016 with a managers in public and private health complex. Three focus group discussions with nine faculty members were also conducted. A data collection form was used to collect the demographic characteristics and perspectives of the participants.FindingsFrom the perspective of managers, managerialism, decentralization, using market mechanism, performance management, customer orientation and performance budgeting were the main elements of NPM in the Iranian context. The most important infrastructures for implementing this reform were as follows: education and training, information technology, the proper use of human resources, decision support systems, top management commitment, organizational culture, flexibility of rules, rehabilitating of the aging infrastructures, and expanding the coverage of services. The NPM was generally identified to be an effective replacement for the traditional administration method. These reforms may be helpful in strengthening the public health complex and the management capacity, as well. NPM also seems to be useful in interacting the public health sector with the private sector in terms of personnel and resources, performance, reward structure, and methods of doing business.

Evaluation of growth performance of abergele goats under traditional management systems in Sekota District, Ethiopia.

PubMed

Deribe, Belay; Taye, Mengistie

2013-07-15

The study was conducted at Abergele in the semi arid parts of Sekota district to evaluate growth performance of Abergele goats managed under traditional management systems. Data on growth and growth rates were collected from 724 kids for two years. The least squares mean birth, three months, six months and yearling weight of kids obtained were 1.91 +/- 0.04, 6.84 +/- 0.19, 9.13 +/- 0.31 and 16.42 +/- 1.20 kg, respectively. Parity of doe and birth type of kid significantly affected birth weight and three months weight while sex of kid and season of birth of kid affected birth, three months, six months and yearling weight consistently. Kids from first parity does were lighter at birth, three months and six months of age than kids from higher parity does. Twin born kids were lower in weight at birth and three months of ages than their single born counterparts. Female kids and kids born during the dry season had lower weight at all ages considered. The least squares mean pre-weaning and post-weaning growth rates obtained were 53.4 +/- 2.30 and 29.3 +/- 4.32 g day(-1), respectively. Parity of doe, type of birth and season birth of kid affected pre-weaning growth rate. Kids from first parity does, twin born kids and kids born during the dry season had lower growth rate. The significant effect of fixed factors needs to be considered in an effort to improve productivity of goats in the study areas.

Aging management guideline for commercial nuclear power plants - heat exchangers

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

Booker, S.; Lehnert, D.; Daavettila, N.

1994-06-01

This Aging Management Guideline (AMG) describes recommended methods for effective detection and mitigation of age-related degradation mechanisms in commercial nuclear power plant heat exchangers important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specific aging mechanisms (expected or already experienced) and aging management program activitiesmore » to the more generic results and recommendations presented herein.« less

Experimental performances of a battery thermal management system using a phase change material

NASA Astrophysics Data System (ADS)

Hémery, Charles-Victor; Pra, Franck; Robin, Jean-François; Marty, Philippe

2014-12-01

Li-ion batteries are leading candidates for mobility because electric vehicles (EV) are an environmentally friendly mean of transport. With age, Li-ion cells show a more resistive behavior leading to extra heat generation. Another kind of problem called thermal runway arises when the cell is too hot, what happens in case of overcharge or short circuit. In order to evaluate the effect of these defects at the whole battery scale, an air-cooled battery module was built and tested, using electrical heaters instead of real cells for safety reasons. A battery thermal management system based on a phase change material is developed in that study. This passive system is coupled with an active liquid cooling system in order to initialize the battery temperature at the melting of the PCM. This initialization, or PCM solidification, can be performed during a charge for example, in other words when the energy from the network is available.

The Diabetes Self-management Assessment Report Tool (D-SMART): process evaluation and patient satisfaction.

PubMed

Charron-Prochownik, Denise; Zgibor, Janice C; Peyrot, Mark; Peeples, Malinda; McWilliams, Janis; Koshinsky, Janice; Noullet, William; Siminerio, Linda M

2007-01-01

The purpose of this article is to present the results of the process evaluation and patient experience in completing the Diabetes Self-management Assessment Report Tool (D-SMART), an instrument within the AADE Outcome System to assist diabetes educators to assess, facilitate, and track behavior change in the provision of diabetes self-management education (DSME). The D-SMART was integrated into computer and telephonic systems at 5 sites within the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) network. Data were obtained from 290 patients with diabetes using the system at these programs via paper-and-pencil questionnaires following baseline D-SMART assessments and electronic system measurement of system performance. Process evaluation included time of completion, understanding content, usability of technology, and satisfaction with the system. Patients were 58% female and 85% Caucasian and had a mean age of 58 years. Fifty-six percent of patients had no more than a high school education, and 78% had Internet access at home. Most patients reported completing the D-SMART at home (78%), in 1 attempt (86%) via the Internet (55%), and in less than 30 minutes. Seventy-six percent believed the questions were easy to understand, and 80% did not need assistance. Age was negatively associated with ease of use. Moreover, 76% of patients believed the D-SMART helped them think about their diabetes, with 67% indicating that it gave the diabetes educator good information about themselves and their diabetes. Most (94%) were satisfied with the D-SMART. Level of satisfaction was independent of the system being used. The D-SMART was easily completed at home in 1 attempt, content was understandable, and patients were generally satisfied with the wording of questions and selection of answers. The D-SMART is easy to use and enhanced communication between the patient and clinician; however, elderly patients may need more assistance. Computer-based and telephonic D-SMARTs appear to be feasible and useful assessment methods for diabetes educators.

Prevalence of coccidiosis among village and exotic breed of chickens in Maiduguri, Nigeria

PubMed Central

Lawal, Jallailudeen Rabana; Jajere, Saleh Mohammed; Ibrahim, Umar Isa; Geidam, Yaqub Ahmed; Gulani, Isa Adamu; Musa, Gambo; Ibekwe, Benjamin U.

2016-01-01

Aim: Coccidiosis is an important enteric parasitic disease of poultry associated with significant economic losses to poultry farmers worldwide. This survey was conducted from June 2014 through July 2015 with the main goal of investigating the prevalence and associated risk factors of coccidiosis among village and exotic breeds of chickens in Maiduguri, Northeastern Nigeria. Materials and Methods: A total of 600 fecal samples from live and slaughtered birds comprising 284 young, 141, growers and 175 adult birds; 379 male and 221 female birds; 450 exotic and 150 local breeds of birds were randomly collected either as bird’s fresh droppings or cutting open an eviscerated intestine of slaughtered birds, while noting their age, sex, and breeds. Samples were analyzed using standard parasitological methods and techniques. Results: An overall prevalence rate of 31.8% (95% confidence interval: 28.07-35.52) was obtained. Higher prevalence rates were recorded in growing birds 58.9% (50.78-67.02), female birds 35.3% (29.00-41.60), exotic birds 42.4% (37.83-46.97), and broiler birds 68.7% (61.28-76.12). Similarly, higher infection rates were also observed among birds sampled from Mairi ward 66.7% (56.03-77.37), intensive management system 46.5% (41.61-51.39), and constructed local cages 54.0% (46.02-61.98). The difference in prevalence of coccidiosis among age groups, breeds, among exotic breeds, sampling sites, husbandry management systems, and litter management systems was statistically significant (<0.0001). However, no significant difference (p>0.05) of infection rates was observed in sex. Conclusion: Coccidiosis is endemic in both commercial and backyard poultry farms in Maiduguri due to poor management practices encouraging Eimeria oocysts build-up. It is therefore, recommended that poultry farmers should practice strict biosecurity measures on their farms, creating awareness on the prevalence of coccidiosis, routine vaccination against coccidiosis and educating poultry farmers on the need for maintaining good hygienic standards and good flock health management. PMID:27397991

What happens to health professionals when the ill patient is the health care system? Understanding the experience of practising medicine in the Romanian socio-cultural context.

PubMed

Spânu, Florina; Băban, Adriana; Bria, Mara; Dumitrascu, Dan L

2013-09-01

Our aims were to investigate the sources of work strain and stress, and the way in which they are experienced by Romanian health professionals in a work context shaped by the ongoing 20 years long reform of the national health care system. An exploratory, qualitative design was used to investigate medical professionals' perceptions of stress and work strain. Twenty eight interviews and two focus groups were conducted with 38 physicians, residents and nurses, between the age of 26 and 53. A semi-structured interview guide was used for data gathering and the major themes were identified using thematic analysis of the transcripts. Three themes emerged in the analysis: governance and health system management, scarcity of resources, and health system reputation. Health professionals described the image of a suffering health system, exhausted by an inconsistent management plan, underfunded and understaffed; a system that is a constant source of discontent, bitterness and doubts for them and their patients. Romanian health professionals' experiences reveal a health care system which after 20 years of reform managed to shape a learned helplessness culture within the medical community and drive a large proportion of its workforce across the borders. © 2012 The British Psychological Society.

Marketing information system online design for craftsmen small medium enterprises (case study: craftsmen ac)

NASA Astrophysics Data System (ADS)

Fitriana, Rina; Kurniawan, Wawan; Barlianto, Anung; Adriansyah Putra, Rizki

2016-02-01

AC is small and medium enterprises which is engaged in the field of crafts. This SME (Small Medium Enterprise) didn't have an integrated information system for managing sales. This research aims to design a marketing Information system online as applications that built as web base. The integrated system is made to manage sales and expand its market share. This study uses a structured analysis and design in its approach to build systems and also implemented a marketing framework of STP (Segmentation, Targeting, Positioning) and 4P (Price, Product, Place, Promotion) to obtain market analysis. The main market target customer craftsmen AC is women aged 13 years to 35 years. The products produced by AC are shoes, brooch, that are typical of the archipelago. The prices is range from Rp. 2000 until Rp. 400.000. Marketing information system online can be used as a sales transaction document, promoting the goods, and for customer booking products.

Wireless Fluid-Level Measurement System Equips Boat Owners

NASA Technical Reports Server (NTRS)

2008-01-01

While developing a measurement acquisition system to be used to retrofit aging aircraft with vehicle health monitoring capabilities, Langley Research Center developed an innovative wireless fluid-level measurement system. The NASA technology was of interest to Tidewater Sensors LLC, of Newport News, Virginia, because of its many advantages over conventional fuel management systems, including its ability to provide an accurate measurement of volume while a boat is experiencing any rocking motion due to waves or people moving about on the boat. These advantages led the company to license this novel fluid-level measurement system from NASA for marine applications.

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

PubMed

Honma, Katsuaki; Sakai, Ritsuko; Takeshima, Akiko; Shimamori, Yoshimitsu; Hayase, Yukitoshi

2004-10-01

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

Occupational health and safety management practices and musculoskeletal disorders in aged care.

PubMed

Oakman, Jodi; Bartram, Timothy

2017-05-15

Purpose The purpose of this paper is to examine whether occupational health and safety (OHS) management used to manage musculoskeletal disorders (MSDs) in the aged care sector reflects contemporary research evidence of best practice to reduce the incidence of these disorders. Design/methodology/approach In total, 58 interviews were conducted with managers and supervisors in the aged care sector across four organisations in Australia. Policies and procedures relating to MSDs were reviewed for each organisation. Findings Policies and procedures for managing MSDs do not reflect contemporary evidence, which supports a complex aetiology, related to a range of physical and psychosocial workplace factors. Despite strong evidence that psychosocial factors contribute to MSD development, these were not included in the policies and procedures reviewed. Findings from the interviews management practices including leadership and various components of HRM were functioning well but fragmentation was evident due to the challenging nature of the aged care sector. Practical implications To address the significant burden of MSDs in the aged care sector, policies and procedures need to include coverage of psychosocial and physical workplace factors. The development of systematic and integrated OHS management at the workplace level may play an important role in the effective management of MSDs. Originality/value This study offers insights into the previously unexplored area of MSD risk management and the role of management practices such as HRM in the aged care sector.

Aging in Community: Developing a More Holistic Approach to Enhance Older Adults' Well-Being.

PubMed

Davitt, Joan K; Madigan, Elizabeth A; Rantz, Marilyn; Skemp, Lisa

2016-01-01

Public health advances have contributed to increased longevity; however, individuals are more likely to live longer with multiple chronic conditions. The existing health care system primarily focuses on treating disease rather than addressing well-being as a holistic construct that includes physical, social, and environmental components. The current commentary emphasizes the importance of supporting healthy active aging and aging in community. The barriers to aging in community and the state of the intervention science in response to this problem are discussed, and recommendations for future research are provided. Active aging is more than managing illness or care transitions-it promotes engagement, participation, dignity, self-fulfillment, self-determination, and support for older adults. To support aging in community and healthy active aging, a paradigm shift is needed in how the well-being of older adults is thought about and supported. Copyright 2016, SLACK Incorporated.

Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health.

PubMed

Alshamsan, Riyadh; Lee, John Tayu; Rana, Sangeeta; Areabi, Hasan; Millett, Christopher

2017-09-01

Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage.

Comparative health system performance in six middle-income countries: cross-sectional analysis using World Health Organization study of global ageing and health

PubMed Central

Alshamsan, Riyadh; Lee, John Tayu; Rana, Sangeeta; Areabi, Hasan; Millett, Christopher

2017-01-01

Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage. PMID:28895493

The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: Contested discourses of ageing

PubMed Central

Myers, Jason; Smith, Glenn; Higgs, Paul; Burns, Aine; Hopkins, Katherine; Jones, Louise

2014-01-01

Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a ‘natural’ and a ‘normal’ paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap. PMID:24695386

The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: contested discourses of ageing.

PubMed

Low, Joe; Myers, Jason; Smith, Glenn; Higgs, Paul; Burns, Aine; Hopkins, Katherine; Jones, Louise

2014-11-01

Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a 'natural' and a 'normal' paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap. © The Author(s) 2014.

Bristol Ridge: A 28-nm $$\\times$$ 86 Performance-Enhanced Microprocessor Through System Power Management

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

Sundaram, Sriram; Grenat, Aaron; Naffziger, Samuel

Power management techniques can be effective at extracting more performance and energy efficiency out of mature systems on chip (SoCs). For instance, the peak performance of microprocessors is often limited by worst case technology (Vmax), infrastructure (thermal/electrical), and microprocessor usage assumptions. Performance/watt of microprocessors also typically suffers from guard bands associated with the test and binning processes as well as worst case aging/lifetime degradation. Similarly, on multicore processors, shared voltage rails tend to limit the peak performance achievable in low thread count workloads. In this paper, we describe five power management techniques that maximize the per-part performance under the before-mentionedmore » constraints. Using these techniques, we demonstrate a net performance increase of up to 15% depending on the application and TDP of the SoC, implemented on 'Bristol Ridge,' a 28-nm CMOS, dual-core x 86 accelerated processing unit.« less

Recent Technology of Sensing, Monitoring, Diagnosis, and Maintenance for Aged Electric Power and Energy System

NASA Astrophysics Data System (ADS)

Matsumoto, Satoshi

This paper deals with the recent topics related to sensing, monitoring, and diagnosis for electric power equipment. Moreover the risk management for such equipments has been an object of study in many terms such as economical, technical aspects, safety and rest, CSR (Corporate Social Responsibility) etc. The relationship between the function of the economic engineering and the maintenance strategy for electric power system are reviewed.

77 FR 16270 - Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-20

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0070] Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION: Draft..., ``Updated Aging Management Criteria for PWR Reactor Vessel Internal Components.'' This draft LR-ISG revises...

77 FR 23513 - Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0070] Updated Aging Management Criteria for Reactor Vessel Internal Components of Pressurized Water Reactors AGENCY: Nuclear Regulatory Commission. ACTION: Draft...-ISG), LR-ISG-2011-04, ``Updated Aging Management Criteria for PWR Reactor Vessel Internal Components...

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Preterm birth complications are the leading cause of deaths for children under five years. Antenatal corticosteroids (ACS) are effective at reducing mortality and serious morbidity amongst infants born at <34 weeks gestation. WHO guidelines strongly recommend use of ACS for women at risk of imminent preterm birth where gestational age, imminent preterm birth, and risk of maternal infection can be assessed, and appropriate maternal/newborn care provided. However, coverage remains low in high-burden countries for reasons not previously systematically investigated. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for ACS. Results Eleven out of twelve countries provided data in response to the ACS questionnaire. Health system building blocks most frequently reported as having significant or very major bottlenecks were health information systems (11 countries), essential medical products and technologies (9 out of 11 countries) and health service delivery (9 out of 11 countries). Bottlenecks included absence of coverage data, poor gestational age metrics, lack of national essential medicines listing, discrepancies between prescribing authority and provider cadres managing care, delays due to referral, and lack of supervision, mentoring and quality improvement systems. Conclusions Analysis centred on health system building blocks in which 9 or more countries (>75%) reported very major or significant bottlenecks. Health information systems should include improved gestational age assessment and track ACS coverage, use and outcomes. Better health service delivery requires clarified policy assigning roles by level of care and cadre of provider, dependent on capability to assess gestational age and risk of preterm birth, and the implementation of guidelines with adequate supervision, mentoring and quality improvement systems, including audit and feedback. National essential medicines lists should include dexamethasone for antenatal use, and dexamethasone should be integrated into supply logistics. PMID:26390927

Sickness absence trends after loss control management

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

Tabaluyan, T.; Kuswadji, S.

1996-12-31

To assess the influence of loss control management programs applied in an oil and gas company to sickness absence trends. After the implementation of loss control management programs in 1990, sickness absence records in 1991, 1992 and 1993 were studied. International Safety Rating System (ISRS) management elements were audited each year. Absence parameter used were sickness frequency, mean sickness days examined by employee group age, length of service, work schedule and work location. Although frequency of sickness absences remain unchanged, there was a marked decrease of mean days per absence for certain worker groups. The effects were true among agemore » group 40-49 years, service group 15-19 years, service group 20-24 years and office workers. Shorter sickness absences among certain group of employees was noted following implementation of loss control management programs.« less

Human Factors Society, Annual Meeting, 35th, San Francisco, CA, Sept. 2-6, 1991, Proceedings. Vols. 1 2

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

Not Available

These proceedings discuss human factor issues related to aerospace systems, aging, communications, computer systems, consumer products, education and forensic topics, environmental design, industrial ergonomics, international technology transfer, organizational design and management, personality and individual differences in human performance, safety, system development, test and evaluation, training, and visual performance. Particular attention is given to HUDs, attitude indicators, and sensor displays; human factors of space exploration; behavior and aging; the design and evaluation of phone-based interfaces; knowledge acquisition and expert systems; handwriting, speech, and other input techniques; interface design for text, numerics, and speech; and human factor issues in medicine. Also discussedmore » are cumulative trauma disorders, industrial safety, evaluative techniques for automation impacts on the human operators, visual issues in training, and interpreting and organizing human factor concepts and information.« less

Influence of Different Forest System Management Practices on Leaf Litter Decomposition Rates, Nutrient Dynamics and the Activity of Ligninolytic Enzymes: A Case Study from Central European Forests

PubMed Central

Schulz, Elke; Schloter, Michael; Buscot, François; Hofrichter, Martin; Krüger, Dirk

2014-01-01

Leaf litter decomposition is the key ecological process that determines the sustainability of managed forest ecosystems, however very few studies hitherto have investigated this process with respect to silvicultural management practices. The aims of the present study were to investigate the effects of forest management practices on leaf litter decomposition rates, nutrient dynamics (C, N, Mg, K, Ca, P) and the activity of ligninolytic enzymes. We approached these questions using a 473 day long litterbag experiment. We found that age-class beech and spruce forests (high forest management intensity) had significantly higher decomposition rates and nutrient release (most nutrients) than unmanaged deciduous forest reserves (P<0.05). The site with near-to-nature forest management (low forest management intensity) exhibited no significant differences in litter decomposition rate, C release, lignin decomposition, and C/N, lignin/N and ligninolytic enzyme patterns compared to the unmanaged deciduous forest reserves, but most nutrient dynamics examined in this study were significantly faster under such near-to-nature forest management practices. Analyzing the activities of ligninolytic enzymes provided evidence that different forest system management practices affect litter decomposition by changing microbial enzyme activities, at least over the investigated time frame of 473 days (laccase, P<0.0001; manganese peroxidase (MnP), P = 0.0260). Our results also indicate that lignin decomposition is the rate limiting step in leaf litter decomposition and that MnP is one of the key oxidative enzymes of litter degradation. We demonstrate here that forest system management practices can significantly affect important ecological processes and services such as decomposition and nutrient cycling. PMID:24699676

Influence of different forest system management practices on leaf litter decomposition rates, nutrient dynamics and the activity of ligninolytic enzymes: a case study from central European forests.

PubMed

Purahong, Witoon; Kapturska, Danuta; Pecyna, Marek J; Schulz, Elke; Schloter, Michael; Buscot, François; Hofrichter, Martin; Krüger, Dirk

2014-01-01

Leaf litter decomposition is the key ecological process that determines the sustainability of managed forest ecosystems, however very few studies hitherto have investigated this process with respect to silvicultural management practices. The aims of the present study were to investigate the effects of forest management practices on leaf litter decomposition rates, nutrient dynamics (C, N, Mg, K, Ca, P) and the activity of ligninolytic enzymes. We approached these questions using a 473 day long litterbag experiment. We found that age-class beech and spruce forests (high forest management intensity) had significantly higher decomposition rates and nutrient release (most nutrients) than unmanaged deciduous forest reserves (P<0.05). The site with near-to-nature forest management (low forest management intensity) exhibited no significant differences in litter decomposition rate, C release, lignin decomposition, and C/N, lignin/N and ligninolytic enzyme patterns compared to the unmanaged deciduous forest reserves, but most nutrient dynamics examined in this study were significantly faster under such near-to-nature forest management practices. Analyzing the activities of ligninolytic enzymes provided evidence that different forest system management practices affect litter decomposition by changing microbial enzyme activities, at least over the investigated time frame of 473 days (laccase, P<0.0001; manganese peroxidase (MnP), P = 0.0260). Our results also indicate that lignin decomposition is the rate limiting step in leaf litter decomposition and that MnP is one of the key oxidative enzymes of litter degradation. We demonstrate here that forest system management practices can significantly affect important ecological processes and services such as decomposition and nutrient cycling.

Tree regeneration following group selection harvesting in southern Indiana

Treesearch

Dale R. Weigel; George R. Parker

1995-01-01

An increased interest in the use of group selection harvesting in the Central Hardwood forests has emphasized the lack of scientific information about species response under this uneven-aged management system. Tree regeneration response following group selection harvesting was studied on thirty-six group selection openings on the Naval Surface Warfare Center, Crane...

Taking the High Road: Privacy in the Age of Drones

ERIC Educational Resources Information Center

Hamilton, Lucas; Harrington, Michael; Lawrence, Cameron; Perrot, Remy; Studer, Severin

2017-01-01

This case examines the technological, ethical and legal issues surrounding the use of drones in business. Mary McKay, a recent Management Information Systems (MIS) graduate sets up a professional photography and videography business. She gains a leg up on the competition with drone-mounted cameras and live video streaming through the free…

Teaching Internet Security, Safety in Our Classrooms

ERIC Educational Resources Information Center

DeFranco, Joanna F.

2011-01-01

Internet security is an important topic for educators due to curriculums now incorporating tools such as the Internet, Google docs, e-portfolios, and course management systems. Those tools require students to spend more time online, where they are susceptible to manipulation or intimidation if they do not stay on task. Kids of all ages lack…

Desktop Social Science: Coming of Age.

ERIC Educational Resources Information Center

Dwyer, David C.; And Others

Beginning in 1985, Apple Computer, Inc. and several school districts began a collaboration to examine the impact of intensive computer use on instruction and learning in K-12 classrooms. This paper follows the development of a Macintosh II-based management and retrieval system for text data undertaken to store and retrieve oral reflections of…

White-tailed deer age ratios as herd management and predator impact measures in Pennsylvania

USGS Publications Warehouse

Rosenberry, Christopher S.; Norton, Andrew S.; Diefenbach, Duane R.; Fleegle, Jeannine T.; Wallingford, Bret D.

2011-01-01

A review of the Pennsylvania Game Commission's (PGC) deer management program and public concern about predator impacts on deer (Odocoileus virginianus) populations compelled the PGC to investigate the role of age ratios in developing management recommendations. Age ratios, such as proportion of juveniles in the antlerless harvest, may provide an index to population productivity and predator impacts. We estimated proportion of juveniles in the antlerless harvest from hunter-killed deer, population trends using the Pennsylvania (USA) sex–age–kill model, and reproduction from road-killed females. Using these estimates and a simulation model, we concluded that no single age-ratio value would serve as a reliable measure of population status. Wildlife Management Unit-specific trends in proportion of juveniles in the antlerless harvest and population trends provided the most relevant management information. We also provide an example decision chart to guide management actions in response to declining age ratios in the harvest. Although predator management activities and juvenile survival studies are often desired by the public, our decision-chart example indicated a number of deer management options exist before investing resources in predator management activities and juvenile survival studies.

Use of multispecies occupancy models to evaluate the response of bird communities to forest degradation associated with logging.

PubMed

Carrillo-Rubio, Eduardo; Kéry, Marc; Morreale, Stephen J; Sullivan, Patrick J; Gardner, Beth; Cooch, Evan G; Lassoie, James P

2014-08-01

Forest degradation is arguably the greatest threat to biodiversity, ecosystem services, and rural livelihoods. Therefore, increasing understanding of how organisms respond to degradation is essential for management and conservation planning. We were motivated by the need for rapid and practical analytical tools to assess the influence of management and degradation on biodiversity and system state in areas subject to rapid environmental change. We compared bird community composition and size in managed (ejido, i.e., communally owned lands) and unmanaged (national park) forests in the Sierra Tarahumara region, Mexico, using multispecies occupancy models and data from a 2-year breeding bird survey. Unmanaged sites had on average higher species occupancy and richness than managed sites. Most species were present in low numbers as indicated by lower values of detection and occupancy associated with logging-induced degradation. Less than 10% of species had occupancy probabilities >0.5, and degradation had no positive effects on occupancy. The estimated metacommunity size of 125 exceeded previous estimates for the region, and sites with mature trees and uneven-aged forest stand characteristics contained the highest species richness. Higher estimation uncertainty and decreases in richness and occupancy for all species, including habitat generalists, were associated with degraded young, even-aged stands. Our findings show that multispecies occupancy methods provide tractable measures of biodiversity and system state and valuable decision support for landholders and managers. These techniques can be used to rapidly address gaps in biodiversity information, threats to biodiversity, and vulnerabilities of species of interest on a landscape level, even in degraded or fast-changing environments. Moreover, such tools may be particularly relevant in the assessment of species richness and distribution in a wide array of habitats. © 2014 Society for Conservation Biology.

Dairy operation management practices and herd milk production.

PubMed

Losinger, W C; Heinrichs, A J

1996-03-01

A national US survey collected data on herd milk production and management of Holstein herds. Step-wise selection identified management practices that were related to herd milk production using only operations that calculated herd milk production as well as using data from all operations. Results were similar. Milk production was highest in the West. Operations with < 100 dairy cows had lower production than did larger operations. Operations with > 25% registered cattle had higher production than operations with no registered cattle. Dairy operations that reported a mean BW > 545 kg at first calving had higher mean milk production than operations with a mean BW < or = 545 kg at first calving. Operations that reported mean age at first calving < 27 mo had higher mean milk production than operations with a mean age > or = 27 mo at first calving. In addition, use of the following management practices was associated with higher rolling herd average milk production: calves born in individual areas in buildings, calves hand-fed first colostrum, starter grain fed to preweaned calves, ionophores fed to heifers from birth to first calving, DHIA record-keeping system used, computerized records, and no new cattle introduced in the previous 12 mo.

Differences in the management of hypertension, diabetes mellitus and dyslipidemia between obesity classes.

PubMed

Martínez-St John, D R J; Palazón-Bru, A; Gil-Guillén, V F; Sepehri, A; Navarro-Cremades, F; Orozco-Beltrán, D; Carratalá-Munuera, C; Cortés, E; Rizo-Baeza, M M

2016-01-01

We did not find any paper that assessed clinical inertia in obese patients. Therefore, no paper has compared the clinical inertia rates between morbidly and nonmorbidly obese patients. A cross-sectional observational study was carried out. We analysed 8687 obese patients ⩾40 years of age who attended their health-care center for a checkup as part of a preventive program. The outcome was morbid obesity. Secondary variables were as follows: failure in the management of high blood pressure (HBP), high blood cholesterol (HBC) and high fasting blood glucose (HFBG); gender; personal history of hypertension, dyslipidemia, diabetes, smoking and cardiovascular disease; and age (years). We analysed the association between failures and morbid obesity by calculating the adjusted odds ratio (OR). Of 8687 obese patients, 421 had morbid obesity (4.8%, 95% confidence interval (CI): 4.4-5.3%). The prevalence rates for failures were as follows: HBP, 34.7%; HBC, 35.2%; and HFBG, 12.4%. Associated factors with morbid obesity related with failures were as follows: failure in the management of HBP (OR=1.42, 95% CI: 1.15-1.74, P=0.001); failure in the management of HBC (OR=0.73, 95% CI: 0.58-0.91, P=0.004); and failure in the management of HFBG (OR=2.24, 95% CI: 1.66-3.03, P<0.001). Morbidly obese patients faced worse management for HBP and HFBG, and better management for HBC. It would be interesting to integrate alarm systems to avoid this problem.

Management Mangrove Experiences Form Coastal People

NASA Astrophysics Data System (ADS)

Indah, P. N.; Radianto, I.; Abidin, Z.; Amir, I. T.; Pribadi, D. U.

2018-01-01

The mangrove area has an important meaning in beach ecosystem, both from ecological and economical aspects. For this, the rehabilitation of mangrove forest is done as one effort that aims to maintain and return the mangrove forest function as one of life system supporters, especially in beach area. The most respondent ages of coast people of Gending, Pajarakan, dan Kraksaan districts, Probolinggo Regency are between 30 to 59 years old, i.e. as 86 people or 95.55% indicates that coast people are productive ages so they can be hoped very potential for having role in supporting mangrove ecosystem management of Probolinggo Regency coast. The average respondent educational rates are mostly Elementary School to Senior High School, i.e. as 76 people. Generally, human resources of coast people have relatively good education level. Thereby, it can be hoped to have positive potencies for the role of coast people themselves toward the mangrove ecosystem management support of Probolinggo Regency coast. The average most respondents have family burdens two and three people as six people or 6.67 percent. But, there are still three respondents who have not have family burdens. Generally, more and more members help in respondent’s jobs. The mangrove ecosystem management strategy of Probolinggo Regency coast is by involving people role (people and people figures) and governmental supports through the models of mangrove forest management strategy, the model of embankment cultivation management by entering mangrove as input resources of production facilities, and ecotourism management by the purpose of improving people income.

Diagnostic workstation for digital hand atlas in bone age assessment

NASA Astrophysics Data System (ADS)

Cao, Fei; Huang, H. K.; Pietka, Ewa; Gilsanz, Vicente; Ominsky, Steven

1998-06-01

Bone age assessment by a radiological examination of a hand and wrist image is a procedure frequently performed in pediatric patients to evaluate growth disorders, determine growth potential in children and monitor therapy effects. The assessment method currently used in radiological diagnosis is based on atlas matching of the diagnosed hand image with the reference set of atlas patterns, which was developed in 1950s and is not fully applicable for children of today. We intent to implement a diagnostic workstation for creating a new reference set of clinically normal images which will serve as a digital atlas and can be used for a computer-assisted bone age assessment. In this paper, we present the initial data- collection and system setup phase of this five-year research program. We describe the system design, user interface implementation and software tool development for collection, visualization, management and processing of clinically normal hand and wrist images.

[Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology].

PubMed

Kabata, Piotr Maciej; Waldman, Wojciech; Sein Anand, Jacek

2015-01-01

In this paper the structure of poisonings is described, based on the material collected from tele-toxicology consults by the Pomeranian Center of Toxicology in Gdańsk and harvested from its Electronic Poison Information Management System. In addition, we analyzed conclusions drawn from a 27-month operation of the system. Data were harvested from the Electronic Poison Information Management System developed in 2012 and used by the Pomeranian Center of Toxicology since then. The research was based on 2550 tele-toxicology consults between January 1 and December 31, 2014. Subsequently the data were electronically cleaned and presented using R programming language. The Pomeranian voivodeship was the prevalent localisation of calls (N = 1879; 73.7%). Most of the calls came from emergency rooms (N = 1495; 58.63%). In the case of 1396 (54.7%) patients the time-lag between intoxication and the consult was less than 6 h. There were no differences in the age distribution between genders. Mean age was 26.3 years. Young people predominated among intoxicated individuals. The majority of intoxications were incidental (N = 888; 34.8%) or suicidal (N = 814; 31.9%) and the most of them took place in the patient's home. Information about Poison Control Center consultations access should be better spread among medical service providers. The extent of poison information collected by Polish Poison Control Centers should be limited and unified. This should contribute to the increased percentage of properly documented consultations. Additional duties stemming from the need of digital archiving of consults provided, require the involvement of additional staff, leading to the increased operation costs incurred by Poison Control Centers. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Inflammaging and cardiovascular disease: Management by medicinal plants.

PubMed

Shayganni, Erfaneh; Bahmani, Mahmoud; Asgary, Sedigheh; Rafieian-Kopaei, Mahmoud

2016-10-15

In aging, a host of molecular and cellular changes occur which accelerate alteration and progression of inflammatory diseases. These conditions in the elderly people cause appearance of a phenomenon which has been denoted as "inflammaging". Understanding the pathogenesis and finding new methods for management of inflammaging are essential. In this paper we tried not only to explain inflammaging and its treatments with concentrating on medical plants but to collect a sufficient collection of anti-inflammatory plants with focusing on their mechanism of action. In this review paper, by searching in indexing cites, desired articles were obtained since 1995 by using keywords of inflammation, inflammaging, inflammation pathophysiology, free radicals and inflammation, aging inflammation, inflammatory disease, and plants or herbal medicine in inflammation. In advanced age the generation of free radicals increases in cardiovascular system. Pathological inflammation is also associated with production of excess free radicals More importantly, chronic inflammation makes aged people susceptible to age-related diseases. Some medicinal plants have been shown promising results in inhibition of inflammaging. Some other sections such as inflammation and inflammaging in cardiovascular diseases, oxidative stress in cardiovascular complications, prevention and treatment strategies are presented. The results of published papers show that the symptoms of several inflammatory diseases can be inhibited or treated by active ingredients from medicinal plants. Copyright © 2015 Elsevier GmbH. All rights reserved.

A randomized study of contingency management and spirometric lung age for motivating smoking cessation among injection drug users.

PubMed

Drummond, Michael B; Astemborski, Jacquie; Lambert, Allison A; Goldberg, Scott; Stitzer, Maxine L; Merlo, Christian A; Rand, Cynthia S; Wise, Robert A; Kirk, Gregory D

2014-07-28

Even after quitting illicit drugs, tobacco abuse remains a major cause of morbidity and mortality in former injection drug users. An important unmet need in this population is to have effective interventions that can be used in the context of community based care. Contingency management, where a patient receives a monetary incentive for healthy behavior choices, and incorporation of individual counseling regarding spirometric "lung age" (the age of an average healthy individual with similar spirometry) have been shown to improve cessation rates in some populations. The efficacy of these interventions on improving smoking cessation rates has not been studied among current and former injection drug users. In a randomized, factorial design study, we recruited 100 active smokers from an ongoing cohort study of current and former injection drug users to assess the impact of contingency management and spirometric lung age on smoking cessation. The primary outcome was 6-month biologically-confirmed smoking cessation comparing contingency management, spirometric lung age or both to usual care. Secondary outcomes included differences in self-reported and biologically-confirmed cessation at interim visits, number of visits attended and quit attempts, smoking rates at interim visits, and changes in Fagerstrom score and self-efficacy. Six-month biologically-confirmed smoking cessations rates were 4% usual care, 0% lung age, 14% contingency management and 0% for combined lung age and contingency management (p = 0.13). There were no differences in secondary endpoints comparing the four interventions or when pooling the lung age groups. Comparing contingency management to non-contingency management, 6-month cessation rates were not different (7% vs. 2%; p = 0.36), but total number of visits with exhaled carbon monoxide-confirmed abstinence were higher for contingency management than non-contingency management participants (0.38 vs. 0.06; p = 0.03), and more contingency management participants showed reduction in their Fagerstrom score from baseline to follow-up (39% vs. 18%; p = 0.03). While lung age appeared ineffective, contingency management was associated with more short-term abstinence and lowered nicotine addiction. Contingency management may be a useful tool in development of effective tobacco cessation strategies among current and former injection drug users. Clinicaltrials.gov NCT01334736 (April 12, 2011).

Nutritional management of replacement sheep utilizing southern forages: a review.

PubMed

Chappell, G L

1993-11-01

Intensive sheep production systems seem to be an appropriate means of fully using the available resources, particularly the forages, of the southern region. In such systems, ewes should lamb first at approximately 1 yr of age. Programs to accomplish this goal must be well-planned and carefully integrated and executed. The primary goal is to achieve two-thirds of the ewe's projected mature weight before exposure for breeding. General management must reduce heat stress and parasitism. Forage quality must be maintained at a level consistent with National Research Council requirements for energy and protein. Protein is not normally a limiting factor. Energy supplementation and grazing pressure can be used to maintain growth without over-condition, which reduces subsequent performance.

What can posturography tell us about vestibular function?

NASA Technical Reports Server (NTRS)

Black, F. O.

2001-01-01

Patients with balance disorders want answers to the following basic questions: (1) What is causing my problem? and (2) What can be done about my problem? Information to fully answer these questions must include status of both sensory and motor components of the balance control systems. Computerized dynamic posturography (CDP) provides quantitative assessment of both sensory and motor components of postural control along with how the sensory inputs to the brain interact. This paper reviews the scientific basis and clinical applications of CDP. Specifically, studies describing the integration of vestibular inputs with other sensory systems for postural control are briefly summarized. Clinical applications, including assessment, rehabilitation, and management are presented. Effects of aging on postural control along with prevention and management strategies are discussed.

A Mobile Health Intervention for Self-Management and Lifestyle Change for Persons With Type 2 Diabetes, Part 2: One-Year Results From the Norwegian Randomized Controlled Trial RENEWING HEALTH

PubMed Central

Torbjørnsen, Astrid; Wahl, Astrid Klopstad; Jenum, Anne Karen; Småstuen, Milada Cvancarova; Årsand, Eirik; Ribu, Lis

2014-01-01

Background Self-management is crucial in the daily management of type 2 diabetes. It has been suggested that mHealth may be an important method for enhancing self-management when delivered in combination with health counseling. Objective The objective of this study was to test whether the use of a mobile phone–based self-management system used for 1 year, with or without telephone health counseling by a diabetes specialist nurse for the first 4 months, could improve glycated hemoglobin A1c (HbA1c) level, self-management, and health-related quality of life compared with usual care. Methods We conducted a 3-arm prospective randomized controlled trial involving 2 intervention groups and 1 control group. Eligible participants were persons with type 2 diabetes with an HbA1c level ≥7.1% (≥54.1 mmol/mol) and aged ≥18 years. Both intervention groups received the mobile phone–based self-management system Few Touch Application (FTA). The FTA consisted of a blood glucose–measuring system with automatic wireless data transfer, diet manual, physical activity registration, and management of personal goals, all recorded and operated using a diabetes diary app on the mobile phone. In addition, one intervention group received health counseling based on behavior change theory and delivered by a diabetes specialist nurse for the first 4 months after randomization. All groups received usual care by their general practitioner. The primary outcome was HbA1c level. Secondary outcomes were self-management (heiQ), health-related quality of life (SF-36), depressive symptoms (CES-D), and lifestyle changes (dietary habits and physical activity). Data were analyzed using univariate methods (t test, ANOVA) and multivariate linear and logistic regression. Results A total of 151 participants were randomized: 51 to the FTA group, 50 to the FTA-health counseling (FTA-HC) group, and 50 to the control group. Follow-up data after 1 year were available for 120 participants (79%). HbA1c level decreased in all groups, but did not differ between groups after 1 year. The mean change in the heiQ domain skills and technique acquisition was significantly greater in the FTA-HC group after adjusting for age, gender, and education (P=.04). Other secondary outcomes did not differ between groups after 1 year. In the FTA group, 39% were substantial users of the app; 34% of the FTA-HC group were substantial users. Those aged ≥63 years used the app more than their younger counterparts did (OR 2.7; 95% CI 1.02-7.12; P=.045). Conclusions The change in HbA1c level did not differ between groups after the 1-year intervention. Secondary outcomes did not differ between groups except for an increase in the self-management domain of skill and technique acquisition in the FTA-HC group. Older participants used the app more than the younger participants did. PMID:25499872

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

PubMed

Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

A categorization of water system breakdowns: Evidence from Liberia, Nigeria, Tanzania, and Uganda.

PubMed

Klug, Tori; Cronk, Ryan; Shields, Katherine F; Bartram, Jamie

2018-04-01

In rural sub-Saharan Africa, one in three handpumps are non-functional at any time. While there is some evidence describing factors associated with non-functional water systems, there is little evidence describing the categories of water system breakdowns that commonly occur. Insufficient water availability from broken down systems can force people to use unimproved water sources, which undermines the health benefits of an improved water source. We categorized common water system breakdowns using quantitative and qualitative monitoring data from Liberia, Nigeria, Tanzania, and Uganda (each N>3600 water systems) and examined how breakdown category varies by water system type and management characteristics. Specific broken parts were mentioned more frequently than all other reasons for breakdown; hardware parts frequently found at fault for breakdown were aprons (Liberia), pipes (Tanzania and Uganda), taps/spouts (Tanzania and Uganda), and lift mechanisms (Nigeria). Statistically significant differences in breakdown category were identified based on system type, age, management type, and fee collection type. Categorization can help to identify common reasons for water system breakdown. The analysis of these data can be used to develop improved monitoring instruments to inform actors of different breakdown types and provide reasons for system non-functionality. Improved monitoring instruments would enable actors to target appropriate resources to address specific breakdowns likely to arise based on system type and management characteristics in order to inform improved implementation of and post-construction support for water systems in sub-Saharan Africa. Copyright © 2017 Elsevier B.V. All rights reserved.

Causes and Correlates of Calf Mortality in Captive Asian Elephants (Elephas maximus)

PubMed Central

Mar, Khyne U.; Lahdenperä, Mirkka; Lummaa, Virpi

2012-01-01

Juvenile mortality is a key factor influencing population growth rate in density-independent, predation-free, well-managed captive populations. Currently at least a quarter of all Asian elephants live in captivity, but both the wild and captive populations are unsustainable with the present fertility and calf mortality rates. Despite the need for detailed data on calf mortality to manage effectively populations and to minimize the need for capture from the wild, very little is known of the causes and correlates of calf mortality in Asian elephants. Here we use the world's largest multigenerational demographic dataset on a semi-captive population of Asian elephants compiled from timber camps in Myanmar to investigate the survival of calves (n = 1020) to age five born to captive-born mothers (n = 391) between 1960 and 1999. Mortality risk varied significantly across different ages and was higher for males at any age. Maternal reproductive history was associated with large differences in both stillbirth and liveborn mortality risk: first-time mothers had a higher risk of calf loss as did mothers producing another calf soon (<3.7 years) after a previous birth, and when giving birth at older age. Stillbirth (4%) and pre-weaning mortality (25.6%) were considerably lower than those reported for zoo elephants and used in published population viability analyses. A large proportion of deaths were caused by accidents and lack of maternal milk/calf weakness which both might be partly preventable by supplementary feeding of mothers and calves and work reduction of high-risk mothers. Our results on Myanmar timber elephants with an extensive keeping system provide an important comparison to compromised survivorship reported in zoo elephants. They have implications for improving captive working elephant management systems in range countries and for refining population viability analyses with realistic parameter values in order to predict future population size of the Asian elephant. PMID:22396757

Causes and correlates of calf mortality in captive Asian elephants (Elephas maximus).

PubMed

Mar, Khyne U; Lahdenperä, Mirkka; Lummaa, Virpi

2012-01-01

Juvenile mortality is a key factor influencing population growth rate in density-independent, predation-free, well-managed captive populations. Currently at least a quarter of all Asian elephants live in captivity, but both the wild and captive populations are unsustainable with the present fertility and calf mortality rates. Despite the need for detailed data on calf mortality to manage effectively populations and to minimize the need for capture from the wild, very little is known of the causes and correlates of calf mortality in Asian elephants. Here we use the world's largest multigenerational demographic dataset on a semi-captive population of Asian elephants compiled from timber camps in Myanmar to investigate the survival of calves (n = 1020) to age five born to captive-born mothers (n = 391) between 1960 and 1999. Mortality risk varied significantly across different ages and was higher for males at any age. Maternal reproductive history was associated with large differences in both stillbirth and liveborn mortality risk: first-time mothers had a higher risk of calf loss as did mothers producing another calf soon (<3.7 years) after a previous birth, and when giving birth at older age. Stillbirth (4%) and pre-weaning mortality (25.6%) were considerably lower than those reported for zoo elephants and used in published population viability analyses. A large proportion of deaths were caused by accidents and lack of maternal milk/calf weakness which both might be partly preventable by supplementary feeding of mothers and calves and work reduction of high-risk mothers. Our results on Myanmar timber elephants with an extensive keeping system provide an important comparison to compromised survivorship reported in zoo elephants. They have implications for improving captive working elephant management systems in range countries and for refining population viability analyses with realistic parameter values in order to predict future population size of the Asian elephant.

[Evolution in the use and the expenditures of a healthcare provider].

PubMed

Duarte, André Luís de Castro Moura; Oliveira, Felippe de Medeiros; Santos, Anderson de Andrade; Santos, Bento Fortunato Cardoso Dos

2017-08-01

Brazil's aging population and the rising number of people reliant upon the country's supplementary healthcare system have elicited the concern of public and private managers regarding the increase in healthcare costs. In this paper, the costs per gender, per type of medical expenses and per age group of a major Brazilian self-managed healthcare provider between 2007 and 2013 were analyzed. This healthcare provider is of interest because, besides portraying a single condition of revenue growth restricted to the existing contributors, it also replicates the demographic profile expected for Brazil in 2050, when approximately one-third of its population will be over 60 years of age. The analyses confirm the current literature as they show an increase in healthcare plan usage by the elderly and the difference between admission rates by gender. They also reveal an increase in average length of stay in hospital and the increase in medical costs far above inflation, especially for materials and medicines. It is hoped that this study will help scholars and others interested in comparisons of medical expense trends, especially by age and sex, and that it encourages further collaboration on the sustainability of health insurance providers in Brazil.

Clinical Recommendation: Vulvovaginitis.

PubMed

Zuckerman, Andrea; Romano, Mary

2016-12-01

Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified. Copyright © 2016.

A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis.

PubMed

Kastner, Monika; Sawka, Anna M; Hamid, Jemila; Chen, Maggie; Thorpe, Kevin; Chignell, Mark; Ewusie, Joycelyne; Marquez, Christine; Newton, David; Straus, Sharon E

2014-09-25

Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems, yet gaps in management still exist. In response, we developed a multi-component osteoporosis knowledge translation (Op-KT) tool involving a patient-initiated risk assessment questionnaire (RAQ), which generates individualized best practice recommendations for physicians and customized education for patients at the point of care. The objective of this study was to evaluate the effectiveness of the Op-KT tool for appropriate disease management by physicians. The Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments of the outcomes 12 months before (baseline) and 12 months after tool implementation (52 data points in total). Inclusion criteria were family physicians and their patients at risk for osteoporosis (women aged ≥ 50 years, men aged ≥ 65 years). Primary outcomes were the initiation of appropriate osteoporosis screening and treatment. Analyses included segmented linear regression modeling and analysis of variance. The Op-KT tool was implemented in three family practices in Ontario, Canada representing 5 family physicians with 2840 age eligible patients (mean age 67 years; 76% women). Time series regression models showed an overall increase from baseline in the initiation of screening (3.4%; P < 0.001), any osteoporosis medications (0.5%; P = 0.006), and calcium or vitamin D (1.2%; P = 0.001). Improvements were also observed at site level for all the three sites considered, but these results varied across the sites. Of 351 patients who completed the RAQ unprompted (mean age 64 years, 77% women), the mean time for completing the RAQ was 3.43 minutes, and 56% had any disease management addressed by their physician. Study limitations included the inherent susceptibility of our design compared with a randomized trial. The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practices, and highlights its potential to facilitate patient self-management. Next steps include wider implementation and evaluation of the tool in primary care.

Aging Management Guideline for commercial nuclear power plants: Motor control centers; Final report

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

Toman, G.; Gazdzinski, R.; O`Hearn, E.

1994-02-01

This Aging Management Guideline (AMG) provides recommended methods for effective detection and mitigation of age-related degradation mechanisms in Boiling Water Reactor (BWR) and Pressurized Water Reactor (PWR) commercial nuclear power plant motor control centers important to license renewal. The intent of this AMG is to assist plant maintenance and operations personnel in maximizing the safe, useful life of these components. It also supports the documentation of effective aging management programs required under the License Renewal Rule 10 CFR Part 54. This AMG is presented in a manner that allows personnel responsible for performance analysis and maintenance to compare their plant-specificmore » aging mechanisms (expected or already experienced) and aging management program activities to the more generic results and recommendations presented herein.« less

Intensive management affects composition of betaproteobacterial ammonia oxidizers in turfgrass systems.

PubMed

Dell, Emily A; Bowman, Daniel; Rufty, Thomas; Shi, Wei

2008-07-01

Turfgrass is a highly managed ecosystem subject to frequent fertilization, mowing, irrigation, and application of pesticides. Turf management practices may create a perturbed environment for ammonia oxidizers, a key microbial group responsible for nitrification. To elucidate the long-term effects of turf management on these bacteria, we assessed the composition of betaproteobacterial ammonia oxidizers in a chronosequence of turfgrass systems (i.e., 1, 6, 23, and 95 years old) and the adjacent native pines by using both 16S rRNA and amoA gene fragments specific to ammonia oxidizers. Based on the Shannon-Wiener diversity index of denaturing gradient gel electrophoresis patterns and the rarefaction curves of amoA clones, turf management did not change the relative diversity and richness of ammonia oxidizers in turf soils as compared to native pine soils. Ammonia oxidizers in turfgrass systems comprised a suite of phylogenetic clusters common to other terrestrial ecosystems. Nitrosospira clusters 0, 2, 3, and 4; Nitrosospira sp. Nsp65-like sequences; and Nitrosomonas clusters 6 and 7 were detected in the turfgrass chronosequence with Nitrosospira clusters 3 and 4 being dominant. However, both turf age and land change (pine to turf) effected minor changes in ammonia oxidizer composition. Nitrosospira cluster 0 was observed only in older turfgrass systems (i.e., 23 and 95 years old); fine-scale differences within Nitrosospira cluster 3 were seen between native pines and turf. Further investigations are needed to elucidate the ecological implications of the compositional differences.

Managing U.S. Air Force Aircraft Operating and Support Costs: Insights from Recent RAND Analysis and Opportunities for the Future

DTIC Science & Technology

2016-01-01

operating and support (O&S) cost growth: Fuel costs drove 31 percent of overall O&S cost growth, unit-level personnel costs 30 percent, weapon system ...hours. • The root causes of weapon system sustainment costs are war-related effects and aging effects; while the former will diminish with the end of...the cost growth experienced for these large and costly fleets, with a particular focus on weapon system sustainment (WSS) costs.2 We focused on WSS

Age at asthma onset and asthma self-management education among adults in the United States.

PubMed

Mirabelli, Maria C; Beavers, Suzanne F; Shepler, Samantha H; Chatterjee, Arjun B

2015-01-01

Asthma self-management education improves asthma-related outcomes. We conducted this analysis to evaluate variation in the percentages of adults with active asthma reporting components of asthma self-management education by age at asthma onset. Data from 2011 to 2012 Asthma Call-back Surveys were used to estimate percentages of adults with active asthma reporting six components of asthma self-management education. Components of asthma self-management education include having been taught to what to do during an asthma attack and receiving an asthma action plan. Differences in the percentages of adults reporting each component and the average number of components reported across categories of age at asthma onset were estimated using linear regression, adjusted for age, education, race/ethnicity, sex, smoking status, and years since asthma onset. Overall, an estimated 76.4% of adults with active asthma were taught what to do during an asthma attack and 28.7% reported receiving an asthma action plan. Percentages reporting each asthma self-management education component declined with increasing age at asthma onset. Compared with the referent group of adults whose asthma onset occurred at 5-14 years of age, the percentage of adults reporting being taught what to do during an asthma attack was 10% lower among those whose asthma onset occurred at 65-93 years of age (95% CI: -18.0, -2.5) and the average number of components reported decreased monotonically across categories of age at asthma onset of 35 years and older. Among adults with active asthma, reports of asthma self-management education decline with increasing age at asthma onset.

Examining the impact of succession management practices on organizational performance: A national study of U.S. hospitals.

PubMed

Groves, Kevin S

2017-08-03

Spearheaded by the industry's transition from volume- to value-based care, the health care reform movement has spurred both unprecedented challenges and opportunities for developing more effective and sustainable health care delivery organizations. Whereas the formidable challenges of leading hospitals and health systems have been widely discussed, including reimbursement degradation, the rapidly aging workforce, and the imminent wave of executive retirements, the opportunity to leverage succession management and talent development capabilities to overcome these challenges has been largely overlooked. To address this key research and practice need, this multiphase study develops and validates an assessment of succession management practices for health care organizations. Utilizing data collected from two national samples of hospital organizations, the results provide a 32-item succession management assessment comprising seven distinct sets of succession management practices. The results indicate that succession management practices are strongly associated with multiple hospital performance metrics, including patient satisfaction and Medicare Spending per Beneficiary, leadership bench strength, and internal/external placement rate for executive level positions. The author concludes this article with a discussion of several practical implications for health care executives and boards, including employing the succession management assessment for diagnosing development opportunities, benchmarking succession planning and talent development practices against similar hospitals or health systems, and elevating the profile of succession management as a strategic priority in today's increasingly uncertain health care landscape.

Assessing habitat selection in Spring by male American Woodcock in Maine with a geographic information system

USGS Publications Warehouse

Sprankle, K.E.; Sepik, G.F.; McAuley, D.G.; Longcore, J.R.; McAuley, Daniel G.; Bruggink, John G.; Sepik, Greg F.

2000-01-01

Geographic information system (GIS) technology was used to identify habitats available to and used by male American woodcock (Scolopax minor) equipped with radio transmitters--54 in 1987, 51 in 1988, 46 in 1989 at Moosehorn National Wildlife Refuge, Maine. Woodcock were monitored from time of capture (25 March-15 April) to 15 June each year. To determine habitat selection by male woodcock, the following habitat characteristics were measured: land cover, age and stocking density of the forest overstory, soil drainage and texture, aspect, and percent slope. Habitat selection was examined as affected by the covariates weather and age-class of woodcock, and among years for diurnal and crepuscular periods of the breeding period. Multivariate techniques that compare use and availability of habitats were not available, so a statistical model was developed to rate importance of multiple habitat characteristics selected by woodcock. The most critical period for woodcock in terms of survival was from arrival to: mid-April. Second-year and after-second-year woodcock did not select different (P > 0.05) habitat types, but they did select different types among years and within breeding intervals (P < 0.05). In years when weather was moderate, woodcock selected young, dense stands of speckled alder (Alnus rugosa) and hardwoods, interspersed with forest openings. Suitable habitat can be maintained by creating an uneven-aged forest managed in even-aged blocks composed of several hardwood species. Managers can now quantify suitable woodcock habitat in a GIS and plan large-scale forest-harvesting strategies using data on several habitat characteristics (e.g., land cover, stand age, stocking density, soil drainage and texture, and aspect).

Ageing doctors.

PubMed

Lillis, Steven; Milligan, Eleanor

2017-03-01

Doctors are neither more nor less susceptible than the general population to the effects of ageing. The relevance of deterioration with age depends on the nature of the work undertaken. Reduced muscle strength and visual and auditory deterioration can compromise clinical ability. Accumulation of chronic disease further reduces capacity. Cognitive decline is of particular importance, as good medical care requires considerable cognitive function. Patient safety is paramount, yet older doctors are an important part of the medical workforce and their value should be recognised. Changes in patient case mix, work place support systems and individual adjustments can assist safe practice. Deterioration in health should be acknowledged and requires proactive management. Current methods of ensuring competence are inadequate for supporting ageing doctors. A new initiative is recommended comprising collaboration between regulators, colleges and employing institutions to support the ageing doctor in providing safe and effective practice. © 2017 AJA Inc.

Reservoir rehabilitations: Seeking the Fountain of Youth

USGS Publications Warehouse

Pegg, Mark A.; Pope, Kevin L.; Powell, L.A.; Turek, Kelly C.; Spurgeon, Jonathan J.; Stewart, Nathaniel T.; Hogberg, Nick P.; Porath, Mark T.

2017-01-01

Aging of reservoirs alters the functions, and associated services, of these systems through time. The goal of habitat rehabilitation is often to alter the trajectory of the aging process such that the duration of the desired state is prolonged. There are two important characteristics in alteration of the trajectory—the amplitude relative to current state and the subsequent rate of change, or aging—that ultimately determine the duration of extension for the desired state. Rehabilitation processes largely fall into three main categories: fish community manipulation, water quality manipulation, and physical habitat manipulation. We can slow aging of reservoirs through carefully implemented management actions, perhaps even turning back the hands of time, but we cannot stop aging. We call for new, innovative perspectives that incorporate an understanding of aging processes in all steps of rehabilitation of reservoirs, especially in planning and assessing.

Phosphorous fractions in soils of rubber-based agroforestry systems: Influence of season, management and stand age.

PubMed

Liu, Chenggang; Jin, Yanqiang; Liu, Changan; Tang, Jianwei; Wang, Qingwei; Xu, Mingxi

2018-03-01

Rubber-based agroforestry system is a vital management practice and its productivity is often controlled by soil phosphorus (P) nutrient, but little information is available on P fractions dynamics in such system. The aim of this study was to examine the seasonal, management and stand age effects on P fractions, acid phosphatase activity, microbial biomass P, other physical-chemical properties and litter and roots in four systems: 10-year-old rubber mono- (YM) and intercropping (YI) with N-fixing species (NFS), 22-year-old mono- (MM) and intercropping (MI) in Xishuangbanna, Southwestern China. Most P fractions varied seasonally at different depths, with highest values in the fog-cool season (i.e. labile P at 5-60cm, non-labile P and total P at 30-60cm). By contrast, moderately labile P varied little over time, except in MI that had lower values in the rainy season. Compared with their monoculture counterparts, YI doubled resin-P i concentration but decreased NaHCO 3 -extractable P, HCl-P i and residual-P o at the 0-30cm depth, whereas MI had hardly any changes in P species at the 60-cm depth. Surprisingly, residual-P o was enriched down to the deepest soil (30-60cm) in both YI and MI in the fog-cool season. All P fractions, except NaOH 0.1 -P i , were greatly reduced with increasing stand age. In addition to plants uptake, these changes can be explained by seasonality in soil environments (e.g. moisture, temperature, pH and microbial activity) and decomposition of litter and roots. Moreover, YI decreased labile P o stock, but MI increased moderately labile P i at the 60-cm depth across seasons. The results imply that a large amount of residual-P o exists in acidic Oxisol from China and that they can be reasonably exploited to reduce the application of P fertilizers, highlighting the importance of P o pool. Taken together, intercropping mature rubber plantation with NFS appears to be an effective way to enhance productivity while maintaining adequate soil P concentration over the long run. Copyright © 2017 Elsevier B.V. All rights reserved.

Cardiovascular disease and type 1 diabetes: prevalence, prediction and management in an ageing population

PubMed Central

Lee, Siang Ing; Patel, Mitesh; Jones, Christopher M.; Narendran, Parth

2015-01-01

Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1D). However, evidence of its risks and management is often extrapolated from studies in type 2 diabetic (T2D) patients or the general population. This approach is unsatisfactory given that the underlying pathology, demographics and natural history of the disease differ between T1D and T2D. Furthermore, with a rising life expectancy, a greater number of T1D patients are exposed to the cardiovascular (CV) risk factors associated with an ageing population. The aim of this review is to examine the existing literature around CVD in T1D. We pay particular attention to CVD prevalence, how well we manage risk, potential biomarkers, and whether the studies included the older aged patients (defined as aged over 65). We also discuss approaches to the management of CV risk in the older aged. The available data suggest a significant CVD burden in patients with T1D and poor management of CV risk factors. This is underpinned by a poor evidence base for therapeutic management of CV risk specifically for patients with T1D, and in the most relevant population – the older aged patients. We would suggest that important areas remain to be addressed, particularly exploring the risks and benefits of therapeutic approaches to CVD management in the older aged. PMID:26568811

Hen genetic strain and extended cold storage influence on physical egg quality from cage-free aviary housing system.

PubMed

Jones, D R; Karcher, D M; Regmi, P; Robison, C O; Gast, R K

2018-04-02

In the United States, there is an increase in need for cage-free eggs in retail and food manufacturing sectors. Understanding the impact of cage-free systems and the corresponding management on egg quality is pertinent as the U.S. industry adapts existing housing and builds new cage-free housing structures. A study was conducted comparing 2 brown shell and 2 white shell hen strains housed in a cage-free aviary system. Each set of eggs were placed in cold storage and assessed at 0, 2, 4, 8, and 12 wk. Eggs were collected at 21, 31, 42, and 60 wk of hen age. A full profile of physical quality measurements was conducted on up to 18 intact eggs for each hen strain/egg storage/hen age combination. Egg weight increased approximately 10 g for brown shell and 14 g for white shell eggs as hens aged. Many of the properties monitored were significantly impacted by all 3 main effects (hen strain, egg storage, and hen age) resulting in 3-way interactions. A brown and a white shell strain had stronger shells (44 N; P < 0.0001) than the remaining brown and white shell strains (42 N and 39 N, respectively). The current study also determined volume of shell, total length, maximum width, and percent length at maximum width to more accurately indicate egg shape than shape index. One brown shell strain produced eggs with the most consistent shape characteristics over the hen ages monitored. White shell eggs from the cage-free aviary housing produced the highest whole-egg total solids between 31 to 60 wk of hen age, whereas brown shell eggs resulted in the most consistent level of whole-egg total solids (22-23.5%). The brown and white shell strains in the current study produce cage-free aviary eggs with distinctive physical quality attributes. The outcomes from this study can be utilized by the U.S. egg industry in planning management strategies and market placement of cage-free eggs.

[Age management in enteprises as a part of occupational safety and health in elderly workers].

PubMed

Bugajska, Joanna; Makowiec-Dabrowska, Teresa; Wagrowska-Koski, Ewa

2010-01-01

An aging society is one of the most important demographic, social and economic challenges facing the contemporary world. Human capacity to perform work changes with age, which is mostly caused by the decrease in physical capacity, physical fitness and in some elements of psychophysical fitness (e.g., perceptibility, reaction time, efficiency of sense organs). Moreover, the incidence of disorders of the circulatory, respiratory, and musculoskeletal systems as well as of hormonal and metabolism disorders is higher in older persons. On the other hand, the requirements posed by professional work, as long as no change of post takes place, most often remain the same irrespective of age. As a result, the actual workload may increase with age. Although work ability decreases with age, the demographic and economic contexts point to the necessity to prolong occupational activity. It is justifiable to encourage an increasing number of elderly workers to remain in employment but only if the measures are being taken to maintain their work ability during the entire occupational activity period and to advance their qualifications. These measures must be accompanied by activities targeted at the modification of tasks, work stands, time and rhythm of work, so as to adapt them to the changing worker's capacities. Numerous activities are being systematically implemented in enterprises and the process is called "age management". The article describes the main assumptions of this new approach and the role of occupational physicians in the whole process.

78 FR 33120 - Final Interim Staff Guidance LR-ISG-2011-04; Updated Aging Management Criteria for Reactor Vessel...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-03

..., ``Generic Aging Lessons Learned Report'' (GALL Report), for the aging management of Pressurized Water... communicate insights and lessons learned and to address emergent issues not covered in license renewal... ensure that PWR license renewal applicants will adequately address age-related degradation and aging...

A comparative study of commercial lithium ion battery cycle life in electrical vehicle: Aging mechanism identification

NASA Astrophysics Data System (ADS)

Han, Xuebing; Ouyang, Minggao; Lu, Languang; Li, Jianqiu; Zheng, Yuejiu; Li, Zhe

2014-04-01

When lithium-ion batteries age with cycling, the battery capacity decreases and the resistance increases. The aging mechanism of different types of lithium-ion batteries differs. The loss of lithium inventory, loss of active material, and the increase in resistance may result in battery aging. Generally, analysis of the battery aging mechanism requires dismantling of batteries and using methods such as X-ray diffraction and scanning electron microscopy. These methods may permanently damage the battery. Therefore, the methods are inappropriate for the battery management system (BMS) in an electric vehicle. The constant current charging curves while charging the battery could be used to get the incremental capacity and differential voltage curves for identifying the aging mechanism; the battery state-of-health can then be estimated. This method can be potentially used in the BMS for online diagnostic and prognostic services. The genetic algorithm could be used to quantitatively analyze the battery aging offline. And the membership function could be used for onboard aging mechanism identification.

Analysis of behavioral risk factor surveillance system data to assess the health of Hispanic Americans with diabetes in El Paso County, Texas.

PubMed

Martinez, Nelda C; Bader, Julia

2007-01-01

The purpose of this study is to determine and describe the health of Hispanic Americans who live in El Paso County, Texas, along the US-Mexico border, particularly the multidimensional self-management practices of those with diabetes. This study also assesses Hispanic Americans with diabetes consistent with Healthy People 2010 diabetes goals and objectives. Data from the 2002 Paso del Norte Behavioral Risk Factor Surveillance System are used for analysis of behavioral health risk factors associated with diabetes among Hispanic Americans in El Paso County, Texas. One- and two-way frequency tables with logistic regression and tests for comparison of means are used for data analysis. The greatest numbers of Hispanic American residents are younger, with those diagnosed with diabetes aged 45 years and older and with lower level of education, lowest income level, and unable to work. The odds of having diabetes are 4 times greater with increasing age and 6 times greater with lower income level. The type of medical treatment is consistent with the frequency of various diabetes self-management behaviors to optimize health. Hispanic Americans are within the goal for several Healthy People 2010 targets for diabetes. Hispanic Americans along the US-Mexico border remain at risk for development of diabetes, although several self-management behavioral activities are recognized as important for prevention of diabetes to optimize quality of life.

Flash crashes, bursts, and black swans: parallels between financial markets and healthcare systems.

PubMed

West, Bruce J; Clancy, Thomas R

2010-11-01

As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on management in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the 16th in a series of articles applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, Dr Clancy, the editor of this column, and co-author, Dr West, discuss how the collapse of global financial markets in 2008 may provide valuable insight into mechanisms of complex system behavior in healthcare. Dr West, a physicist and expert in the field of complex systems and network science, is author of a chapter in the book, On the Edge: Nursing in the Age of Complexity (Lindberg C, Nash S, Linberg C. Bordertown, NJ: Plexus Press; 2008) and his most recent book, Disrupted Networks: From Physics to Climate Change (West BJ, Scafetta N. Singapore: Disrupted Networks, World Scientific Publishing; 2010).

Aged care managers' perceptions of staff preparedness for caring for older survivors of genocide and mass trauma in Australia: How prepared are aged care workers?

PubMed

Teshuva, Karen; Wells, Yvonne

2017-03-01

To investigate aged care managers' perceptions of staff preparedness for working with older people who experienced genocide or mass trauma earlier in their lives (referred to in this paper as 'older survivors'). A survey of 60 aged care service managers was conducted (50% response rate). Trauma knowledge and skills scales with Cronbach's alpha scores of 0.74 and 0.90 respectively, were used. Scores across groups were compared using Student's t-tests. Three-quarters of the respondents reported that their agency had provided aged care services for older survivors. The majority of these managers perceived their staff to be moderately informed about trauma-related issues and half rated staff trauma-related skills positively. These ratings were positively associated with trauma-related staff training, service type and service location. Results suggest that, overall, managers perceive a need to improve aged care staff's preparedness for providing care for older survivors. © 2016 AJA Inc.

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract

PubMed Central

Memon, Mariya Nazish; Bukhari, Sadia; Bhutto, Israr Ahmed

2016-01-01

Objective: To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. Method: We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. Results: Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1st daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. Conclusion: The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children. PMID:27182257

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract.

PubMed

Memon, Mariya Nazish; Bukhari, Sadia; Bhutto, Israr Ahmed

2016-01-01

To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1(st) daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children.

BRIC Health Systems and Big Pharma: A Challenge for Health Policy and Management.

PubMed

Rodwin, Victor G; Fabre, Guilhem; Ayoub, Rafael F

2018-01-02

BRIC nations - Brazil, Russia, India, and China - represent 40% of the world's population, including a growing aging population and middle class with an increasing prevalence of chronic disease. Their healthcare systems increasingly rely on prescription drugs, but they differ from most other healthcare systems because healthcare expenditures in BRIC nations have exhibited the highest revenue growth rates for pharmaceutical multinational corporations (MNCs), Big Pharma. The response of BRIC nations to Big Pharma presents contrasting cases of how governments manage the tensions posed by rising public expectations and limited resources to satisfy them. Understanding these tensions represents an emerging area of research and an important challenge for all those who work in the field of health policy and management (HPAM). © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sex steroids, the insulin-like growth factor regulatory system, and aging: implications for the management of older postmenopausal women.

PubMed

Rosen, C J; Glowacki, J; Craig, W

1998-01-01

Aging is associated with profound changes in the growth hormone/insulin-like growth factor (IGF) regulatory system. These include reductions in growth hormone, IGF-I, IGFBP3, and IGFBP-5 and an increase in IGFBP-4. These changes, coupled with rather marked declines in sex steroid production from both the ovary and adrenals may combine to have very deleterious effects on several organ systems in the postmenopausal woman. In particular, the prevalence of two very common diseases, osteoporosis and coronary artery disease, increase dramatically after the cessation of gonadal steroid production. The complex interrelationship between the IGF regulatory system and estrogens/androgens in the postmenopausal period may provide important clues as to the pathophysiology of both these disorders. In this paper, we begin to define the role of IGF-I (and its constituent IGF binding proteins) in skeletal and vascular tissue. Recent experimental data show the effects of estrogen on circulating and tissue IGFs in older individuals. Finally, estrogen replacement therapy affects the IGF regulatory system in postmenopausal women. Although conclusions from early studies remain somewhat preliminary, it is likely that the IGF regulatory system will be a prime target for future studies into the pathogenesis of several age and sex hormone related degenerative disorders.

The data management of a phase III efficacy trial of an 11-valent pneumococcal conjugate vaccine and related satellite studies conducted in the Philippines

PubMed Central

2012-01-01

Background A large phase III placebo-controlled, randomized efficacy trial of an investigational 11-valent pneumococcal conjugate vaccine against pneumonia in children less than 2 years of age was conducted in the Philippines from July 2000 to December 2004. Clinical data from 12,194 children who were given either study vaccine or placebo was collected from birth up to two years of age for the occurrence of radiologically proven pneumonia as the primary endpoint, and for clinical pneumonia and invasive pneumococcal disease as the secondary endpoints. Several tertiary endpoints were also explored. Along the core trial, several satellite studies on herd immunity, cost-effectiveness of the study vaccine, acute otitis media, and wheezing were conducted. Results We describe here in detail how the relevant clinical records were managed and how quality control procedures were implemented to ensure that valid data were obtained respectively for the core trial and for the satellite studies. We discuss how the task was achieved, what the challenges were and what might have been done differently. Conclusions There were several factors that made the task of data management doable and efficient. First, a pre-trial data management system was available. Secondly, local committed statisticians, programmers and support staff were available and partly familiar to clinical trials. Thirdly, the personnel had undergone training during trial and grew with the task they were supposed to do. Thus the knowledge needed to develop and operate clinical data system was fully transferred to local staff. Trial registration Current Controlled Trials ISRCTN62323832 PMID:22676626

The data management of a phase III efficacy trial of an 11-valent pneumococcal conjugate vaccine and related satellite studies conducted in the Philippines.

PubMed

Sanvictores, Diozele Hazel M; Lucero, Marilla G; Nohynek, Hanna; Tallo, Veronica L; Tanskanen, Antti; Nillos, Leilani T; Williams, Gail

2012-06-07

A large phase III placebo-controlled, randomized efficacy trial of an investigational 11-valent pneumococcal conjugate vaccine against pneumonia in children less than 2 years of age was conducted in the Philippines from July 2000 to December 2004. Clinical data from 12,194 children who were given either study vaccine or placebo was collected from birth up to two years of age for the occurrence of radiologically proven pneumonia as the primary endpoint, and for clinical pneumonia and invasive pneumococcal disease as the secondary endpoints. Several tertiary endpoints were also explored. Along the core trial, several satellite studies on herd immunity, cost-effectiveness of the study vaccine, acute otitis media, and wheezing were conducted. We describe here in detail how the relevant clinical records were managed and how quality control procedures were implemented to ensure that valid data were obtained respectively for the core trial and for the satellite studies. We discuss how the task was achieved, what the challenges were and what might have been done differently. There were several factors that made the task of data management doable and efficient. First, a pre-trial data management system was available. Secondly, local committed statisticians, programmers and support staff were available and partly familiar to clinical trials. Thirdly, the personnel had undergone training during trial and grew with the task they were supposed to do. Thus the knowledge needed to develop and operate clinical data system was fully transferred to local staff. Current Controlled Trials ISRCTN62323832.

Learning to Manage Change in the Third Age

ERIC Educational Resources Information Center

Innocent, Natasha

2010-01-01

Everyone is living through a period of considerable demographic change, which is predicted to continue and escalate. People are living longer and, generally, healthier lives, and the lifelong learning system in the UK needs to catch-up with this new reality. There is a need for a much more flexible approach that offers choice and opportunities to…

Behavioral Management of Exceptional Children Using Video Games as Reward.

ERIC Educational Resources Information Center

Buckalew, L.W.; Buckalew, Patricia Bowman

1983-01-01

Seventeen children ranging in age from 9 to 15 years and from grades four and eight in five classes for students with emotional conflicts were placed on a video game reward system. The observation of enhanced classroom decorum and individual performance of students suggest the effectiveness of this reward in modifying behavior. (Author/PN)

Knowledge Management & Its Applications in Distance Education

ERIC Educational Resources Information Center

Saxena, Anurag

2007-01-01

It is the digital economy age in which we are living presently. Thus, traditional thinking is proving futile and newer methods are substituting the older ones. If one has to achieve developmental goals, one has to build a knowledge repository. Success of any system today is defined by its knowledge capital. For example for a university, knowledge…

The Influence of Prior Knowledge, Peer Review, Age, and Gender in Online Philosophy Discussions

ERIC Educational Resources Information Center

Cuddy, Lucas Stebbins

2016-01-01

Using a primarily experimental design, this study investigated whether discussion boards in online community college philosophy classes can be designed in the Blackboard course management system to lead to higher order thinking. Discussions were designed using one of two teaching techniques: the activation of prior knowledge or the use of peer…

IS/IT Education vs. Business Education: The Plight of Social Collapse in Technical Business Environments

ERIC Educational Resources Information Center

Hall, Brian

2011-01-01

In an age when information, management and technology are supposed to be hand-in-hand, there is often a rift between these elements when considering people and comportment. The detachment is caused by a distressing lack of understanding between Information Systems (IS)/Information Technology (IT) students and professionals and those they interact…

Relationships between growth, quality, and stocking within managed old-growth northern hardwoods

Treesearch

Chris Gronewold; Anthony W. D' Amato; Brian J. Palik

2012-01-01

An understanding of long-term growth dynamics is central to the development of sustainable uneven-aged silvicultural systems for northern hardwood forests in eastern North America. Of particular importance are quantitative assessments of the relationships between stocking control and long-term growth and quality development. This study examined these relationships in a...

Spatial occurrence of a habitat-tracking saproxylic beetle inhabiting a managed forest landscape.

PubMed

Schroeder, L Martin; Ranius, Thomas; Ekbom, Barbara; Larsson, Stig

2007-04-01

Because of the dynamic nature of many managed habitats, proper evaluation of conservation efforts calls for models that take into account both spatial and temporal habitat dynamics. We develop a metapopulation model for successional-type systems, in which habitat quality changes over time in a predictable fashion. The occupancy and recruitment of the predatory saproxylic (dependent on dead wood) beetle Harminius undulatus was studied in a managed boreal forest landscape, covering 24,449 ha, in central Sweden. In a first step, we analyzed the beetle's occupancy pattern in relation to stand characteristics, and the amounts of present and past habitat in the surrounding landscape. Managed forest is suitable habitat when > or =60 years old, and immediately after cutting, but not between the ages of 10 and 60 years. The observed occupancy of H. undulatus was positively correlated with the stand's age as habitat. We used a metapopulation model to predict the current probability of occurrence in each forest stand, given the spatiotemporal distribution of suitable forest stands during the last 50 years. Metapopulation parameters were estimated by matching predicted spatial distributions with observed spatial distributions. The model predicted observed spatial distributions better than a similar model that assumed constant habitat quality of each forest stand. Thus, metapopulation models for successional-type systems, such as dead wood dependent organisms in managed forest landscapes, should include habitat dynamics. An estimated 82% of the landscape-wide recruitment took place in managed stands, which covered 87% of the forest area, in comparison with 18% in unmanaged stands, which covered 13% of the forest area. Among the managed stand types, > or =60-year-old stands and 3-7-year-old clear-cuttings contributed to 79% of the total recruitment while 8-59-year-old stands only contributed 3%. The results suggest the following guidelines to improve conditions for H. undulatus and other species with similar habitat requirements: (1) the proportion of the landscape constituted by younger stands should not be allowed to grow too large, (2) the rotation period of managed stands should not be allowed to be too short, and (3) dead wood should be retained and created at final cutting.

A Comparison between Electrochemical Impedance Spectroscopy and Incremental Capacity-Differential Voltage as Li-ion Diagnostic Techniques to Identify and Quantify the Effects of Degradation Modes within Battery Management Systems

NASA Astrophysics Data System (ADS)

Pastor-Fernández, Carlos; Uddin, Kotub; Chouchelamane, Gael H.; Widanage, W. Dhammika; Marco, James

2017-08-01

Degradation of Lithium-ion batteries is a complex process that is caused by a variety of mechanisms. For simplicity, ageing mechanisms are often grouped into three degradation modes (DMs): conductivity loss (CL), loss of active material (LAM) and loss of lithium inventory (LLI). State of Health (SoH) is typically the parameter used by the Battery Management System (BMS) to quantify battery degradation based on the decrease in capacity and the increase in resistance. However, the definition of SoH within a BMS does not currently include an indication of the underlying DMs causing the degradation. Previous studies have analysed the effects of the DMs using incremental capacity and differential voltage (IC-DV) and electrochemical impedance spectroscopy (EIS). The aim of this study is to compare IC-DV and EIS on the same data set to evaluate if both techniques provide similar insights into the causes of battery degradation. For an experimental case of parallelized cells aged differently, the effects due to LAM and LLI were found to be the most pertinent, outlining that both techniques are correlated. This approach can be further implemented within a BMS to quantify the causes of battery ageing which would support battery lifetime control strategies and future battery designs.

Developing a 3D Road Cadastral System: Comparing Legal Requirements and User Needs

NASA Astrophysics Data System (ADS)

Gristina, S.; Ellul, C.; Scianna, A.

2016-10-01

Road transport has always played an important role in a country's growth and, in order to manage road networks and ensure a high standard of road performance (e.g. durability, efficiency and safety), both public and private road inventories have been implemented using databases and Geographical Information Systems. They enable registering and managing significant amounts of different road information, but to date do not focus on 3D road information, data integration and interoperability. In an increasingly complex 3D urban environment, and in the age of smart cities, however, applications including intelligent transport systems, mobility and traffic management, road maintenance and safety require digital data infrastructures to manage road data: thus new inventories based on integrated 3D road models (queryable, updateable and shareable on line) are required. This paper outlines the first step towards the implementation of 3D GIS-based road inventories. Focusing on the case study of the "Road Cadastre" (the Italian road inventory as established by law), it investigates current limitations and required improvements, and also compares the required data structure imposed by cadastral legislation with real road users' needs. The study aims to: a) determine whether 3D GIS would improve road cadastre (for better management of data through the complete life-cycle infrastructure projects); b) define a conceptual model for a 3D road cadastre for Italy (whose general principles may be extended also to other countries).

A Micro-Developmental View of Parental Well-being in Families Coping with Chronic Illness

PubMed Central

Queen, Tara L.; Butner, Jonathan; Wiebe, Deborah J.; Berg, Cynthia A.

2016-01-01

Families are co-regulating systems in which the daily experiences of one member affect the well-being of another member of the family. We examined daily, micro-developmental processes by modeling the associations between adolescents’ daily problems and emotional experiences in managing type 1 diabetes and changes in parental negative and positive affect surrounding the illness. Using a daily diary method, 161 mothers (M age=40 years), fathers (M age=42 years), and early adolescents (M age=12.4 years) rated their negative and positive emotions surrounding diabetes for 14 days. Adolescents reported, via a checklist, the number of problems they experienced in managing diabetes each day. Using dynamical systems modeling, we found that adolescents’ problems and emotions were related to changes in their parents’ reports of negative affect, though differently for mothers and fathers. On days when adolescents reported more problems, fathers’ affect changed more slowly back to homeostasis. Adolescents’ problems were not associated with change in mothers’ negative affect, but when adolescents reported greater negative daily affect, mothers were drawn to greater negative affect, displaying a higher set point. Models accounting for parental coupling effects suggested that when adolescents reported more negative affect, mothers’ affect changed more slowly back to homeostasis. Neither adolescents’ problems nor their emotions were associated with changes in mothers’ or fathers’ reports of daily positive affect. These results indicate different temporal patterns in mothers’ and fathers’ negative affect that illustrate how mothers, fathers, and adolescents react differently to chronic illness within the family system. PMID:27148935

Exploring staff diabetes medication knowledge and practices in regional residential care: triangulation study.

PubMed

Wellard, Sally Jane; Rasmussen, Bodil; Savage, Sally; Dunning, Trisha

2013-07-01

This study is drawn from a larger project that aimed to identify the staffing and organisational factors influencing the quality of diabetes care for older people living in residential care in regional Victoria, Australia. The focus of the current study is on medication management for residents with diabetes. With a continuous rise in diabetes in the population, there is an associated increase in the prevalence of diabetes in aged care residential settings. However, there is little specific guidance on how to manage diabetes in older people living in institutional settings who experience multiple concurrent chronic conditions. A triangulation strategy consisting of three phases. A one-shot cross-sectional survey (n = 68) focus group interviews and a case file audit (n = 20). Data were collected between May 2009-January 2010. Staff knowledge of diabetes and its contemporary medication management was found to be suboptimal. Challenges to managing residents with diabetes included limited time, resident characteristics and communication systems. Additionally, the variability in medical support available to residents and a high level of polypharmacy added to the complexity of medication management of resident. The current study suggests administering medicine to residents in aged care settings is difficult and has potentially serious medical, professional and economic consequences. Limitations to staff knowledge of contemporary diabetes care and medications potentially place residents with diabetes at risk of receiving less than optimal diabetes care. Providing evidence-based guidelines about diabetes care in residential care settings is essential to achieve acceptable outcomes and increase the quality of life for residents in public aged care. Continuing education programs in diabetes care specifically related to medication must be provided to all health professionals and encompass scope of practice. © 2013 John Wiley & Sons Ltd.

Developing recreational harvest regulations for an unexploited lake trout population

USGS Publications Warehouse

Lenker, Melissa A; Weidel, Brian C.; Jensen, Olaf P.; Solomon, Christopher T.

2016-01-01

Developing fishing regulations for previously unexploited populations presents numerous challenges, many of which stem from a scarcity of baseline information about abundance, population productivity, and expected angling pressure. We used simulation models to test the effect of six management strategies (catch and release; trophy, minimum, and maximum length limits; and protected and exploited slot length limits) on an unexploited population of Lake Trout Salvelinus namaycush in Follensby Pond, a 393-ha lake located in New York State’s Adirondack Park. We combined field and literature data and mark–recapture abundance estimates to parameterize an age-structured population model and used the model to assess the effects of each management strategy on abundance, catch per unit effort (CPUE), and harvest over a range of angler effort (0–2,000 angler-days/year). Lake Trout density (3.5 fish/ha for fish ≥ age 13, the estimated age at maturity) was similar to densities observed in other unexploited systems, but growth rate was relatively slow. Maximum harvest occurred at levels of effort ≤ 1,000 angler-days/year in all the scenarios considered. Regulations that permitted harvest of large postmaturation fish, such as New York’s standard Lake Trout minimum size limit or a trophy size limit, resulted in low harvest and high angler CPUE. Regulations that permitted harvest of small and sometimes immature fish, such as a protected slot or maximum size limit, allowed high harvest but resulted in low angler CPUE and produced rapid declines in harvest with increases in effort beyond the effort consistent with maximum yield. Management agencies can use these results to match regulations to management goals and to assess the risks of different management options for unexploited Lake Trout populations and other fish species with similar life history traits.

Health Management Information System utilization in Pakistan: challenges, pitfalls and the way forward.

PubMed

Qazi, Muhammad Suleman; Ali, Moazzam

2011-12-01

Use of data generated through the Health Management Information System (HMIS) in decision making has been facing various challenges ever since its inception in Pakistan. This descriptive qualitative study attempts to explore the perceptions of health managers to identify the status and issues in use of HMIS. Overall 26 managers (all men, ages ranging from 26 to 49 years; selected from federal level (2), provincial (4) and seven selected districts (20) from all four provinces) were interviewed face to face. The respondents identified a number of hurdles resulting in non-use, misuse and disuse of data. These included limited scope of HMIS, dubious data quality, political motives behind demand of data and an element of corruption in data reporting etc. A great deal of political and administrative will is required to institutionalize transparency in decision making in health management and HMIS is an important tool for doing so. Appropriate legislation and regulations are needed to create a conducive policy environment that would help in changing the existing decision making culture. The effective use of information requires that besides capacity development of district health managers in understanding and use of data, the higher level decision makers are provided with relevant data timely and in an easily understandable form along with the recommended actions pertinent to this data.

A study of medical device regulation management model in Asia.

PubMed

Wu, Yi-Hui; Li, Fong-An; Fan, Yin-Ting; Tu, Pei-Weng

2016-06-01

With the aging of the post-war baby boomer generation, the increasing demands for healthcare are driving the growth of medical industry and development of new products in order to meet the immense needs from the aging population. However, medical devices are designed to maintain the health and safety of people, therefore, medical devices are undergoing rigorous management by competent health authorities in all countries. In recent years, Asian countries have been reforming their regulations and standards for medical devices with substantial changes. The study is a summary of the framework of medical device regulations in Asian countries, including Asian Harmonization Working Party (AHWP), Japan, China, Taiwan, South Korea, India and Singapore. Expert commentary: Asian countries are constantly reforming their medical device regulations. The emergence of brand-new technology and quality management issues arose by global manufacturing have imposed difficulties in harmonizing and reaching consensus between countries. The third-party conformity assessment system for medical devices can reduce the costs for competent health authorities and shorten the review time, which could facilitate the feasibility of harmonization of medical device regulations.

Clinicopathological profile and management of 161 cases of actinic cheilitis.

PubMed

Lopes, Maria Luiza Diniz de Sousa; Silva Júnior, Francisco Leonardo da; Lima, Kenio Costa; Oliveira, Patrícia Teixeira de; Silveira, Éricka Janine Dantas da

2015-01-01

Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies.

Effects of RN Age and Experience on Transformational Leadership Practices.

PubMed

Herman, Susan; Gish, Mary; Rosenblum, Ruth; Herman, Michael

2017-06-01

This study reported the evolution of transformational leadership (TL) practices and behaviors across years of age, management experience, and professional nursing practice within a professional nursing leadership organization. Recent studies of CNO TL found valuations peak near age 60 years. This study reported on a wider range of management positions, correlating years of RN practice and management experience and age to TL metrics. This study used Kouzes and Posner's Leadership Practices Inventory-Self-Assessment (LPI-S) to survey a nursing leadership organization, the Association of California Nurse Leaders (ACNL). Anonymous responses were analyzed to identify leadership trends in age and years of professional service. On average, LPI-S metrics of leadership skills advance through years of management, RN experience, and age. The TL scores are statistically higher in most LPI-S categories for those with more than 30 years of RN or management experience. Decade-averaged LPI-S TL metrics in the ACNL survey evolve linearly throughout age before peaking in the decade from age 60 to 69 years. A similar evolution of TL metrics is seen in decades of either years of management experience or years of RN experience. Transformational leadership increased with nursing maturity particularly for LPI-S categories of "inspire a shared vision," "challenge the process," and "enable others to act." In the ACNL population studied, decade-averaged leadership metrics advanced. Leadership evolution with age in the broader RN population peaked in age bracket 60 to 69 years. The LPI-S averages declined when older than 70 years, coinciding with a shift from full-time work toward retirement and part-time employment.

Managers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study.

PubMed

Kjelle, Elin; Lysdahl, Kristin Bakke; Olerud, Hilde Merete; Myklebust, Aud Mette

2018-04-25

In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers. Eleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team. Five main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities. The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services.

An Adaptive Multi-Purpose Inventory Management System for Military Aircraft Maintenance: A Case Study of Royal Jordanian Air Force (RJAF)

NASA Astrophysics Data System (ADS)

Al-Khawaldeh, Ihsan Naji

Inventory management is a vital tool for any organization to survive the competency and reduce the operating cost. In the field of aviation its importance is more provident as the spares are more on the move. Apart from the aspects related to inventory management like quantity, quality, price, lead time...etc., inventory in aviation caters for those items, where to store them and how and when to circulate them. On other hand, safety which is a prominent crucial factor in aviation field makes it more and more demanding to have an inventory management as an integral part of both aviation maintenance management and quality assurance program. Just-in Time (JIT) inventory management systems that worked well in reducing the waste and increasing the profit might not work well in aviation field both civil and military. Hence, a need for an adaptive management system that takes care of cost reduction along with high readiness is of a vital need. The Inventory Management System (IMS) in aviation and especially in military is seen to follow a mix of the different inventory management methods. In other word, it is a combination of Fixed-Order Quantity (Q-Model), and Fixed-Time Period Reordering (P-model) to cope with the dynamics of aviation maintenance needs. The uniqueness feature of aviation inventory, where a shortage of trivial spares like nuts, bolts may at some point be considered as critical, grounding a complete fleet especially one that matters a flight safety issue. Different Platforms, operating locations, aging and many others influence the need for an adaptive inventory system. Using Access software for a simple programming and using it as inventory management system that will help in defining the rate of usage of spares, and consumables, and on the other hand may give an insight in material deficiency, that will lead for engineering design improvement and modification. The main aim of this (IMS) is reduction of both A.O.G chances, and inventory cost related to effective usage of needed items based on the maintenance requirements. The key to success lies in the perseverance to use the software and develop its capabilities continuously, through a qualified workforce.

Ecosystem carbon density and allocation across a chronosequence of longleaf pine forests.

PubMed

Samuelson, Lisa J; Stokes, Thomas A; Butnor, John R; Johnsen, Kurt H; Gonzalez-Benecke, Carlos A; Martin, Timothy A; Cropper, Wendell P; Anderson, Pete H; Ramirez, Michael R; Lewis, John C

2017-01-01

Forests can partially offset greenhouse gas emissions and contribute to climate change mitigation, mainly through increases in live biomass. We quantified carbon (C) density in 20 managed longleaf pine (Pinus palustris Mill.) forests ranging in age from 5 to 118 years located across the southeastern United States and estimated above- and belowground C trajectories. Ecosystem C stock (all pools including soil C) and aboveground live tree C increased nonlinearly with stand age and the modeled asymptotic maxima were 168 Mg C/ha and 80 Mg C/ha, respectively. Accumulation of ecosystem C with stand age was driven mainly by increases in aboveground live tree C, which ranged from <1 Mg C/ha to 74 Mg C/ha and comprised <1% to 39% of ecosystem C. Live root C (sum of below-stump C, ground penetrating radar measurement of lateral root C, and live fine root C) increased with stand age and represented 4-22% of ecosystem C. Soil C was related to site index, but not to stand age, and made up 39-92% of ecosystem C. Live understory C, forest floor C, downed dead wood C, and standing dead wood C were small fractions of ecosystem C in these frequently burned stands. Stand age and site index accounted for 76% of the variation in ecosystem C among stands. The mean root-to-shoot ratio calculated as the average across all stands (excluding the grass-stage stand) was 0.54 (standard deviation of 0.19) and higher than reports for other conifers. Long-term accumulation of live tree C, combined with the larger role of belowground accumulation of lateral root C than in other forest types, indicates a role of longleaf pine forests in providing disturbance-resistant C storage that can balance the more rapid C accumulation and C removal associated with more intensively managed forests. Although other managed southern pine systems sequester more C over the short-term, we suggest that longleaf pine forests can play a meaningful role in regional forest C management. © 2016 by the Ecological Society of America.

Managed care aspects of managing multiple sclerosis.

PubMed

Owens, Gary M

2013-11-01

Multiple sclerosis (MS) is a chronic disease of the central nervous system usually diagnosed in the second or third decade of life; MS is more common among women than men by a ratio of 3 to 1. With its relatively early age of onset and symptoms that impair patients' quality of life, MS requires lifelong, dynamic treatment, and places a substantial economic burden on individuals, healthcare systems, and society. The costs associated with providing benefits for MS therapy are growing rapidly and the increasing complexity of the MS market is impacting disease management for payers. Employers are also increasingly aware of the costs associated with MS and are asking health plans to advise on the most appropriate and cost-effective ways to manage both pharmacologic and non-pharmacologic therapies for MS. Health plans, by necessity, must therefore balance appropriate access to treatments for MS with the need to manage rising treatment costs. To meet this goal, payers require population-based solutions, guidelines, and treatment algorithms for the management of MS that can be used in clinical and formulary management decision making in the context of an evolving therapeutic landscape. Further, comparative studies are necessary for payers to determine which agents may work best on a population basis. Due to the current lack of appropriate clinical guidance and insufficient head-to-head data on disease-modifying drugs, strategies for health plans and clinical management have been designed using the best available evidence. Undoubtedly, management of this class will continue to evolve with the launch of newer agents.

Investigation of Cost and Energy Optimization of Drinking Water Distribution Systems.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Gordon, Matthew; Bunn, Simon; Jacangelo, Joseph G

2015-11-17

Holistic management of water and energy resources through energy and water quality management systems (EWQMSs) have traditionally aimed at energy cost reduction with limited or no emphasis on energy efficiency or greenhouse gas minimization. This study expanded the existing EWQMS framework and determined the impact of different management strategies for energy cost and energy consumption (e.g., carbon footprint) reduction on system performance at two drinking water utilities in California (United States). The results showed that optimizing for cost led to cost reductions of 4% (Utility B, summer) to 48% (Utility A, winter). The energy optimization strategy was successfully able to find the lowest energy use operation and achieved energy usage reductions of 3% (Utility B, summer) to 10% (Utility A, winter). The findings of this study revealed that there may be a trade-off between cost optimization (dollars) and energy use (kilowatt-hours), particularly in the summer, when optimizing the system for the reduction of energy use to a minimum incurred cost increases of 64% and 184% compared with the cost optimization scenario. Water age simulations through hydraulic modeling did not reveal any adverse effects on the water quality in the distribution system or in tanks from pump schedule optimization targeting either cost or energy minimization.

The ubiquitin proteasomal system: a potential target for the management of Alzheimer's disease.

PubMed

Gadhave, Kundlik; Bolshette, Nityanand; Ahire, Ashutosh; Pardeshi, Rohit; Thakur, Krishan; Trandafir, Cristiana; Istrate, Alexandru; Ahmed, Sahabuddin; Lahkar, Mangala; Muresanu, Dafin F; Balea, Maria

2016-07-01

The cellular quality control system degrades abnormal or misfolded proteins and consists of three different mechanisms: the ubiquitin proteasomal system (UPS), autophagy and molecular chaperones. Any disturbance in this system causes proteins to accumulate, resulting in neurodegenerative diseases such as amyotrophic lateral sclerosis, Alzheimer's disease (AD), Parkinson's disease, Huntington's disease and prion or polyglutamine diseases. Alzheimer's disease is currently one of the most common age-related neurodegenerative diseases. However, its exact cause and pathogenesis are unknown. Currently approved medications for AD provide symptomatic relief; however, they fail to influence disease progression. Moreover, the components of the cellular quality control system represent an important focus for the development of targeted and potent therapies for managing AD. This review aims to evaluate whether existing evidence supports the hypothesis that UPS impairment causes the early pathogenesis of neurodegenerative disorders. The first part presents basic information about the UPS and its molecular components. The next part explains how the UPS is involved in neurodegenerative disorders. Finally, we emphasize how the UPS influences the management of AD. This review may help in the design of future UPS-related therapies for AD. © 2016 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

Risk factors for kid mortality in West African Dwarf goats under an intensive management system in Ghana.

PubMed

Turkson, P K; Antiri, Y K; Baffuor-Awuah, O

2004-05-01

Breeding records from 1997 to 2000 for West African Dwarf goats kept under an intensive management system on the National Breeding Station at Kintampo in Ghana were analysed for the effect on mortality of sex, season and type of birth, and birth weight. The pre-weaning and post-weaning mortalities were 10% (n = 390) and 23.1% (n = 351), respectively, while the overall mortality from birth up to 12 months of age was 30.8% (n = 390). The post-weaning period recorded significantly higher proportions of deaths in males, females, single-born and twins, during the rainy and dry seasons, and for kids with low or high birth weight, compared to the pre-weaning period. There was significantly higher mortality in male kids than in female kids. The odds and risks of death for male kids were about twice those for females at post-weaning and up to 1 year of age. At pre-weaning and up to 1 year of age, a higher proportion of the dead were twins. Twins had approximately 2.5 the risk of death at pre-weaning, compared to singles. Also, kids born in the rainy season had significantly higher mortality than those born in the dry season. Kids that died by the time of weaning were significantly lighter in weight at birth than those that survived. Male kids had significantly higher mean weights at birth and at weaning, but not at 12 months of age. The significance of these findings is discussed.

Hardware-related infections after deep brain stimulation surgery: review of incidence, severity and management in 212 single-center procedures in the first year after implantation.

PubMed

Piacentino, Massimo; Pilleri, Manuela; Bartolomei, Luigi

2011-12-01

Device-related infection is a common occurrence after deep brain stimulation (DBS) surgery, and may result in additional interventions and a loss of efficacy of therapy. This retrospective review aimed to evaluate the incidence, severity and management of device-related infections in 212 DBS procedures performed in our institute. Data on 106 patients, in whom 212 DBS procedures were performed between 2001 and 2011 at our institute by a single neurosurgeon (M.P.), were reviewed to assess the incidence, severity, management and clinical characteristics of infections in the first year after the implantation of a DBS system. Infections occurred in 8.5% of patients and 4.2% of procedures. Of the nine infections, eight involved the neurostimulator and extensions, and one the whole system. The infections occurred 30.7 days after implantation: 7 within 30 days and 2 within 6 months. Infected and uninfected patients were comparable in terms of age, sex, indication for DBS implantation and neurostimulator location. In eight cases, the system components involved were removed and re-implanted after 3 months, while in one case the complete hardware was removed and not re-implanted. The overall incidence of postoperative infections after DBS system implantation was 4.2%; this rate decreased over time. All infections required further surgery. Correct and timely management of partial infections may result in successful salvage of part of the system.

Managing biological networks by using text mining and computer-aided curation

NASA Astrophysics Data System (ADS)

Yu, Seok Jong; Cho, Yongseong; Lee, Min-Ho; Lim, Jongtae; Yoo, Jaesoo

2015-11-01

In order to understand a biological mechanism in a cell, a researcher should collect a huge number of protein interactions with experimental data from experiments and the literature. Text mining systems that extract biological interactions from papers have been used to construct biological networks for a few decades. Even though the text mining of literature is necessary to construct a biological network, few systems with a text mining tool are available for biologists who want to construct their own biological networks. We have developed a biological network construction system called BioKnowledge Viewer that can generate a biological interaction network by using a text mining tool and biological taggers. It also Boolean simulation software to provide a biological modeling system to simulate the model that is made with the text mining tool. A user can download PubMed articles and construct a biological network by using the Multi-level Knowledge Emergence Model (KMEM), MetaMap, and A Biomedical Named Entity Recognizer (ABNER) as a text mining tool. To evaluate the system, we constructed an aging-related biological network that consist 9,415 nodes (genes) by using manual curation. With network analysis, we found that several genes, including JNK, AP-1, and BCL-2, were highly related in aging biological network. We provide a semi-automatic curation environment so that users can obtain a graph database for managing text mining results that are generated in the server system and can navigate the network with BioKnowledge Viewer, which is freely available at http://bioknowledgeviewer.kisti.re.kr.

Paroxysmal supraventricular tachycardia in an octogenarian.

PubMed

Lutwak, Nancy; Dill, Curt

2012-09-01

Paroxysmal supraventricular tachycardia is a common dysrhythmia that occurs at all ages. Its management is determined by presenting symptoms and previous history of the patient. Patients present with a continuum of symptoms ranging from palpitations to syncope. The incidence of supraventricular tachycardia increases with age. To discuss the etiology, precipitating factors, and acute management of supraventricular tachycardia; and to discuss nodal reentry circuits and representative electrocardiographic findings. We present the case of an 84-year-old man with gallstone pancreatitis, choledolcholithiasis, and cholecystitis complicated by paroxysmal supraventricular tachycardia. We review this dysrhythmia, emphasizing its significance in elderly patients. Supraventricular tachycardia is a common dysrhythmia that can result in syncope or myocardial infarction. We present a case of an elderly man with new-onset atrioventricular (AV) nodal reentry tachycardia, possibly precipitated by overdrive of his autonomic nervous system due to pain and infection. As the percentage of the elderly in our population is growing rapidly and the incidence of AV nodal reentry tachycardia increases with age, emergency physicians should be familiar with this dysrhythmia-its etiology, precipitating factors, presentations, and treatment. It will present more frequently in the future. Published by Elsevier Inc.

Active and Healthy Ageing as a Wicked Problem: The Contribution of a Multidisciplinary Research University.

PubMed

Riva, Giuseppe; Graffigna, Guendalina; Baitieri, Maddalena; Amato, Alessandra; Bonanomi, Maria Grazia; Valentini, Paolo; Castelli, Guido

2014-01-01

The quest for an active and healthy ageing can be considered a "wicked problem." It is a social and cultural problem, which is difficult to solve because of incomplete, changing, and contradictory requirements. These problems are tough to manage because of their social complexity. They are a group of linked problems embedded in the structure of the communities in which they occur. First, they require the knowledge of the social and cultural context in which they occur. They can be solved only by understanding of what people do and why they do it. Second, they require a multidisciplinary approach. Wicked problems can have different solutions, so it is critical to capture the full range of possibilities and interpretations. Thus, we suggest that Università Cattolica del Sacro Cuore (UCSC) is well suited for accepting and managing this challenge because of its applied research orientation, multidisciplinary approach, and integrated vision. After presenting the research activity of UCSC, we describe a possible "systems thinking" strategy to consider the complexity and interdependence of active ageing and healthy living.

Age-related macular degeneration: current treatments

PubMed Central

Hubschman, Jean Pierre; Reddy, Shantan; Schwartz, Steven D

2009-01-01

Purpose: Although important progress has been made in understanding age-related macular degeneration (AMD), management of the disease continues to be a challenge. AMD research has led to a widening of available treatment options and improved prognostic perspectives. This essay reviews these treatment options. Design: Interpretative essay. Methods: Literature review and interpretation. Results: Current treatments to preserve vision in patients with non-exudative AMD include antioxidant vitamins and mineral supplementations. Exudative AMD is currently most often treated monthly with anti-VEGF intravitreal injections. However, investigators are beginning to experiment with combination therapy and surgical approaches in an attempt to limit the number of treatment and reduce the financial burden on the health care system. Conclusion: By better understanding the basis and pathogenesis of AMD, newer therapies will continue to be developed that target specific pathways in patients with AMD, with the hoped for outcome of better management of the disease and improved visual acuity. PMID:19668560

Best practice in unbilled account management: one medical center's story.

PubMed

Menaker, Debra; Miller, Joshua

2016-02-01

After implementing its new electronic health record, a large metropolitan academic medical center (AMC) decided to optimize its supporting business systems, beginning with billing. By identifying problems and taking the following corrective actions immediately, the AMC significantly reduced the number and average age of its unbilled accounts: Realigning system automation to improve routing efficiency. Facilitating interdisciplinary collaboration to better identify and correct the root causes of issues. Ensuring transparent data reporting by setting up different ways of viewing the underlying information.

Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015.

PubMed

Barbour, Kamil E; Moss, Susan; Croft, Janet B; Helmick, Charles G; Theis, Kristina A; Brady, Teresa J; Murphy, Louise B; Hootman, Jennifer M; Greenlund, Kurt J; Lu, Hua; Wang, Yan

2018-03-16

Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. 2015. The Behavioral Risk Factor Surveillance System is an annual, random-digit-dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%-33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%-42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%-19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%-61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%-53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain, and arthritis-attributable social participation restriction; ≥14 physically unhealthy days during the past 30 days; ≥14 mentally unhealthy days during the past 30 days; obesity; and leisure-time physical inactivity) and the lowest percentage of leisure-time walking. The prevalence, health-related characteristics, and management of arthritis varied substantially across states. The modeled prevalence of arthritis varied considerably by county. The findings highlight notable geographic variability in prevalence, health-related characteristics, and management of arthritis. Targeted use of evidence-based interventions that focus on physical activity and self-management education can reduce pain and improve function and quality of life for adults with arthritis and thus might reduce these geographic disparities.

Obese Employee Participation Patterns in a Wellness Program.

PubMed

Fink, Jennifer T; Smith, David R; Singh, Maharaj; Ihrke, Doug M; Cisler, Ron A

2016-04-01

The purpose of this research was to retrospectively examine whether demographic differences exist between those who participated in an employee wellness program and those who did not, and to identify the selection of employees' choice in weight management activities. A nonequivalent, 2-group retrospective design was used. This study involved employees at a large, not-for-profit integrated health system. Of the total organization employee pool (29,194), 19,771 (68%) employees volunteered to be weighed (mean body mass index [BMI]=28.9) as part of an employee wellness program. Weight management activities available included: (1) Self-directed 5% total body weight loss; (2) Healthy Solutions at home; (3) Weight Watchers group meetings; (4) Weight Watchers online; and (5) Employee Assistance Program (EAP)-directed healthy weight coaching. Measures were participation rate and available weight management activity participation rate among obese employees across demographic variables, including sex, age, race, job type, and job location. The analysis included chi-square tests for all categorical variables; odds ratios were calculated to examine factors predictive of participation. Of the total 19,771 employees weighed, 6375 (32%) employees were obese (defined as BMI ≥30); of those, 3094 (49%) participated in available weight management activities. Participation was higher among females, whites, those ages >50 years, and non-nursing staff. In conclusion, participation rate varied significantly based on demographic variables. Self-directed 5% weight loss was the most popular weight management activity selected. (Population Health Management 2016;19:132-135).

Using the Viability Theory to Assess the Flexibility of Forest Managers Under Ecological Intensification

NASA Astrophysics Data System (ADS)

Mathias, Jean-Denis; Bonté, Bruno; Cordonnier, Thomas; de Morogues, Francis

2015-11-01

Greater demand for wood material has converged with greater demand for biodiversity conservation to make balancing forest ecosystem services a key societal issue. Forest managers, owners, or policymakers need new approaches and methods to evaluate their ability to adapt to this dual objective. We analyze the ability of forest owners to define sustainable forest management options based on viability theory and a new flexibility index. This new indicator gauges the adaptive capacity of forest owners based on the number of sustainable actions available to them at a given time. Here we study a public forest owner who regulates harvest intensity and frequency in order to meet demand for timber wood at forest scale and to meet a biodiversity recommendation via a minimum permanently maintained volume of deadwood per hectare at stand scale. Dynamical systems theory was used to model uneven-aged forest dynamics—including deadwood dynamics—and the dynamics of timber wood demand and tree removals. Uneven-aged silver fir forest management in the "Quatre Montagnes region" (Vercors, France) is used as an illustrative example. The results explain situations where a joint increase in wood production and deadwood retention does not reduce the flexibility index more than increasing either one dimension alone, thus opening up ecological intensification options. To conclude, we discuss the value of the new flexibility index for addressing environmental management and ecological intensification issues.

Managing age discrimination: an examination of the techniques used when seeking employment.

PubMed

Berger, Ellie D

2009-06-01

This article examines the age-related management techniques used by older workers in their search for employment. Data are drawn from interviews with individuals aged 45-65 years (N = 30). Findings indicate that participants develop "counteractions" and "concealments" to manage perceived age discrimination. Individuals counteract employers' ageist stereotypes by maintaining their skills and changing their work-related expectations and conceal age by altering their résumés, physical appearance, and language used. This research suggests that there is a need to reexamine the hiring practices of employers and to improve legislation in relation to their accountability.

The Joint Commission has provided a tool to change your work force: are you paying attention?

PubMed

Decker, P J; Strader, M K

1998-03-01

Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.

The Space Station Freedom - International cooperation and innovation in space safety

NASA Technical Reports Server (NTRS)

Rodney, George A.

1989-01-01

The Space Station Freedom (SSF) being developed by the United States, European Space Agency (ESA), Japan, and Canada poses novel safety challenges in design, operations, logistics, and program management. A brief overview discloses many features that make SSF a radical departure from earlier low earth orbit (LEO) space stations relative to safety management: size and power levels; multiphase manned assembly; 30-year planned lifetime, with embedded 'hooks and scars' forevolution; crew size and skill-mix variability; sustained logistical dependence; use of man, robotics and telepresence for on-orbit maintenance of station and free-flyer systems; closed-environment recycling; use of automation and expert systems; long-term operation of collocated life-sciences and materials-science experiments, requiring control and segregation of hazardous and chemically incompatible materials; and materials aging in space.

Natural stand dynamics in longleaf pine: How climatic disturbances shape the community.

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

Outcalt, Kenneth, W.

2001-06-01

Longleaf pine (Pinus palustris) once dominated the overstory of a wide range of southern plant communities from the Atlantic to Texas. Although periodic fires shaped the longleaf pine communities, climatic caused disturbances, significantly impacted them as well, changing stand structure and providing open sites for regeneration. Tornadoes, which usually operate at the partial stand scale are mimicked by even age management of longleaf pine. Seed-tree and shelterwood systems create conditions similar to less severe hurricanes that remove only some of the overstory. Lightening strikes, are continuously impacting longleaf stands creating small scale gaps of 2 to 4 trees where regenerationmore » is not uniform. Managers using the selection system should be aware of this, and create gaps in dry sandhills sites accordingly.« less

Relevance of health level 7 clinical document architecture and integrating the healthcare enterprise cross-enterprise document sharing profile for managing chronic wounds in a telemedicine context.

PubMed

Finet, Philippe; Gibaud, Bernard; Dameron, Olivier; Le Bouquin Jeannès, Régine

2016-03-01

The number of patients with complications associated with chronic diseases increases with the ageing population. In particular, complex chronic wounds raise the re-admission rate in hospitals. In this context, the implementation of a telemedicine application in Basse-Normandie, France, contributes to reduce hospital stays and transport. This application requires a new collaboration among general practitioners, private duty nurses and the hospital staff. However, the main constraint mentioned by the users of this system is the lack of interoperability between the information system of this application and various partners' information systems. To improve medical data exchanges, the authors propose a new implementation based on the introduction of interoperable clinical documents and a digital document repository for managing the sharing of the documents between the telemedicine application users. They then show that this technical solution is suitable for any telemedicine application and any document sharing system in a healthcare facility or network.

Analysis of the Factors Affecting Consumer Acceptance of Accredited Online Health Information

PubMed Central

2017-01-01

With the increasing use of the internet and the spread of smartphones, health information seekers obtain considerable information through the internet. As the amount of online health information increases, the need for quality management of health information has been emphasized. The purpose of this study was to investigate the factors affecting the intention of using accredited online health information by applying the extended technology acceptance model (Extended-TAM). An online survey was conducted from September 15, 2016 to October 3, 2016, on 500 men and women aged 19–69 years. The results showed that the greatest factor influencing the acceptance of the accredited health information was perceived usefulness, and the expectation for the quality of the accreditation system was the most important mediator variable. In order to establish the health information accreditation system as a means to provide easy and useful information to the consumers, it is necessary to carry out quality management and promote the system through the continuous monitoring of the accreditation system. PMID:28960026

Clinical issues in the management of patients with myelodysplasia.

PubMed

Schiffer, Charles A

2006-01-01

The management of patients with myelodysplasia (MDS) can be quite complex and varies according to both the clinical manifestations in individual patients as well as complicating medical conditions. Allogeneic stem cell transplantation is the only curative treatment, but because of the older age of the patient population must be applied selectively, particularly in those with lower risk MDS as well as in patients whose clinical course is more frankly "preleukemic." Issues pertinent to the use of 5-azacytidine, decitabine and lenalidomide in patients with both higher and lower International Prognostic Staging System (IPSS) stage disease are discussed.

Disease management programs in Germany's statutory health insurance system.

PubMed

Busse, Reinhard

2004-01-01

The introduction in 1996 of free choice among sickness funds in Germany was accompanied by a "risk structure compensation" (RSC) mechanism based on average spending by age and sex. Because chronically ill people were not adequately taken into account, competition for newly insured consumers concentrated on the healthy. The introduction in 2002 of disease management programs addresses this problem: Insured people in such programs are treated as a separate RSC category, making them a more "attractive" group that no longer generates a deficit. The degree of sickness fund activities and the fierce dispute with physicians are valid indicators that the incentives work.

Does increasing rotation length lead to greater forest carbon storage?

NASA Astrophysics Data System (ADS)

Ter-Mikaelian, M. T.; Colombo, S. J.; Chen, J.

2016-12-01

Forest management is a key factor affecting climate change mitigation by forests. Increasing the age of harvesting (also referred to as rotation length) is a management practice that has been proposed as a means of increasing forest carbon sequestration and storage. However, studies of the effects of increasing harvest age on forest carbon stocks have mostly been limited to forest plantations. In contrast, this study assesses the effects of increased harvest age of managed natural forests of Ontario (Canada) at two scales. At the stand level, we assess merchantable volume yield curves to differentiate those for which increasing the age of harvest results in an increase in total forest carbon stocks versus those for which increased harvest age reduces carbon stocks. The stand level results are then applied to forest landscapes to demonstrate that the effect of increasing the age of harvest on forest carbon storage is specific to the forest growth rates for a given forest landscape and depends on the average age at which forests are harvested under current (business-as-usual) management practice. We discuss the implications of these results for forest management aimed at mitigating climate change.

European Top Managers' Age-Related Workplace Norms and Their Organizations' Recruitment and Retention Practices Regarding Older Workers.

PubMed

Oude Mulders, Jaap; Henkens, Kène; Schippers, Joop

2017-10-01

Top managers guide organizational strategy and practices, but their role in the employment of older workers is understudied. We study the effects that age-related workplace norms of top managers have on organizations' recruitment and retention practices regarding older workers. We investigate two types of age-related workplace norms, namely age equality norms (whether younger and older workers should be treated equally) and retirement age norms (when older workers are expected to retire) while controlling for organizational and national contexts. Data collected among top managers of 1,088 organizations from six European countries were used for the study. Logistic regression models were run to estimate the effects of age-related workplace norms on four different organizational outcomes: (a) recruiting older workers, (b) encouraging working until normal retirement age, (c) encouraging working beyond normal retirement age, and (d) rehiring retired former employees. Age-related workplace norms of top managers affect their organizations' practices, but in different ways. Age equality norms positively affect practices before the boundary of normal retirement age (Outcomes a and b), whereas retirement age norms positively affect practices after the boundary of normal retirement age (Outcomes c and d). Changing age-related workplace norms of important actors in organizations may be conducive to better employment opportunities and a higher level of employment participation of older workers. However, care should be taken to target the right types of norms, since targeting different norms may yield different outcomes. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effects of two-age management and clearcutting on songbird density and reproductive success

Treesearch

Jeffery V. Nichols; Petra Bohall Wood

1995-01-01

We examined density and reproductive success of passerine species on 7 uncut forest stands and on 12 stands harvested 10-14 years ago on the Monongahela National Forest of West Virginia (6 clearcut stands and 6 stands harvested using 2-age management). In 2-age management, stands resemble a shelterwood cut with 10-30 overstory trees/acre left uncut. Uncut periphery...

Are multidose drug dispensing systems initiated for the appropriate patients?

PubMed

Mertens, Bram J; Kwint, H F; van Marum, Rob J; Bouvy, Marcel L

2018-05-16

It is unknown if multidose drug dispensing (MDD) systems are initiated for the appropriate patients. Therefore, the objective of this study was to compare the medication management problems of patients who were about to start with a MDD system (MDD patients) and patients who continued manually dispensed medication (non-MDD users) in order to identify if the appropriate patients receive a MDD system. Patient interviews (semi-structured) were conducted by 44 community pharmacists at the patient's home. Patients over 65 years of age, home dwelling and using at least five chronic drugs, were eligible for the study. An assessment tool was developed including 22 potential medication management problems, covering four domains: functional (7), organizational (7), medication adherence (6), and medication knowledge (2). Median scores were calculated with the interquartile range. Additionally, cognitive function was assessed with the Mini-Cog and frailty using the Groningen Frailty Indicator. One hundred eighty-eight MDD users and 230 non-MDD users were interviewed. MDD users were older, more often female, and using more drugs. Forty-two percent of the MDD users were possibly cognitively impaired and 63% were assessed as frail compared to 20 and 27% respectively of the non-MDD users. MDD users had more potential organizational problems (3 vs. 1; p < 0.01), functional problems (2 vs. 1; p < 0.01), medication adherence problems (1 vs. 0; p < 0.01), and medication knowledge problems (1 vs. 0; p < 0.01) compared to non-MDD users. Seventy percent of the MDD users scored six or more potential medication management problems while this was 22% among non-MDD users. The majority of MDD systems were initiated for patients who experienced multiple potential medication management problems suggesting a decreased medication management capacity.

A Japanese model of disease management.

PubMed

Nakashima, Naoki; Kobayashi, Kunihisa; Inoguchi, Toyoshi; Nishida, Daisuke; Tanaka, Naomi; Nakazono, Hiromi; Hoshino, Akihiko; Soejima, Hidehisa; Takayanagi, Ryoichi; Nawata, Hajime

2007-01-01

We started a disease management model, Carna, that includes two programs: one for primary prevention of lifestyle diseases and one for secondary/tertiary prevention of diabetes mellitus. These programs support the family doctor system and education for participants to allow the concept of disease management to take root in Japan. We developed a critical pathway system that can optimize health care of individual participants by matching individual status. This is the core technology of the project. Under the primary prevention program, we can perform the health check-up/ instruction tasks in the 'Tokutei Kenshin', which will start for all Japanese citizens aged 40-74 years in April 2008. In the diabetic program, Carna matches doctors and new patients, prevents patient dropout, supports detection of early-stage complications by distributing questionnaires periodically, and facilitates medical specialists' cooperation with family doctors. Carna promotes periodic medical examinations and quickly provides the result of blood tests to patients. We are conducting a study to assess the medical outcomes and business model. The study will continue until the end of 2007.

Prognostics and Health Management in Nuclear Power Plants: A Review of Technologies and Applications

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

Coble, Jamie B.; Ramuhalli, Pradeep; Bond, Leonard J.

This report reviews the current state of the art of prognostics and health management (PHM) for nuclear power systems and related technology currently applied in field or under development in other technological application areas, as well as key research needs and technical gaps for increased use of PHM in nuclear power systems. The historical approach to monitoring and maintenance in nuclear power plants (NPPs), including the Maintenance Rule for active components and Aging Management Plans for passive components, are reviewed. An outline is given for the technical and economic challenges that make PHM attractive for both legacy plants through Lightmore » Water Reactor Sustainability (LWRS) and new plant designs. There is a general introduction to PHM systems for monitoring, fault detection and diagnostics, and prognostics in other, non-nuclear fields. The state of the art for health monitoring in nuclear power systems is reviewed. A discussion of related technologies that support the application of PHM systems in NPPs, including digital instrumentation and control systems, wired and wireless sensor technology, and PHM software architectures is provided. Appropriate codes and standards for PHM are discussed, along with a description of the ongoing work in developing additional necessary standards. Finally, an outline of key research needs and opportunities that must be addressed in order to support the application of PHM in legacy and new NPPs is presented.« less

Feasibility of a novel remote daily monitoring system for age-related macular degeneration using mobile handheld devices: results of a pilot study.

PubMed

Kaiser, Peter K; Wang, Yi-Zhong; He, Yu-Guang; Weisberger, Annemarie; Wolf, Stephane; Smith, Craig H

2013-10-01

This pilot study evaluated the feasibility of the Health Management Tool (HMT), a novel computing system using mobile handheld devices, to remotely monitor retinal visual function daily in patients with neovascular age-related macular degeneration treated with ranibizumab. Patients with neovascular age-related macular degeneration in at least 1 eye (newly diagnosed or successfully treated < 1 year) and eligible for ranibizumab therapy were enrolled in this 16-week, prospective, open-label, single-arm study. Patients performed a shape discrimination hyperacuity test (myVisionTrack [mVT]) daily on the HMT device (iPhone 3GS) remotely and at all clinic visits. Data entered into HMT devices were collected in the HMT database, which also sent reminders for patients to take mVT. Among 160 patients from 24 U.S. centers enrolled in the study (103 [64%] ≥ 75 years of age), 84.7% on average complied with daily mVT testing and ≈ 98.9% complied with at least weekly mVT testing. The HMT database successfully uploaded more than 17,000 mVT assessment values and sent more than 9,000 reminders. Elderly patients with neovascular age-related macular degeneration were willing and able to comply with daily self-testing of retinal visual function using mobile handheld devices in this novel system of remote vision monitoring.

New Jersey Children's Behavioral Healthcare System: cross service delivery planning for transitional population of youth (ages 16 and 18+ years).

PubMed

McGill, Kenneth; McGill, Scott A

2011-08-01

The continued need for improvement within a 'system of care' is essential as the need for mental health services by those 'youth' within the child welfare system continually grows. This article outlines the statewide reform of New Jersey's Children's Behavioral Healthcare System, which began in 2000, as well as including the recommendations of the University of South Florida as part of their 'Final Report: Independent Assessment of New Jersey's Child Behavioral Health Services' on continued changes within the system of care. Successful outcomes have resulted from this welfare reform initiative, which include most notably the significant caseload decrease of the Division of Youth and Family Services (DYFS) and the creation of a new cabinet entity, the Department of Children and Families (DCF). This article specifically outlines systemic recommendations to best serve the target population of 'transitional' youth between the ages of 16 to 18+ years utilizing interagency cooperation based upon 'theory of change' and Total Clinical Outcomes Management (TCOM) strategies. Copyright © 2010 Elsevier Ltd. All rights reserved.

Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukemiaNet.

PubMed

Barbui, Tiziano; Barosi, Giovanni; Birgegard, Gunnar; Cervantes, Francisco; Finazzi, Guido; Griesshammer, Martin; Harrison, Claire; Hasselbalch, Hans Carl; Hehlmann, Rudiger; Hoffman, Ronald; Kiladjian, Jean-Jacques; Kröger, Nicolaus; Mesa, Ruben; McMullin, Mary F; Pardanani, Animesh; Passamonti, Francesco; Vannucchi, Alessandro M; Reiter, Andreas; Silver, Richard T; Verstovsek, Srdan; Tefferi, Ayalew

2011-02-20

We present a review of critical concepts and produce recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first- and second-line therapy, and therapy for special issues. Key questions were selected according the criterion of clinical relevance. Statements were produced using a Delphi process, and two consensus conferences involving a panel of 21 experts appointed by the European LeukemiaNet (ELN) were convened. Patients with polycythemia vera (PV) and essential thrombocythemia (ET) should be defined as high risk if age is greater than 60 years or there is a history of previous thrombosis. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. Monitoring response in PV and ET should use the ELN clinicohematologic criteria. Corticosteroids, androgens, erythropoiesis-stimulating agents, and immunomodulators are recommended to treat anemia of PMF, whereas hydroxyurea is the first-line treatment of PMF-associated splenomegaly. Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequent RBC transfusions. The risk of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years.

Philadelphia-Negative Classical Myeloproliferative Neoplasms: Critical Concepts and Management Recommendations From European LeukemiaNet

PubMed Central

Barbui, Tiziano; Barosi, Giovanni; Birgegard, Gunnar; Cervantes, Francisco; Finazzi, Guido; Griesshammer, Martin; Harrison, Claire; Hasselbalch, Hans Carl; Hehlmann, Rudiger; Hoffman, Ronald; Kiladjian, Jean-Jacques; Kröger, Nicolaus; Mesa, Ruben; McMullin, Mary F.; Pardanani, Animesh; Passamonti, Francesco; Vannucchi, Alessandro M.; Reiter, Andreas; Silver, Richard T.; Verstovsek, Srdan; Tefferi, Ayalew

2011-01-01

We present a review of critical concepts and produce recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first- and second-line therapy, and therapy for special issues. Key questions were selected according the criterion of clinical relevance. Statements were produced using a Delphi process, and two consensus conferences involving a panel of 21 experts appointed by the European LeukemiaNet (ELN) were convened. Patients with polycythemia vera (PV) and essential thrombocythemia (ET) should be defined as high risk if age is greater than 60 years or there is a history of previous thrombosis. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. Monitoring response in PV and ET should use the ELN clinicohematologic criteria. Corticosteroids, androgens, erythropoiesis-stimulating agents, and immunomodulators are recommended to treat anemia of PMF, whereas hydroxyurea is the first-line treatment of PMF-associated splenomegaly. Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequent RBC transfusions. The risk of allogeneic stem-cell transplantation–related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years. PMID:21205761

Differences in characteristics between suicide cases of farm managers compared to those of farm labourers in Queensland, Australia.

PubMed

Arnautovska, Urska; McPhedran, Samara; De Leo, Diego

2015-01-01

Farmers constitute an occupation group at a heightened suicide risk compared to the general population. To date, research has tried to explain this peculiarity by identifying suicide risk factors that are common to the whole of the farming population. There are, however, indications that risk factors may be different for different sub-populations of farmers, such as younger/older farmers or farm managers/farm labourers. This study compared the characteristics of suicides by farm managers and farm labourers, while controlling for the effect of age. A review of two datasets, the Queensland Suicide Register and the National Coroners Information System, was conducted in which a total of 78 cases of farm managers and 69 cases of farm labourers were identified as a suicide during 2000-2009, Queensland, Australia. The main outcome measures included various demographic characteristics, circumstances related to death, health and mental health variables, and history of stressful life events. The two groups differed in marital status, living arrangements, ethnicity, physical and mental illness, alcohol and drug abuse, contact with a health professional prior to death, and specific life events such as relationship breakdown and recent/pending unemployment. The majority of these differences were not statistically significant once age was accounted for. However, differences in psychiatric variables and experience of a recent/pending unemployment remained significant. This study contributes towards better understanding of suicide among farmers in different job positions, and highlights the need for tailored suicide prevention initiatives that consider a combination of age- and job-specific suicide risk and protective factors among farmers.

Early Onset Ageing and Service Preparation in People with Intellectual Disabilities: Institutional Managers' Perspective

ERIC Educational Resources Information Center

Lin, Jin-Ding; Wu, Chia-Ling; Lin, Pei-Ying; Lin, Lan-Ping; Chu, Cordia M.

2011-01-01

Although longevity among older adults with intellectual disabilities is increasing, there is limited information on their premature aging related health characteristics and how it may change with increasing age. The present paper provides information of the institutional manager's perception on early onset aging and service preparation for this…

77 FR 14567 - Draft General Management Plan/Environmental Impact Statement for the Ice Age Complex at Cross...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-12

... Impact Statement for the Ice Age Complex at Cross Plains, Cross Plains, Wisconsin AGENCY: National Park... General Management Plan/Environmental Impact Statement for the Ice Age Complex at Cross Plains, Wisconsin... also send comments to Superintendent, Ice Age National Scenic Trail, 700 Rayovac Drive, Suite 100...

The Effect of Furlow Palatoplasty Timing on Speech Outcomes in Submucous Cleft Palate.

PubMed

Swanson, Jordan W; Mitchell, Brianne T; Cohen, Marilyn; Solot, Cynthia; Jackson, Oksana; Low, David; Bartlett, Scott P; Taylor, Jesse A

2017-08-01

Because some patients with submucous cleft palate (SMCP) are asymptomatic, surgical treatment is conventionally delayed until hypernasal resonance is identified during speech production. We aim to identify whether speech outcomes after repair of a SMCP is influenced by age of repair. We retrospectively studied nonsyndromic children with SMCP. Speech results, before and after any surgical treatment or physical management of the palate were compared using the Pittsburgh Weighted Speech Scoring system. Furlow palatoplasty was performed on 40 nonsyndromic patients with SMCP, and 26 patients were not surgically treated. Total composite speech scores improved significantly among children repaired between 3 and 4 years of age (P = 0.02), but not older than 4 years (P = 0.63). Twelve (86%) of 14 patients repaired who are older than 4 years had borderline or incompetent speech (composite Pittsburgh Weighted Speech Scoring ≥3) compared with 2 (29%) of 7 repaired between 3 and 4 years of age (P = 0.0068), despite worse prerepair scores in the latter group. Resonance improved in children repaired who are older than 4 years, but articulation errors persisted to a greater degree than those treated before 4 years of age (P = 0.01.) CONCLUSIONS: Submucous cleft palate repair before 4 years of age appears associated with lower ultimate rates of borderline or incompetent speech. Speech of patients repaired at or after 4 years of age seems to be characterized by persistent misarticulation. These findings highlight the importance of timely diagnosis and management.

Cavity trees, snags, and selection cutting: a northern hardwood case study

Treesearch

Laura S. Kenefic; Ralph D. Nyland

2007-01-01

Although traditional application of the selection system includes a focus on high-value trees that may reduce cavities and snags, few studies have quantified those habitat features in managed uneven-aged stands. We examined the effects of single-tree selection cutting on cavity trees and snags in a northern hardwood stand immediately prior to the second cutting....

The Northern hardwood forest ecosystem: ten years of recovery from clearcutting

Treesearch

J.W. Hornbeck; C.W. Martin; R.S. Pierce; F.H. Bormann; G.E. Likens; J.S. Eaton; J.S. Eaton

1987-01-01

Two even-age management systems, progressive strip cutting and block clearcutting, have been studied since 1970 on small watersheds at the Hubbard Brook Experimental Forest, New Hampshire. In the strip cutting, all merchantable trees were harvested in a series of three strips over 4 years (1970-74). In the block clearcutting, all trees were harvested in a single...

Embedded Diagnostic/Prognostic Reasoning and Information Continuity for Improved Avionics Maintenance

DTIC Science & Technology

2006-01-01

enabling technologies such as built-in-test, advanced health monitoring algorithms, reliability and component aging models, prognostics methods, and...deployment and acceptance. This framework and vision is consistent with the onboard PHM ( Prognostic and Health Management) as well as advanced... monitored . In addition to the prognostic forecasting capabilities provided by monitoring system power, multiple confounding errors by electronic

Change Trajectories for the Youth Outcome Questionnaire Self-Report: Identifying Youth at Risk for Treatment Failure

ERIC Educational Resources Information Center

Cannon, Jennifer A. N.; Warren, Jared S.; Nelson, Philip L.; Burlingame, Gary M.

2010-01-01

This study used longitudinal youth outcome data in routine mental health services to test a system for identifying cases at risk for treatment failure. Participants were 2,715 youth (M age = 14) served in outpatient managed care and community mental health settings. Change trajectories were developed using multilevel modeling of archival data.…

Reproduction cutting methods for naturally regenerated pine stands in the south

Treesearch

James M. Guldin

2004-01-01

It is projected that plantations will make up 25 percent of the South's forest land area by the year 2040. Thus the remaining 75 percent of that area will consist of naturally regenerated pine, pine-hardwood, and hardwood stands. Naturally regenerated pines can be managed successfully by even-aged and unevenaged silvicultural systems when the reproduction cutting...

Growth rate responses of Missouri and lower Yellowstone river fishes to a latitudinal gradient

USGS Publications Warehouse

Pegg, M.A.; Pierce, C.L.

2001-01-01

Growth rate coefficients estimated for channel catfish Ictalurus punctatus, emerald shiners Notropis atherinoides, freshwater drums Aplodinotus grunniens, river carpsuckers Carpiodes carpio and saugers Stizostedion canadense collected in 1996-1998 from nine river sections of the Missouri and lower Yellowstone rivers at two life-stages (young-of-the-year and age 1 + years) were significantly different among sections. However, they showed no river-wide latitudinal trend except for age 1 + years emerald shiners that did show a weak negative relation between growth and both latitude and length of growing season. The results suggest growth rates of fishes along the Missouri River system are complex and could be of significance in the management and conservation of fish communities in this altered system. ?? 2001 The Fisheries Society of the British Isles.

Accessing Faith-Based Organizations Using Public Transportation.

PubMed

Lewinson, Terri; Maley, Olivia; Esnard, Ann-Margaret

2017-01-01

Nondriving aging adults are at risk of experiencing mobility barriers that inhibit access to important community resources for managing health and wellbeing. This multimethod study explores bus transportation experiences of older adults who live in extended stay hotels and use faith-based organizations to access resources. Interviews from 17 nondriving older adults were analyzed for perspectives about using faith-based organizations and residents' experiences navigating to faith-based organizations through available bus transportation in their communities. Residents described both favorable and unfavorable experiences when reaching out for help from faith-based organizations. Although they report reliance on faith-based organizations for a variety of resources, residents were challenged by an ineffective bus system that interfered with resource accessibility. Suggestions for improving bus transit systems and providing alternative, aging-friendly transportation options are discussed.

Forest management strategy affects saproxylic beetle assemblages: A comparison of even and uneven-aged silviculture using direct and indirect sampling.

PubMed

Joelsson, Klara; Hjältén, Joakim; Gibb, Heloise

2018-01-01

Management of forest for wood production has altered ecosystem structures and processes and led to habitat loss and species extinctions, worldwide. Deadwood is a key resource supporting forest biodiversity, and commonly declines following forest management. However, different forest management methods affect dead wood differently. For example, uneven-aged silviculture maintains an age-stratified forest with ongoing dead wood production, while even-aged silviculture breaks forest continuity, leading to long periods without large trees. We asked how deadwood-dependent beetles respond to different silvicultural practices and if their responses depend on deadwood volume, and beetles preference for decay stages of deadwood. We compared beetle assemblages in five boreal forest types with different management strategies: clearcutting and thinning (both representing even-aged silviculture), selective felling (representing uneven-aged silviculture), reference and old growth forest (both uneven-aged controls without a recent history [~50 years] of management, but the latter with high conservation values). We collected beetles using window traps and by sieving the bark from experimental logs (bolts). Beetle assemblages on clear-cuts differed from all other stand types, regardless of trapping method or decay stage preference. Thinning differed from reference stands, indicating incomplete recovery after clear-cutting, while selective felling differed only from clear-cuts. In contrast to our predictions, early and late successional species responded similarly to different silvicultural practices. However, there were indications of marginal assemblage differences both between thinned stands and selective felling and between thinned and old growth stands (p = 0.10). The stand volume of early decay stage wood influenced assemblage composition of early, but not late successional species. Uneven-aged silviculture maintained species assemblages similar to those of the reference and old growth stands and might therefore be a better management option when considering biodiversity conservation.

HIV enteropathy and aging: gastrointestinal immunity, mucosal epithelial barrier, and microbial translocation.

PubMed

Wang, Hongyin; Kotler, Donald P

2014-07-01

Despite decreases in morbidity and mortality as a result of antiretroviral therapy, gastrointestinal dysfunction remains common in HIV infection. Treated patients are at risk for complications of 'premature' aging, such as cardiovascular disease, osteopenia, neurocognitive decline, malignancies, and frailty. This review summarizes recent observations in this field. Mucosal CD4 lymphocytes, especially Th17 cells, are depleted in acute HIV and simian immune deficiency virus (SIV) infections, although other cell types also are affected. Reconstitution during therapy often is incomplete, especially in mucosa. Mucosal barrier function is affected by both HIV infection and aging and includes paracellular transport via tight junctions and uptake through areas of apoptosis; other factors may affect systemic antigen exposure. The resultant microbial translocation is associated with systemic immune activation in HIV and SIV infections. There is evidence of immune activation and microbial translocation in the elderly. The immune phenotypes of immunosenescence in HIV infection and aging appear similar. There are several targets for intervention; blockage of residual mucosal virus replication, preventing antigen uptake, modulating the microbiome, improving T cell recovery, combining therapies aimed at mucosal integrity, augmenting mucosal immunity, and managing traditional risk factors for premature aging in the general population. Aging may interact with HIV enteropathy to enhance microbial translocation and immune activation.

Exascale Storage Systems the SIRIUS Way

NASA Astrophysics Data System (ADS)

Klasky, S. A.; Abbasi, H.; Ainsworth, M.; Choi, J.; Curry, M.; Kurc, T.; Liu, Q.; Lofstead, J.; Maltzahn, C.; Parashar, M.; Podhorszki, N.; Suchyta, E.; Wang, F.; Wolf, M.; Chang, C. S.; Churchill, M.; Ethier, S.

2016-10-01

As the exascale computing age emerges, data related issues are becoming critical factors that determine how and where we do computing. Popular approaches used by traditional I/O solution and storage libraries become increasingly bottlenecked due to their assumptions about data movement, re-organization, and storage. While, new technologies, such as “burst buffers”, can help address some of the short-term performance issues, it is essential that we reexamine the underlying storage and I/O infrastructure to effectively support requirements and challenges at exascale and beyond. In this paper we present a new approach to the exascale Storage System and I/O (SSIO), which is based on allowing users to inject application knowledge into the system and leverage this knowledge to better manage, store, and access large data volumes so as to minimize the time to scientific insights. Central to our approach is the distinction between the data, metadata, and the knowledge contained therein, transferred from the user to the system by describing “utility” of data as it ages.

Forging a Frailty-Ready Healthcare System to Meet Population Ageing

PubMed Central

Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

2017-01-01

The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization’s World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy (“living well”), the well unhealthy (“living with illness”), the unwell unhealthy (“living with frailty”), and the end-of-life (EoL) (“dying well”). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as “wellness kampungs” and “share-a-pot”. A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National Healthcare Group, innovative projects to address the needs of the frail elderly have been developed in the areas of: (a) admission avoidance through joint initiatives with long-term care facilities, nurse-led geriatric assessment at the emergency department and geriatric assessment clinics; (b) inpatient care, such as the Framework for Inpatient care of the Frail Elderly, orthogeriatric services, and geriatric surgical services; and (c) discharge to care, involving community transitional care teams and the development of community infrastructure for post-discharge support; and an appropriate transition to EoL care. In the area of EoL care, the National Strategy for Palliative Care has been developed to build an integrated system to: provide care for frail elderly with advance illnesses, develop advance care programmes that respect patients’ choices, and equip healthcare professionals to cope with the challenges of EoL care. PMID:29186782

Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

PubMed

Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

2017-11-24

The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy ("living well"), the well unhealthy ("living with illness"), the unwell unhealthy ("living with frailty"), and the end-of-life (EoL) ("dying well"). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as "wellness kampungs" and "share-a-pot". A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National Healthcare Group, innovative projects to address the needs of the frail elderly have been developed in the areas of: (a) admission avoidance through joint initiatives with long-term care facilities, nurse-led geriatric assessment at the emergency department and geriatric assessment clinics; (b) inpatient care, such as the Framework for Inpatient care of the Frail Elderly, orthogeriatric services, and geriatric surgical services; and (c) discharge to care, involving community transitional care teams and the development of community infrastructure for post-discharge support; and an appropriate transition to EoL care. In the area of EoL care, the National Strategy for Palliative Care has been developed to build an integrated system to: provide care for frail elderly with advance illnesses, develop advance care programmes that respect patients' choices, and equip healthcare professionals to cope with the challenges of EoL care.

Ageing Mechanisms and Control. Specialists’ Meeting on Life Management Techniques for Ageing Air Vehicles (Les mecanismes vieillissants et le controle) (Reunions des specialistes des techniques de gestion du cycle de vie pour vehicules aeriens vieillissants)

DTIC Science & Technology

2003-02-01

Beam Weld Repair and Qualification of Titanium Fan Blades for Military Gas Turbine Engines”, NATO-RTO-AVT Workshop on Cost Effective Applications of...announced in the Meeting Announcement Research of Extension of the Life Cycle of Helicopter Rotor Blade in Hungary 39 by M. Balaskó, G. Endröczi, J...and Power Systems MP-069(I), February 2003 Low Cost Composite Structures / Cost Effective Application of Titanium Alloys in Military Platforms MP-069

Business Issues in an Aging America. A Report from The Travelers Insurance Companies Conference, Managing an Aging Workforce (New York, NY, February 1982).

ERIC Educational Resources Information Center

Travelers Insurance Companies, Hartford, CT.

This report consists of excerpts from nine papers presented at a conference on managing an aging workforce. The first excerpt deals with the nature and impact of age-related changes. Discussed next is the need to better identify the changes that come with age and to develop improved methods to assess human capability without respect to age. The…

Does whom you work with matter? Effects of referent group gender and age composition on managers' compensation.

PubMed

Ostroff, Cheri; Atwater, Leanne E

2003-08-01

Much research has examined gender and age effects on compensation, concluding that a wage gap exists favoring men and negative stereotypes against older workers persist. Although the effect of an employee's gender or age has been widely studied, little work has examined the impact of the demographic characteristics of a focal employee's immediate referent groups (e.g., subordinates, peers, or supervisors) on pay. The effect of the gender and age composition of a focal manager's subordinates, peers, and supervisor on the manager's compensation levels was investigated in a sample of 2,178 managers across a wide range of organizations and functional areas. After controlling for a number of human capital variables, results indicated that not only does a wage gap favoring men exist, but also managerial pay is lower when managers' referent groups are largely female, when subordinates are outside the prime age group, and when peers and supervisors are younger.

Provider-Induced Demand in the Treatment of Carotid Artery Stenosis: Variation in Treatment Decisions Between Private Sector Fee-for-Service vs Salary-Based Military Physicians.

PubMed

Nguyen, Louis L; Smith, Ann D; Scully, Rebecca E; Jiang, Wei; Learn, Peter A; Lipsitz, Stuart R; Weissman, Joel S; Helmchen, Lorens A; Koehlmoos, Tracey; Hoburg, Andrew; Kimsey, Linda G

2017-06-01

Although many factors influence the management of carotid artery stenosis, it is not well understood whether a preference toward procedural management exists when procedural volume and physician compensation are linked in the fee-for-service environment. To explore evidence for provider-induced demand in the management of carotid artery stenosis. The Department of Defense Military Health System Data Repository was queried for individuals diagnosed with carotid artery stenosis between October 1, 2006, and September 30, 2010. A hierarchical multivariable model evaluated the association of the treatment system (fee-for-service physicians in the private sector vs salary-based military physicians) with the odds of procedural intervention (carotid endarterectomy or carotid artery stenting) compared with medical management. Subanalysis was performed by symptom status at the time of presentation. The association of treatment system and of management strategy with clinical outcomes, including stroke and death, was also evaluated. Data analysis was conducted from August 15, 2015, to August 2, 2016. The odds of procedural intervention based on treatment system was the primary outcome used to indicate the presence and effect of provider-induced demand. Of 10 579 individuals with a diagnosis of carotid artery stenosis (4615 women and 5964 men; mean [SD] age, 65.6 [11.4] years), 1307 (12.4%) underwent at least 1 procedure. After adjusting for demographic and clinical factors, the odds of undergoing procedural management were significantly higher for patients in the fee-for-service system compared with those in the salary-based setting (odds ratio, 1.629; 95% CI, 1.285-2.063; P < .001). This finding remained true when patients were stratified by symptom status at presentation (symptomatic: odds ratio, 2.074; 95% CI, 1.302-3.303; P = .002; and asymptomatic: odds ratio, 1.534; 95% CI, 1.186-1.984; P = .001). Individuals treated in a fee-for-service system were significantly more likely to undergo procedural management for carotid stenosis compared with those in the salary-based setting. These findings remained consistent for individuals with and without symptomatic disease.

Integrating studies in the Missouri Ozark Forest Ecosystem Project: Status and outlook

Treesearch

David Gwaze; Stephen Sheriff; John Kabrick; Larry Vangilder

2011-01-01

The Missouri Ozark Forest Ecosystem Project (MOFEP), which was started in 1989 by the Missouri Department of Conservation, evaluates the effects of forest management practices (even-aged management, uneven-aged management, and no-harvest management) on upland oak-forest components in southern Missouri. MOFEP is a long-term, landscape-level, fully replicated, and...

Optimizing management regimes for carbon storage and other benefits in uneven-aged stands dominated by Norway spruce, with a derivation of the economic supply of carbon storage

Treesearch

Joseph Buongiorno; Espen Andreas Halvorsen; Ole Martin Bollandsas; Terje Gobakken; Ole Hofstad

2012-01-01

This study sought optimal sustainable management regimes of uneven-aged Norway spruce-dominated stands with multiple objectives. The criteria were financial returns, CO2 sequestration and diversity of tree size and species. At prevailing timber prices, harvest and transport costs, and interest rates, uneven-aged management for timber alone was...

Medication and finance management among HIV-infected adults: the impact of age and cognition.

PubMed

Thames, April D; Kim, Michelle S; Becker, Brian W; Foley, Jessica M; Hines, Lindsay J; Singer, Elyse J; Heaton, Robert K; Castellon, Steven A; Hinkin, Charles H

2011-02-01

This study examined the effects of aging and cognitive impairment on medication and finance management in an HIV sample. We observed main effects of age (older < younger) and neuropsychological impairment on functional task performance. Interactions between age and cognition demonstrated that older impaired individuals performed significantly more poorly than all other comparison groups. There were no relationships between laboratory performance and self-reported medication and finance management. The interaction of advancing age and cognitive impairment may confer significant functional limitations for HIV individuals that may be better detected by performance-based measures of functional abilities rather than patient self-report.

Medication and finance management among HIV-infected adults: The impact of age and cognition

PubMed Central

Thames, April D.; Kim, Michelle S.; Becker, Brian W.; Foley, Jessica M.; Hines, Lindsay J.; Singer, Elyse J.; Heaton, Robert K.; Castellon, Steven A.; Hinkin, Charles H.

2013-01-01

This study examined the effects of aging and cognitive impairment on medication and finance management in an HIV sample. We observed main effects of age (older < younger) and neuropsychological impairment on functional task performance. Interactions between age and cognition demonstrated that older impaired individuals performed significantly more poorly than all other comparison groups. There were no relationships between laboratory performance and self-reported medication and finance management. The interaction of advancing age and cognitive impairment may confer significant functional limitations for HIV individuals that may be better detected by performance-based measures of functional abilities rather than patient self-report. PMID:20694873

Understanding views on everyday use of personal health information: Insights from community dwelling older adults.

PubMed

Hartzler, A L; Osterhage, K; Demiris, G; Phelan, E A; Thielke, S M; Turner, A M

2018-09-01

Older adults apply various strategies to pursue healthy aging, but we know little about their views and use of personal health information to accomplish those ends. As a first step in formulating the role of personal health information management (PHIM) in healthy aging, we explored the perspectives of older adults on health and health information used in their everyday lives through four focus groups with 25 community-dwelling adults aged 60 and over. We found that the concept of wellness-the holistic and multidimensional nature of health and wellbeing-plays prominently in how older adults think about health and health information. Participants expressed wellness from a position of personal strength, rather than health-related deficits, by focusing on wellness activities for staying healthy through: (1) personal health practices, (2) social network support, and (3) residential community engagement. Although these themes involve personal health information, existing PHIM systems that focus on disease management are generally not designed to support wellness activities. Substantial opportunity exists to fill this wellness support gap with innovative health information technology designed for older adults. Findings carry implications for the design of PHIM tools that support healthy aging and methods for engaging older adults as co-producers of this critical support.

An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in educational settings.

PubMed

Edwards, Deborah; Noyes, Jane; Lowes, Lesley; Haf Spencer, Llinos; Gregory, John W

2014-09-12

Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3-25 years in educational settings. Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.

Nuclear power plant Generic Aging Lessons Learned (GALL). Main report and appendix A

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

Kaza, K.E.; Diercks, D.R.; Holland, J.W.

The purpose of this generic aging lessons learned (GALL) review is to provide a systematic review of plant aging information in order to assess materials and component aging issues related to continued operation and license renewal of operating reactors. Literature on mechanical, structural, and thermal-hydraulic components and systems reviewed consisted of 97 Nuclear Plant Aging Research (NPAR) reports, 23 NRC Generic Letters, 154 Information Notices, 29 Licensee Event Reports (LERs), 4 Bulletins, and 9 Nuclear Management and Resources Council Industry Reports (NUMARC IRs) and literature on electrical components and systems reviewed consisted of 66 NPAR reports, 8 NRC Generic Letters,more » 111 Information Notices, 53 LERs, 1 Bulletin, and 1 NUMARC IR. More than 550 documents were reviewed. The results of these reviews were systematized using a standardized GALL tabular format and standardized definitions of aging-related degradation mechanisms and effects. The tables are included in volume s 1 and 2 of this report. A computerized data base has also been developed for all review tables and can be used to expedite the search for desired information on structures, components, and relevant aging effects. A survey of the GALL tables reveals that all ongoing significant component aging issues are currently being addressed by the regulatory process. However, the aging of what are termed passive components has been highlighted for continued scrutiny. This document is Volume 1, consisting of the executive summary, summary and observations, and an appendix listing the GALL literature review tables.« less

Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department.

PubMed

Robinson, Melissa; Greenhawt, Matthew; Stukus, David R

2017-08-01

Epinephrine is the first-line treatment for anaphylaxis but may be underused by patients and medical personnel. To evaluate factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC). We performed a retrospective review of electronic medical records for all patients aged 0 to 25 years presenting with anaphylaxis to the ED or UCC at a pediatric academic referral center during 2009 to 2013. A total of 408 patients (mean age, 7.25 years; 62% male) were included for analysis. Only 148 patients (36.3%) received epinephrine before arrival at the ED or UCC. Reactions occurring at home (n = 36/114) were less likely to be treated with epinephrine compared with reactions occurring at school (n = 30/49) (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15-0.59). The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system (OR, 0.50; 95% CI, 0.30-0.85) or 3-organ system (OR, 0.41; 95% CI, 0.21-0.81) presentation compared with 1-organ system involvement. Foods (342 [83.8%]) were the most commonly reported provoking trigger. Patients who did not receive epinephrine before arrival at the ED or UCC were significantly less likely to be discharged to home (OR, 0.56; 95% CI, 0.37-0.86; P = .01). This study identifies factors associated with prehospital management of anaphylaxis for children, which highlight that epinephrine administration may be occurring with considerable delay. Increased awareness and education of caregivers, patients, and medical professionals are necessary to provide optimal management. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Characteristics of HIV patients who missed their scheduled appointments

PubMed Central

Nagata, Delsa; Gutierrez, Eliana Battaggia

2016-01-01

ABSTRACT OBJECTIVE To analyze whether sociodemographic characteristics, consultations and care in special services are associated with scheduled infectious diseases appointments missed by people living with HIV. METHODS This cross-sectional and analytical study included 3,075 people living with HIV who had at least one scheduled appointment with an infectologist at a specialized health unit in 2007. A secondary data base from the Hospital Management & Information System was used. The outcome variable was missing a scheduled medical appointment. The independent variables were sex, age, appointments in specialized and available disciplines, hospitalizations at the Central Institute of the Clinical Hospital at the Faculdade de Medicina of the Universidade de São Paulo, antiretroviral treatment and change of infectologist. Crude and multiple association analysis were performed among the variables, with a statistical significance of p ≤ 0.05. RESULTS More than a third (38.9%) of the patients missed at least one of their scheduled infectious diseases appointments; 70.0% of the patients were male. The rate of missed appointments was 13.9%, albeit with no observed association between sex and absences. Age was inversely associated to missed appointment. Not undertaking anti-retroviral treatment, having unscheduled infectious diseases consultations or social services care and being hospitalized at the Central Institute were directly associated to missed appointments. CONCLUSIONS The Hospital Management & Information System proved to be a useful tool for developing indicators related to the quality of health care of people living with HIV. Other informational systems, which are often developed for administrative purposes, can also be useful for local and regional management and for evaluating the quality of care provided for patients living with HIV. PMID:26786472

Youth with Behavioral Health Disorders Aging Out of Foster Care: a Systematic Review and Implications for Policy, Research, and Practice.

PubMed

Kang-Yi, Christina D; Adams, Danielle R

2017-01-01

This systematic review aimed to (1) identify and summarize empirical studies on youth with behavioral health disorders aging out of foster care and (2) address implications for behavioral health policy, research, and practice. We identified previous studies by searching PubMed, PsycINFO, EBSCO, and ISI Citation Indexes and obtaining references from key experts in the child welfare field. A total of 28 full articles published between 1991 and 2014 were reviewed and summarized into the key areas including systems of care, disability type, transition practice area, study methods, study sample, transition outcome measures, study analysis, and study findings. Considering how fast youth who have behavioral health disorders fall through the crack as they exit foster care, one cannot understate the importance of incorporating timely and appropriate transition planning and care coordination for youth who have behavioral health disorders aging out of foster care into the usual case management performed by behavioral health systems and service providers.

iCanCope with Pain™: User-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs

PubMed Central

Stinson, Jennifer N; Lalloo, Chitra; Harris, Lauren; Isaac, Lisa; Campbell, Fiona; Brown, Stephen; Ruskin, Danielle; Gordon, Allan; Galonski, Marilyn; Pink, Leah R; Buckley, Norman; Henry, James L; White, Meghan; Karim, Allia

2014-01-01

BACKGROUND: While there are emerging web-based self-management programs for children and adolescents with chronic pain, there is currently not an integrated web- and smartphone-based app that specifically addresses the needs of adolescents with chronic pain. OBJECTIVES: To conduct a needs assessment to inform the development of an online chronic pain self-management program for adolescents, called iCanCope with Pain™. METHODS: A purposive sample of adolescents (n=23; 14 to 18 years of age) was recruited from two pediatric chronic pain clinics in Ontario. Interdisciplinary health care providers were also recruited from these sites. Three focus groups were conducted with adolescents (n=16) and one with pediatric health care providers (n=7). Individual adolescent interviews were also conducted (n=7). RESULTS: Qualitative analysis uncovered four major themes: pain impact; barriers to care; pain management strategies; and transition to adult care. Pain impacted social, emotional, physical and role functioning, as well as future goals. Barriers to care were revealed at the health care system, patient and societal levels. Pain management strategies included support systems, and pharmacological, physical and psychological approaches. Transition subthemes were: disconnect between pediatric and adult systems; skills development; parental role; and fear/anxiety. Based on these identified needs, the iCanCope with Pain™ architecture will include the core theory-based functionalities of: symptom self-monitoring; personalized goal setting; pain coping skills training; peer-based social support; and chronic pain education. CONCLUSIONS: The proposed iCanCope with Pain™ program aims to address the self-management needs of adolescents with chronic pain by improving access to disease information, strategies to manage symptoms and social support. PMID:25000507

It's A Family Affair: Reflections About Aging and Health Within a Family Context.

PubMed

Utz, Rebecca L; Berg, Cynthia A; Butner, Jonathan

2017-02-01

One's health and aging cannot be uncoupled from the family system in which it occurs. Not only do families provide genetic material that determines major health risks and outcomes, families also share a culture, environment, and lifestyle that further influence health and aging trajectories. As well, family members are interconnected, so that an illness or a positive lifestyle change in one person can have reverberating effects on the health and well-being of others in the family system. This essay explores how families have the potential to both promote and threaten individual health and well-being, thereby influencing how an individual might age or experience later life. Weaving together personal biographies from three different authors, this essay provides specific examples of how the family affects the health and aging of individuals and how the health and aging of individuals affect the larger family unit. These dynamic processes have the potential to positively or negatively shape individual experiences of health and aging, even among those persons who are not yet in late life. This essay blends a developmental life course perspective with a dynamic family-systems approach to show how families engage in collaborative efforts throughout the life course, in which they both affect and are affected by the diagnosis and management of chronic diseases and the adoption of health promoting behaviors. Applying this perspective to the study of health and aging calls for interdisciplinary thinking, as well as novel methodological and quantitative solutions. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Phosphate-a poison for humans?

PubMed

Komaba, Hirotaka; Fukagawa, Masafumi

2016-10-01

Maintenance of phosphate balance is essential for life, and mammals have developed a sophisticated system to regulate phosphate homeostasis over the course of evolution. However, due to the dependence of phosphate elimination on the kidney, humans with decreased kidney function are likely to be in a positive phosphate balance. Phosphate excess has been well recognized as a critical factor in the pathogenesis of mineral and bone disorders associated with chronic kidney disease, but recent investigations have also uncovered toxic effects of phosphate on the cardiovascular system and the aging process. Compelling evidence also suggests that increased fibroblastic growth factor 23 and parathyroid hormone levels in response to a positive phosphate balance contribute to adverse clinical outcomes. These insights support the current practice of managing serum phosphate in patients with advanced chronic kidney disease, although definitive evidence of these effects is lacking. Given the potential toxicity of excess phosphate, the general population may also be viewed as a target for phosphate management. However, the widespread implementation of dietary phosphate intervention in the general population may not be warranted due to the limited impact of increased phosphate intake on mineral metabolism and clinical outcomes. Nonetheless, the increasing incidence of kidney disease or injury in our aging society emphasizes the potential importance of this issue. Further work is needed to more completely characterize phosphate toxicity and to establish the optimal therapeutic strategy for managing phosphate in patients with chronic kidney disease and in the general population. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Urban caregiver empowerment: Caregiver nativity, child asthma symptoms and emergency department use

PubMed Central

Coutinho, Maria Teresa; Kopel, Sheryl J.; Williams, Brittney; Dansereau, Katie; Koinis-Mitchell, Daphne

2016-01-01

Introduction This study examines the associations between caregiver empowerment, child asthma symptoms, and emergency department use in a sample of school aged urban children with asthma. We examined differences in caregiver empowerment, and in the associations among caregiver empowerment, proportion of days with child asthma symptoms, and emergency department use as a function of caregiver nativity. Methods Participants for this study were part of a larger longitudinal study and included Latino, African American and non-Latino White urban caregivers and their children with asthma (ages 7–9; N=130). Caregiver empowerment was assessed within family, asthma services, and community domains. Results Children whose caregivers reported greater empowerment within the family (knowledge and ability to care for their family) presented with fewer asthma symptoms. Children whose caregivers reported greater empowerment within asthma services (ability to collaborate with asthma providers and healthcare system), presented with more asthma symptoms. Foreign-born caregivers endorsed greater empowerment within the family, while US-born caregivers reported greater empowerment within asthma services. For foreign-born caregivers, higher levels of empowerment in the family were associated with fewer child asthma symptoms. For US-born caregivers, higher levels of empowerment in asthma services were associated with more child asthma symptoms. Discussion Results suggest that caregivers who feel more confident and better able to manage problems within their family may better manage their child's asthma more effectively navigate the asthma healthcare system and manage their child's asthma. PMID:27632543

Light Water Reactor Sustainability Program: Evaluation of Localized Cable Test Methods for Nuclear Power Plant Cable Aging Management Programs

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

Glass, Samuel W.; Fifield, Leonard S.; Hartman, Trenton S.

This Pacific Northwest National Laboratory (PNNL) milestone report describes progress to date on the investigation of nondestructive test (NDE) methods focusing particularly on local measurements that provide key indicators of cable aging and damage. The work includes a review of relevant literature as well as hands-on experimental verification of inspection capabilities. As NPPs consider applying for second, or subsequent, license renewal (SLR) to extend their operating period from 60 years to 80 years, it important to understand how the materials installed in plant systems and components will age during that time and develop aging management programs (AMPs) to assure continuedmore » safe operation under normal and design basis events (DBE). Normal component and system tests typically confirm the cables can perform their normal operational function. The focus of the cable test program is directed toward the more demanding challenge of assuring the cable function under accident or DBE. Most utilities already have a program associated with their first life extension from 40 to 60 years. Regrettably, there is neither a clear guideline nor a single NDE that can assure cable function and integrity for all cables. Thankfully, however, practical implementation of a broad range of tests allows utilities to develop a practical program that assures cable function to a high degree. The industry has adopted 50% elongation at break (EAB) relative to the un-aged cable condition as the acceptability standard. All tests are benchmarked against the cable EAB test. EAB is a destructive test so the test programs must apply an array of other NDE tests to assure or infer the overall set of cable’s system integrity. These cable NDE programs vary in rigor and methodology. As the industry gains experience with the efficacy of these programs, it is expected that implementation practice will converge to a more common approach. This report addresses the range of local NDE cable tests that are or could be practically implemented in a field test situation. These tests include: visual, infrared thermography, interdigital capacitance, indenter, relaxation time indenter, dynamic mechanical analyzer, infrared/near-infrared spectrometry, ultrasound, and distributed fiber optic temperature measurement.« less

Photo-kinesiotherapy: photobiomodulation associated with some kinesiotherapies for orofacial rehabilitation

NASA Astrophysics Data System (ADS)

Zanirato Lizarelli, Rosane de Fátima; Scalize, Priscilla H.; Righetti, Mariah A.; Maurício, Nelson; Morini, Nelson; Melo, Maisa O.; Sant'Anna, Estela; Maia Campos, Patricia M. B. G.; Regalo, Simone C. H.; Bagnato, Vanderlei Salvador

2018-02-01

Physiological aging leads to dysfunction of the stomatognatic system. Photo-kinesiotherapy (PKT) is a program using photobiomodulation (PBM) in combination with different kinesiotherapies. PBM can slow down and manage aging process resulting in orofacial dermal-neuro-muscle rehabilitating. We are searching for a new more efficient therapy to decrease and manage velocity of senescence and dysfunction of stomatognatic system. Under Ethical Comittee approval (CAAE no. 45390715.2.0000.5419), fifteen female patients were selected and divided into 5 groups: G1 - Control group (cosmetics); G2 - Light group (cosmetics + PBM); G3 - Exercises Group (Cosmetics+ PBM + orofacial exercises); G4 - Electrotherapy Group (Cosmetics+ PBM + Electrotherapy - Aussie current); and, G5 - Taping Group (Cosmetics+ PBM + kinesiotherapy). Muscle evaluation was performed using electromyography, ultrasonography and bite force. Skin evaluation was performed in terms of skin hydration and viscoelasticity, skin echogenicity using ultrasonography and standardized high resolution photographies. Measures were done before (baseline values) and after 7 days and 30 days of treatment. The pilot phase (fifhteen patients) was concluded using Kruskal-Wallis statistical tests that showed non-significant differences between groups. However, all treatments affected muscle tone, cutaneous elasticity and dermis echogenicity resulting in interesting individual clinical observations.We suggest that the combination of cosmetics, mechanical and optical stimulus to all kind of different tissues from stomatognathic system can be an efficient choice to orofacial functional and aesthetic rehabilitation. (CNPq - 114735/2015-8)

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

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

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

Balancing the Ecological Function of Residential Stormwater Ponds with Homeowner Landscaping Practices.

PubMed

Monaghan, Paul; Hu, Shangchun; Hansen, Gail; Ott, Emily; Nealis, Charles; Morera, Maria

2016-11-01

Stormwater ponds are installed in urban developments to provide the ecosystem services of flood control and water treatment. In coastal areas, these ponds are connected to watersheds that can drain directly into protected estuaries, making their design, function, and maintenance critical to environmental protection. However, stormwater ponds in residential areas are increasingly managed as aesthetic amenities that add value to real estate rather than as engineered devices with special maintenance requirements. To help extend the life of neighborhood stormwater systems and improve ecosystem services, homeowners should follow best management practices for nutrient management and add shoreline plantings and non-invasive, beneficial aquatic plants to their ponds. This study used focus group and survey research to document the knowledge, behaviors, and attitudes of homeowners living near stormwater ponds in a master-planned community in Florida. The study was designed to use a social marketing research approach to promote Extension best practices. Findings indicate that many residents were aware of the functional components of stormwater systems and respondents' receptivity to best management practices was mediated by age, their attitudes about water quality and whether their home was adjacent to a pond. These findings can be used to target Extension audiences and improve adoption of stormwater pond best management practices for increased protection of water quality.

Balancing the Ecological Function of Residential Stormwater Ponds with Homeowner Landscaping Practices

NASA Astrophysics Data System (ADS)

Monaghan, Paul; Hu, Shangchun; Hansen, Gail; Ott, Emily; Nealis, Charles; Morera, Maria

2016-11-01

Stormwater ponds are installed in urban developments to provide the ecosystem services of flood control and water treatment. In coastal areas, these ponds are connected to watersheds that can drain directly into protected estuaries, making their design, function, and maintenance critical to environmental protection. However, stormwater ponds in residential areas are increasingly managed as aesthetic amenities that add value to real estate rather than as engineered devices with special maintenance requirements. To help extend the life of neighborhood stormwater systems and improve ecosystem services, homeowners should follow best management practices for nutrient management and add shoreline plantings and non-invasive, beneficial aquatic plants to their ponds. This study used focus group and survey research to document the knowledge, behaviors, and attitudes of homeowners living near stormwater ponds in a master-planned community in Florida. The study was designed to use a social marketing research approach to promote Extension best practices. Findings indicate that many residents were aware of the functional components of stormwater systems and respondents' receptivity to best management practices was mediated by age, their attitudes about water quality and whether their home was adjacent to a pond. These findings can be used to target Extension audiences and improve adoption of stormwater pond best management practices for increased protection of water quality.

Depiction of Trends in Administrative Healthcare Data from Hospital Information System.

PubMed

Kalankesh, Leila R; Pourasghar, Faramarz; Jafarabadi, Mohammad Asghari; Khanehdan, Negar

2015-06-01

administrative healthcare data are among main components of hospital information system. Such data can be analyzed and deployed for a variety of purposes. The principal aim of this research was to depict trends of administrative healthcare data from HIS in a general hospital from March 2011 to March 2014. data set used for this research was extracted from the SQL database of the hospital information system in Razi general hospital located in Marand. The data were saved as CSV (Comma Separated Values) in order to facilitate data cleaning and analysis. The variables of data set included patient's age, gender, final diagnosis, final diagnosis code based on ICD-10 classification system, date of hospitalization, date of discharge, LOS(Length of Stay), ward, and survival status of the patient. Data were analyzed and visualized after applying appropriate cleansing and preparing techniques. morbidity showed a constant trend over three years. Pregnancy, childbirth and the puerperium were the leading category of final diagnosis (about 32.8 %). The diseases of the circulatory system were the second class accounting for 13 percent of the hospitalization cases. The diseases of the digestive system had the third rank (10%). Patients aged between 14 and 44 constituted a higher proportion of total cases. Diseases of the circulatory system was the most common class of diseases among elderly patients (age≥65). The highest rate of mortality was observed among patients with final diagnosis of the circulatory system diseases followed by those with diseases of the respiratory system, and neoplasms. Mortality rate for the ICU and the CCU patients were 62% and 33% respectively. The longest average of LOS (7.3 days) was observed among patients hospitalized in the ICU while patients in the Obstetrics and Gynecology ward had the shortest average of LOS (2.4 days). Multiple regression analysis revealed that LOS was correlated with variables of surgery, gender, and type of payment, ward, the class of final diagnosis and age. this study presents trends in administrative health care data residing in hospital information system of a general public hospital. Patterns in morbidity, mortality and length of stay can inform decision making in health care management. Mining trends in administrative healthcare data can add value to the health care management.

An approach to human work systems development under the circumstances of an aging society and international business operations.

PubMed

Ikeda, Y T

1997-12-01

At least three serious aspects of problems exist as obstacles for the national economy in Japan to grow or even to maintain its present level: the lack of natural resources, the trends of a decreasing young labor force, and an increase in the shift of domestic business operations to foreign countries. Although top managers make the decisions of product or service planning, or both, work systems designers are also responsible for conserving the resources. An action against the decrease of the young work force is needed to maintain work systems in an operable condition. The business shifts to foreign countries affect all the people, who are losing job opportunities. The present paper presents an approach to reorienting human work systems within the scope of the work systems designers' roles under the circumstance of these social environments. The following discussion is based on the assumptions that work organizations be productive for themselves and the world, effective and efficient for themselves, and contributive to their communities and the world. In essence, an approach to human work systems development should be fair to managers and workers alike. Presented are cases of these work systems as developed along the perspectives mentioned.

Space age management for social problems

NASA Technical Reports Server (NTRS)

Levine, A. L.

1973-01-01

Attempts to apply space age management to social problems were plagued with difficulties. Recent experience in the State of Delaware and in New York City, however, indicate new possibilities. Project management as practiced in NASA was applied with promising results in programs dealing with housing and social services. Such applications are feasible, according to recent research, because project management utilizes social and behavioral approaches, as well as advanced management tools, such as PERT, to achieve results.

Implementing chronic disease management in the public healthcare sector in Singapore: the role of hospitals.

PubMed

Cheah, J; Heng, B H

2001-01-01

The public health care delivery system in Singapore faces the challenges of a rapidly ageing population, an increasing chronic disease burden, increasing healthcare cost, rising expectations and demand for better health services, and shortage of resources. It is also fragmented, resulting in duplication and lack of coordination between institutions. A disease management approach has been adopted by the National Healthcare Group (NHG) as a critical strategy to provide holistic, cost-effective, seamless and well-coordinated care across the continuum. The framework in the development of the disease management plan included identifying the diseases and defining the target population, organizing a multi-disciplinary team lead by a clinician champion, defining the core components, treatment protocols and evaluation methods, defining the goals, and measuring and managing the outcomes. As disease management and case management for chronic diseases are new approaches adopted in the healthcare delivery system, there is a lack of understanding by healthcare professionals. The leadership and participation of hospital physicians was sought in the planning, design and outcomes monitoring to ensure their 'buy-in' and the successful implementation and effectiveness of the program. The episodic diagnosis related group (DRG)-based framework of funding and subvention for healthcare, and the shortage of step-care care facilities, have been recognized by the Ministry of Health as an impediments to the implementation, and these are currently being addressed.

Managed care penetration and other factors affecting computerized physician order entry in the ambulatory setting.

PubMed

Menachemi, Nir; Ford, Eric W; Chukmaitov, Askar; Brooks, Robert G

2006-12-01

To estimate the current uses level of ambulatory computerized physician order entry (A-CPOE) among physicians and to examine the relationship of managed care penetration as well as other market and practice characteristics to use of A-CPOE by physicians. This study uses both primary and secondary data sources. The primary data source was a large-scale survey of physicians' use of information technologies in Florida. Secondary data on managed care penetration were obtained from the Florida Agency for Health Care Administration, and other market-level data were extracted from the area resource file. A hierarchical logistic regression model was used to examine the correlation of county-level and practice-level characteristics with physicians' self-reported use of A-CPOE systems. Overall, 1360 physicians (32.4%) indicated use of an A-CPOE system. Findings suggest that 1% more managed care penetration was associated with 2.1% lower use of A-CPOE (P = .003). Additionally, practice size, multispecialty affiliation, and primary care practice were significantly and positively correlated with the use of A-CPOE. Physician age was negatively associated with A-CPOE use. Managed care organizations may experience significant financial savings from A-CPOE use by physicians; however, managed care penetration in a community negatively affects A-CPOE use among physicians in their practices. Further study regarding the causal nature of this association is warranted.

Impact of telemedicine in managing type 1 diabetes among school-age children and adolescents: an integrative review.

PubMed

Guljas, Rebecca; Ahmed, Azza; Chang, Karen; Whitlock, Analei

2014-01-01

Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents. Copyright © 2014 Elsevier Inc. All rights reserved.

Long-term conditions, self-management and systems of support: an exploration of health beliefs and practices within the Sikh community, Birmingham, UK.

PubMed

Sidhu, Manbinder S; Griffith, Laura; Jolly, Kate; Gill, Paramjit; Marshall, Tom; Gale, Nicola K

2016-10-01

The global prevalence of non-communicable diseases (NCDs), such as diabetes mellitus and coronary heart disease, continues to rise. Internationally, people of South Asian origin (i.e. by birth or heritage) are much more likely to develop and live with NCDs compared to the general population. The South Asian diaspora population is highly heterogeneous, varying by socioeconomic status, migration history, religion and ethnicity. This article reports the findings of a study to explore the types of support accessed by Punjabi Sikhs living in Birmingham and the Black Country, UK, who were living with NCDs. The study sought to develop a greater understanding of past experiences of accessing support and the importance of relationships in the mobilisation of resources for self-management. It was nested within a larger programme of research which explored attitudes to prevention of chronic diseases in local communities in the region. Seventeen Punjabi Sikh men and women were recruited through purposive sampling. Narrative interviews were conducted and analysed by the research team. Sociological theories on systems of support and social relations were consulted to inform the interpretation of data. The study findings suggest that participants interpreted chronic disease self-management in relation to four primary systems of support: health services for disease management; multiple sources of care, including traditional Indian medicines and the Internet, for symptom management; community groups for lifestyle management; and the family for emotional and physical care. Within these systems of support, participants identified barriers and facilitators to the maintenance of a healthy lifestyle. We focus on intra-group diversity; exploring the intersection of views and experiences by age, gender, generation and caste. The findings have implications for the design and delivery of primary care and community services which support the prevention and management of NCDs in an increasingly diverse population.

[THE EPIDEMIOLOGICAL AND EPIZOOTIOLOGICAL COMPONENT OF TOXOCARIASIS FOCI AS AN ELEMENT OF THE ENVIRONMENTAL MANAGEMENT SYSTEM (IN CASE OF THE REPUBLIC OF ALTAI)].

PubMed

Pautova, E A; Astanina, S Yu; Shchuchinova, L D; Dovgalev, A S

2015-01-01

The epidemiological and epizootiological features of toxocariasis foci were investigated in the Republic of Altai. The results of coproovoscopic examinations of dogs, those of serological screening for toxocariasis among different age and occupational groups and coniingents at risk for HIV infection, hepatitis B and C, patients with allergic and bronchopulmonary diseases, toxocariasis mortality rates in the Republic of Altai, and the materials of sanitary and parasitological studies of soil and other environmental constituents for Toxocara canis eggs provide support for the poor situation of toxocariasis in the region. Relying on the current standards and the findings of this study, the Republic of Altai may be referred to as a moderately dangerous area at medium risk for contamination in terms of epidemic, epizootic, and environmental hazards. The results of assessing the quality of laboratory diagnosis of zoonotic helminthisms call for further improvement of the professional knowledge, abilities, and skills of the employees from health care and veterinary facilities, as well as economic objects within production laboratory control, basing on the principles and requirements of the environmental management system and the food quality and safety management system.

Westinghouse Hanford Company health and safety performance report. Fourth quarter calendar year 1994

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

Lansing, K.A.

1995-03-01

Detailed information pertaining to As Low As Reasonably Achievable/Contamination Control Improvement Project (ALARA/CCIP) activities are outlined. Improved commitment to the WHC ALARA/CCIP Program was experienced throughout FY 1994. During CY 1994, 17 of 19 sitewide ALARA performance goals were completed on or ahead of schedule. Estimated total exposure by facility for CY 1994 is listed in tables by organization code for each dosimeter frequency. Facilities/areas continue to utilize the capabilities of the RPR tracking system in conjunction with the present site management action-tracking system to manage deficiencies, trend performance, and develop improved preventive efforts. Detailed information pertaining to occupational injuries/illnessesmore » are provided. The Industrial Safety and Hygiene programs are described which have generated several key initiatives that are believed responsible for improved safety performance. A breakdown of CY 1994 occupational injuries/illnesses by type, affected body group, cause, job type, age/gender, and facility is provided. The contributing experience of each WHC division/department in attaining this significant improvement is described along with tables charting specific trends. The Radiological Control Program is on schedule to meet all RL Site Management System milestones and program commitments.« less

Nurses' perception of their manager's leadership style and unit climate: are there generational differences?

PubMed

Farag, Amany A; Tullai-McGuinness, Susan; Anthony, Mary K

2009-01-01

To describe and compare how nurses representing four age cohorts perceive their manager's leadership style and unit climate. The current workforce consists of nurses representing four generational cohorts. Nursing literature suggests that nurses from each age cohort think, behave and approach work differently. Limited empirical evidence, however, exists about how nurses from each age cohort perceive two aspects of their work environment: their managers' leadership style and unit climate. This cross-sectional, descriptive survey was conducted using a convenience sample of 475 registered nurses working in different inpatient units in three community non-magnet hospitals. Only nurses from Boomer and Gen-Xers had sufficient representation to be included in the data analysis. Nurses from the two main age cohorts did not differ in their perceptions of their manager's leadership style. Significant differences were found in two unit climate dimensions. The Gen-Xers had a less favourable perception of their unit climate related to warmth and belonging and administrative support. Nurse manager's might reflect on how they interact with different age cohorts; and to involve nurses from various age cohorts in the development of policies to create a flexible work environment.

Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature

PubMed Central

Johnson, Liza-Marie; Church, Christopher L.; Gomez-Garcia, Wendy C.; Popescu, Marcela I.; Margolin, Judith F.; Ribeiro, Raul C.

2014-01-01

The usual age range of acute lymphoblastic malignancies (acute lymphoblastic leukemia and advanced-stage lymphoblastic lymphoma) includes teenagers and young adults (<22 years of age) and coincides with the age of fertility. Concurrence of acute lymphoblastic malignancy with pregnancy is therefore most likely to happen during the younger childbearing ages. However, the therapeutic challenges posed by the dual diagnosis of lymphoblastic malignancy and pregnancy have not specifically been studied in the context of age, and management guidelines for pregnant young patients are lacking. Inconsistency in defining the legal decision-making rights of pregnant teenaged patients adds a further level of complexity in this age group. Management of this challenging combination in the young patient therefore entails unique ethical considerations. Here we present two illustrative cases of teenage pregnancy complicated by acute lymphoblastic malignancy, review the available literature, and offer suggestions for the therapeutic management of such cases in adolescent and young adult patients. Importantly, practical management recommendations are provided in the context of clinical ethics principles that are universally applicable, including in developing countries, where the highest incidence of adolescent pregnancies has been documented. PMID:25538861

The effects of household management practices on the global warming potential of urban lawns.

PubMed

Gu, Chuanhui; Crane, John; Hornberger, George; Carrico, Amanda

2015-03-15

Nitrous oxide (N2O) emissions are an important component of the greenhouse gas (GHG) budget for urban turfgrasses. A biogeochemical model DNDC successfully captured the magnitudes and patterns of N2O emissions observed at an urban turfgrass system at the Richland Creek Watershed in Nashville, TN. The model was then used to study the long-term (i.e. 75 years) impacts of lawn management practice (LMP) on soil organic carbon sequestration rate (dSOC), soil N2O emissions, and net Global Warming Potentials (net GWPs). The model simulated N2O emissions and net GWP from the three management intensity levels over 75 years ranged from 0.75 to 3.57 kg N ha(-1)yr(-1) and 697 to 2443 kg CO2-eq ha(-1)yr(-1), respectively, which suggested that turfgrasses act as a net carbon emitter. Reduction of fertilization is most effective to mitigate the global warming potentials of turfgrasses. Compared to the baseline scenario, halving fertilization rate and clipping recycle as an alternative to synthetic fertilizer can reduce net GWPs by 17% and 12%, respectively. In addition, reducing irrigation and mowing are also effective in lowering net GWPs. The minimum-maintenance LMP without irrigation and fertilization can reduce annual N2O emissions and net GWPs by approximately 53% and 70%, respectively, with the price of gradual depletion of soil organic carbon, when compared to the intensive-maintenance LMP. A lawn age-dependent best management practice is recommended: a high dose fertilizer input at the initial stage of lawn establishment to enhance SOC sequestration, followed by decreasing fertilization rate when the lawn ages to minimize N2O emissions. A minimum-maintained LMP with clipping recycling, and minimum irrigation and mowing, is recommended to mitigate global warming effects from urban turfgrass systems. Among all practices, clipping recycle may be a relatively malleable behavior and, therefore, a good target for interventions seeking to reduce the environmental impacts of lawn management through public education. Our results suggest that a long-term or a chronosequence study of turfgrasses with varying ages is warranted to capture the complete dynamics of contribution of turfgrasses to global warming. Copyright © 2015 Elsevier Ltd. All rights reserved.

Digital rights management for digital cinema

NASA Astrophysics Data System (ADS)

Kirovski, Darko; Peinado, Marcus; Petitcolas, Fabien A. P.

2001-12-01

There is a wide consensus among the feature film production studios that the Internet era brings a new paradigm for film distribution to cinemas worldwide. The benefits of digital cinema to both producers and cinemas are numerous: significantly lower distribution and maintenance costs, immediate access to film libraries, higher presentation quality, and strong potential for developing new business models. Despite these advantages, the studios are still reluctant to jump into the digital age. The main showstopper for digital cinema is the danger of widespread piracy. Piracy already costs Hollywood an estimated two billion dollars annually and digital cinema without proper copyright enforcement could increase this number. In this paper, we present a copyright management system that aims at providing the set of necessary security tools: standard cryptographic primitives and copyright protection mechanisms that enable a reliable and secure feature film delivery system.

[Leadership strategies--the Bible as a guide to management in the health care system].

PubMed

Kudlacek, Stefan; Meran, Johannes G

2006-06-01

Management and leadership are an integral part of any organisation, to optimise procedures and increase efficiency. Aims, ideals and structures first need to be defined for tasks to be carried out successfully, particularly in difficult times. A good example for the way communities can effectively and with conviction pass on their values and standpoints from generation to generation, grow in strength and also influence their surroundings is provided by religion. This paper focuses leadership provided by charismatic personalities within the Jewish and Christian religions. Monasteries have run hospitals without governmental support ever since the Middle Ages. Leadership within today's health care system calls for a variety of strategies in the different phases of development. In times of limited resources and multifarious societies, leadership implies both a scientific as well as an ethical challenge.

Moving Towards the Age-friendly Hospital: A Paradigm Shift for the Hospital-based Care of the Elderly.

PubMed

Huang, Allen R; Larente, Nadine; Morais, Jose A

2011-12-01

Care of the older adult in the acute care hospital is becoming more challenging. Patients 65 years and older account for 35% of hospital discharges and 45% of hospital days. Up to one-third of the hospitalized frail elderly loses independent functioning in one or more activities of daily living as a result of the 'hostile environment' that is present in the acute hospitals. A critical deficit of health care workers with expertise and experience in the care of the elderly also jeopardizes successful care delivery in the acute hospital setting. We propose a paradigm shift in the culture and practice of event-driven acute hospital-based care of the elderly which we call the Age-friendly Hospital concept. Guiding principles include: a favourable physical environment; zero tolerance for ageism throughout the organization; an integrated process to develop comprehensive services using the geriatric approach; assistance with appropriateness decision-making and fostering links between the hospital and the community. Our current proposed strategy is to focus on delirium management as a hospital-wide condition that both requires and highlights the Geriatric Medicine specialist as an expert of content, for program development and of evaluation. The Age-friendly Hospital concept we propose may lead the way to enable hospitals in the fast-moving health care system to deliver high-quality care without jeopardizing risk-benefit, function, and quality of life balances for the frail elderly. Recruitment and retention of skilled health care professionals would benefit from this positive 'branding' of an institution. Convincing hospital management and managing change are significant challenges, especially with competing priorities in a fiscal environment with limited funding. The implementation of a hospital-wide delirium management program is an example of an intervention that embodies many of the principles in the Age-friendly Hospital concept. It is important to change the way hospital care is delivered to older adults in time to meet our needs when we need hospital services ourselves.

Pediatric cranio-vertebral junction tuberculosis: management and outcome.

PubMed

Mehrotra, Anant; Das, Kuntal Kanti; Nair, Anup P; Kumar, Rajan; Srivastava, A K; Sahu, Rabi Narayan; Kumar, Raj

2013-05-01

Tuberculosis (TB) of the cranio-vertebral junction (CVJ) is a rare condition, accounting for 0.3 % to 1 % of all cases of spinal TB. Early diagnosis and treatment are important in preventing long-term neurological sequelae. Management protocol of this rare site of TB is yet to be conclusively established. This holds particularly true for pediatric age group in which this condition is infrequently encountered. A total of 29 consecutive pediatric patients presented to the Department of Neurosurgery at Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, from January 1997 to October2011 with clinical and/or radiological features suggestive of CVJ TB. A clinical grading system to evaluate the neurological status was developed, and all patients were evaluated using this scoring system. Patients were radiologically evaluated with computed tomography (CT) of CVJ and magnetic resonance imaging (MRI) with gadolinium enhancement. These cases were managed according to their grade and followed up. Out of a total of 29 cases, 18 were females and 11 males. Age range was 4 to 18 years with mean age 9 ± 3.8 years. The follow-up period ranged from 2 months to 7.5 years with mean follow-up of 2.7 years. Eleven cases were of grades 1 and 2, and 18 cases were of higher grade (grades 3 and 4). Predominantly conservative approach was utilized in cases with better clinical status, and grade (grades 1 and 2) and surgical intervention was needed in the more severe grades. All cases had significant improvement at the last follow-up. One needs to have a high index of suspicion of CVJ TB if one encounters a case with neck pain, neck restriction, and raised erythrocyte sedimentation rate. CT CVJ and MRI with gadolinium contrast enhancement are the investigations of choice for both establishing a diagnosis and planning the management. For cases with mild neurological deficit, conservative approach would work for majority of cases, and for severe cases, initial conservative approach may be tried, failing which surgical intervention would be needed.

Anthropometric standards for Australian primary school children: Towards a system for monitoring and supporting children's development.

PubMed

Cochrane, Thomas; Davey, Rachel C; de Castella, F Robert

2017-03-01

To provide two foundation elements of a proposed new system to support children's physical and body status development throughout primary school: (a) age and gender appropriate achievement (anthropometric) standards and (b) a system of monitoring, feedback and support. Repeated cross-sectional sampling involving 91 schools across 5 Australian States and Territories between 2000 and 2011. Anthropometric data from 29,928 (14,643 girls, 15,285 boys) Australian children aged between 5 and 12.5 years were used to develop progression standards (norm centiles) covering the primary school years. Measures used were: height, weight, body mass index, per cent body fat, grip strength, standing long jump, cardiorespiratory fitness, sit-ups and sit-and-reach. These norms were then used to develop a Physical Activity and Lifestyle Management (PALM) system that could form the basis for progression, monitoring and reporting of anthropometric achievement standards for children. Tables and representative centile curves (3rd, 15th, 50th, 85th and 97th) for each gender and half-year age group were produced. An illustrative example of the PALM system in operation was also provided. Our research provides gender and half-year age specific anthropometric standards for Australian primary school children. Furthermore, we have developed a monitoring and progression system that could be embedded in school communities to help address the prevalence of underweight, overweight and obesity and decline in physical fitness standards. The proposed system is designed on behalf of children and families and would be administered through school settings. Change, where needed, would be delivered by the supporting school community. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A regeneration indicator for Forest Inventory and Analysis: history, sampling, estimation, analytics, and potential use in the midwest and northeast United States

Treesearch

William H. McWilliams; James A. Westfall; Patrick H. Brose; Daniel C. Dey; Mark Hatfield; Katherine Johnson; Kenneth M. Laustsen; Shawn L. Lehman; Randall S. Morin; Mark D. Nelson; Todd E. Ristau; Alejandro A. Royo; Susan L. Stout; Thomas Willard; Christopher W. Woodall

2015-01-01

The density and composition of regeneration drives future forest character for forests in need of replacement. Forested ecosystems face numerous regeneration stressors including invasive plants, insects and diseases, herbivory, lack of management, and climate change. As stands that make up these systems age, it is imperative to track the viability of forest...

School Operations and Maintenance: Best Practices For Controlling Energy Costs. A Guidebook for K-12 School System Business Officers and Facilities Managers

ERIC Educational Resources Information Center

US Department of Energy, 2004

2004-01-01

Operations and maintenance (O&M) offers not only strategies for maintaining facilities, but also opportunities for reducing energy costs and increasing energy efficiency at existing schools, regardless of age. This Guidebook provides detailed and practical guidance on how K-12 school districts can plan and implement enhancements to their current…

Strategic Performance Management: Organizing People and Their Work in the SEA of the Future

ERIC Educational Resources Information Center

Redding, Sam; Layland, Allison

2015-01-01

A State Education Agency (SEA), whether in a large state or small, is responsible for a complex education system, responsive to a host of stakeholders, and charged with advocating for a multitude of students of all ages attending schools of every description. Much of what an SEA is tasked with accomplishing is set by external entities, from the…

Development of a Diagnosis Related Management System for the Department of OBGYN at Winn Army Community Hospital, Fort Stewart, Georgia

DTIC Science & Technology

1990-05-01

69 z 359 Uterine procedure for non-malig age ា m 360 Vagina , cervix and vulva procedures M 361 Laparoscopy and incisional tubal inter 362 Endoscopic...based retrospective z clinical data. Medical Care, 9, (11),1071-1082. K z Bradford, C.K. (1986). Methodology, myths , and maths of m• • X DRG’s. Virgo

10 CFR 54.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... requiring aging management review in accordance with § 54.21(a) for license renewal have been identified and that the effects of aging on the functionality of such structures and components will be managed to.... Time-limited aging analyses, for the purposes of this part, are those licensee calculations and...

10 CFR 54.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requiring aging management review in accordance with § 54.21(a) for license renewal have been identified and that the effects of aging on the functionality of such structures and components will be managed to.... Time-limited aging analyses, for the purposes of this part, are those licensee calculations and...

10 CFR 54.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... requiring aging management review in accordance with § 54.21(a) for license renewal have been identified and that the effects of aging on the functionality of such structures and components will be managed to.... Time-limited aging analyses, for the purposes of this part, are those licensee calculations and...

Validation of a contemporary adherence measure for children with Type 1 diabetes: the Diabetes Management Questionnaire

PubMed Central

Mehta, S. N.; Nansel, T. R.; Volkening, L. K.; Butler, D. A.; Haynie, D. L.; Laffel, L. M. B.

2016-01-01

Aims To evaluate the psychometric properties of the Diabetes Management Questionnaire, a brief, self-report measure of adherence to contemporary diabetes management for young people with Type 1 diabetes and their caregivers. Methods A total of 273 parent-child dyads completed parallel versions of the Diabetes Management Questionnaire. Eligible children (aged 8–18 years) had Type 1 diabetes for ≥1 year. A multidisciplinary team designed the Diabetes Management Questionnaire as a brief, self-administered measure of adherence to Type 1 diabetes management over the preceding month; higher scores reflect greater adherence. Psychometrics were evaluated for the entire sample and according to age of the child. Results The children (49% female) had a mean ± SD (range) age 13.3 ± 2.9 (8–18) years and their mean ± SD HbA1c was 71 ± 15 mmol/mol (8.6 ± 1.4%). Internal consistency was good for parents (α = 0.83) and children (a = 0.79). Test-retest reliability was excellent for parents (intraclass correlation coefficient =0.83) and good for children (intraclass correlation coefficient = 0.65). Parent and child scores had moderate agreement (intraclass correlation coefficient = 0.54). Diabetes Management Questionnaire scores were inversely associated with HbA1c (parents: r = –0.41, P < 0.0001; children: r = –0.27, P < 0.0001). Psychometrics were stronger in the children aged ≥13 years compared with those aged < 13 years, but were acceptable in both age groups. Mean ± SD Diabetes Management Questionnaire scores were higher among children who were receiving insulin pump therapy (n = 181) than in children receiving multiple daily injections (n = 92) according to parent (75.9 ± 11.8 vs. 70.5 ± 15.5; P = 0.004) and child report (72.2 ± 12.1 vs. 67.6 ± 13.9; P = 0.006). Conclusions The Diabetes Management Questionnaire is a brief, valid self-report measure of adherence to contemporary diabetes self-management for people aged 8–18 years who are receiving either multiple daily injections or insulin pump therapy. PMID:26280463

Practicing Dentists’ Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia

PubMed Central

AlQahtani, Sakher; Zakaria Murshid, Ebtissam; Kassim, Saba

2017-01-01

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as “High”. Multivariable regression analyses revealed significant associations between “High” self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16–4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04–4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31–12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59–11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42–4.38). The interaction of gender x age was significantly associated (p = 0.028) with “High” self-efficacy. Gender-stratified analyses revealed a significant association between age and “High” self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported “Low/Moderate” self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD. PMID:29232884

Practicing Dentists' Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia.

PubMed

AlQahtani, Sakher; Murshid, Ebtissam Zakaria; Fadel, Hani Talal; Kassim, Saba

2017-12-11

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as "High". Multivariable regression analyses revealed significant associations between "High" self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16-4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04-4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31-12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59-11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42-4.38). The interaction of gender x age was significantly associated ( p = 0.028) with "High" self-efficacy. Gender-stratified analyses revealed a significant association between age and "High" self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported "Low/Moderate" self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD.

A risk-based approach to sanitary sewer pipe asset management.

PubMed

Baah, Kelly; Dubey, Brajesh; Harvey, Richard; McBean, Edward

2015-02-01

Wastewater collection systems are an important component of proper management of wastewater to prevent environmental and human health implications from mismanagement of anthropogenic waste. Due to aging and inadequate asset management practices, the wastewater collection assets of many cities around the globe are in a state of rapid decline and in need of urgent attention. Risk management is a tool which can help prioritize resources to better manage and rehabilitate wastewater collection systems. In this study, a risk matrix and a weighted sum multi-criteria decision-matrix are used to assess the consequence and risk of sewer pipe failure for a mid-sized city, using ArcGIS. The methodology shows that six percent of the uninspected sewer pipe assets of the case study have a high consequence of failure while four percent of the assets have a high risk of failure and hence provide priorities for inspection. A map incorporating risk of sewer pipe failure and consequence is developed to facilitate future planning, rehabilitation and maintenance programs. The consequence of failure assessment also includes a novel failure impact factor which captures the effect of structurally defective stormwater pipes on the failure assessment. The methodology recommended in this study can serve as a basis for future planning and decision making and has the potential to be universally applied by municipal sewer pipe asset managers globally to effectively manage the sanitary sewer pipe infrastructure within their jurisdiction. Copyright © 2014 Elsevier B.V. All rights reserved.

Thyroid nodule management: clinical, ultrasound and cytopathological parameters for predicting malignancy

PubMed Central

Maia, Frederico F. R.; Zantut-Wittmann, Denise Engelbrecht

2012-01-01

Although fine-needle aspiration cytology is considered to be the reference method for evaluating thyroid nodules, the results are inaccurate in approximately 10-30% of cases. Several studies have attempted to predict the risk of malignancy in thyroid nodules based on age, nodularity, thyrotropin values, thyroid autoimmune disease, hot/cold nodule status, and ultrasound parameters. However, no consensus has been found, and none of these parameters has significantly affected patient management. The management of indeterminate thyroid nodules and re-biopsies of nodules with initially benign cytological results remain important and controversial topics of discussion. The Bethesda cytological system and several studies on the use of molecular markers to predict malignancy from cytological samples of thyroid nodules need further clarification. More in-depth discussions among and continuous education of the specialists involved in treating thyroid disease are necessary to improve the management of these patients. This review aims to examine the clinical, laboratory, ultrasound, and scintigraphic parameters that can be used for thyroid nodule management. PMID:22948464

STS-114: Discovery Return to Flight: Langley Engineers Analysis Briefing

NASA Technical Reports Server (NTRS)

2005-01-01

This video features a briefing on NASA Langley Research Center (LaRC) contributions to the Space Shuttle fleet's Return to Flight (RTF). The briefing is split into two sections, which LaRC Shuttle Project Manager Robert Barnes and Deputy Manager Harry Belvin deliver in the form of a viewgraph presentation. Barnes speaks about LaRC contributions to the STS-114 mission of Space Shuttle Discovery, and Belvin speaks about LaRC contributions to subsequent Shuttle missions. In both sections of the briefing, LaRC contributions are in the following areas: External Tank (ET), Orbiter, Systems Integration, and Corrosion/Aging. The managers discuss nondestructive and destructive tests performed on ET foam, wing leading edge reinforced carbon-carbon (RCC) composites, on-orbit tile repair, aerothermodynamic simulation of reentry effects, Mission Management Team (MMT) support, and landing gear tests. The managers briefly answer questions from reporters, and the video concludes with several short video segments about LaRC contributions to the RTF effort.

Hypertext and hypermedia systems in information retrieval

NASA Technical Reports Server (NTRS)

Kaye, K. M.; Kuhn, A. D.

1992-01-01

This paper opens with a brief history of hypertext and hypermedia in the context of information management during the 'information age.' Relevant terms are defined and the approach of the paper is explained. Linear and hypermedia information access methods are contrasted. A discussion of hyperprogramming in the handling of complex scientific and technical information follows. A selection of innovative hypermedia systems is discussed. An analysis of the Clinical Practice Library of Medicine NASA STI Program hypermedia application is presented. The paper concludes with a discussion of the NASA STI Program's future hypermedia project plans.

Our ultrasonographic experience in the management of symptomatic hydronephrosis during pregnancy.

PubMed

Dell'Atti, Lucio

2016-03-01

The aim of the present study was to document the role of ultrasound in the diagnosis and management of symptomatic hydronephrosis during pregnancy. In this study, we reviewed 36 consecutive cases of pregnant women whose pregnancy was complicated by symptomatic hydronephrosis. In all patients, management was initially conservative (analgesics and fluids) after hospitalization. The following criteria were used to indicate double-J stent placement under US guidance rather than a conservative treatment: persistent pain with no improvement after conservative treatment, progressive hydronephrosis (>2 cm dilatation of the renal pelvis) or presence of uterine contractions. The mean patient's age was 25 years (17-35) and gestational age at clinical presentation was 24 weeks (13-37). 81 % of cases had a renal pelvis dilatation >2 cm, while in only 19 % of cases there was a hydronephrosis between 1 and 2 cm in diameter; however, calculi were confirmed only in 25 patients. 28 patients required an invasive management with double-J stent insertion under US guidance. The sensitivity and specificity of US in the etiological diagnosis of hydronephrosis during pregnancy was 83 and 91 %, respectively. Conservative management with medical therapy and observation should be the first-line treatment approach. In our opinion a rapid ureteral decompression with the insertion of a ureteral double-J stent, under US visualization, is the safest method in the treatment of pregnant women with obstructed renal systems.

Effects of silvicultural management intensity on fluxes of dissolved and particulate organic matter in 27 forest sites of the Biodiversity Exploratories

NASA Astrophysics Data System (ADS)

Michalzik, Beate; Bischoff, Sebastian; Levia, Delphis; Schwarz, Martin; Escher, Peter; Wilcke, Wolfgang; Thieme, Lisa; Kerber, Katja; Kaupenjohann, Martin; Siemens, Jan

2017-04-01

In forested ecosystems, throughfall and stemflow function as key components in the cycling of water and associated biogeochemistry. Analysing annual flux data collected from 27 intensively monitored forest sites of the Biodiversity Exploratories, we found throughfall fluxes of DOC (dissolved organic carbon) linearly related (R2 = 0.40, p < 0.001) to the silvicultural management intensity indicator (SMI) developed by Schall and Ammer (2013). The SMI combines tree species, stand age and aboveground living and dead woody biomass, thereby allowing the quantifying of silvicultural management intensities of stands differing in species composition, age, silvicultural system as they convert from one stand type into another. Throughfall fluxes of particulate organic C and N (POC and PN) and dissolved N were, however independent from those forest structural metrics as well as annual C and N stemflow fluxes, which varied greatly among management intensity classes. In this context, we suggest that canopy structure metrics are more important drivers of water and matter stemflow dynamics, than structural metrics on the level of forest stands. On the other hand, leaching losses of DOC and POC from the litter layer of forests increased significantly with increasing forest management intensity. The observed relationships revealed by intensive flux monitoring are important because they allow us to link organic matter fluxes to forest metrics of larger forested areas (e.g. derived from LiDAR imagery), and hence to model and up-scale water-bound OC dynamics to the landscape level.

Nonlinear Programming Models to Optimize Uneven-Aged Shortleaf Pine Management

Treesearch

Benedict J. Schulte; Joseph Buongiorno

2002-01-01

Nonlinear programming models of uneven-aged shortleaf pine (Pinus echinata Mill.) management were developed to identify sustainable management regimes that optimize soil expectation value (SEV) or annual sawtimber yields. The models recognize three species groups (shortleaf pine and other softwoods, soft hardwoods and hard hardwoods) and 13 2-inch...

Clinicopathological profile and management of 161 cases of actinic cheilitis*

PubMed Central

Lopes, Maria Luiza Diniz de Sousa; da Silva Júnior, Francisco Leonardo; Lima, Kenio Costa; de Oliveira, Patrícia Teixeira; da Silveira, Éricka Janine Dantas

2015-01-01

BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder of the lip caused by chronic exposure to ultraviolet radiation from the sun. OBJECTIVES To evaluate the clinical, demographic, morphological and therapeutic management in AC cases data associating to the histopathological grading. METHODS Demographic, clinical and management data of 161 patients with AC were analyzed. In biopsied cases, two calibrated examiners performed histopathological grading by binary system. RESULTS There was a prevalence of males (79.5%), aged 40 years or older (77.5%), light-skinned (85.7%), experiencing occupational exposure to sunlight (80.3%), with AC presenting clinically as white lesions (33.6%). Conservative treatment was adopted in 78 cases and biopsy in 83 cases (60.2% graded as low-risk AC). There were no significant associations between histopathological grading and gender (p= 0.509), age (p=0.416), ethnicity (p=0.388), occupational exposure to sunlight (p=1.000) or clinical presentation (p=0.803). CONCLUSION This study reinforces the hypothesis that demographic and clinical characteristics of AC are not related to histopathological grading. Advice on protection from sun exposure should be encouraged to avoid progression of AC and invasive therapies. PMID:26375219

Guide for Operational Configuration Management Program including the adjunct programs of design reconstitution and material condition and aging management. Part 2

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

Not Available

This standard presents program criteria and implementation guidance for an operational configuration management program for DOE nuclear and non-nuclear facilities. This Part 2 includes chapters on implementation guidance for operational configuration management, implementation guidance for design reconstitution, and implementation guidance for material condition and aging management. Appendices are included on design control, examples of design information, conduct of walkdowns, and content of design information summaries.

Clostridium difficile Infection in Older Adults: Systematic Review of Efforts to Reduce Occurrence and Improve Outcomes.

PubMed

Marshall, Leisa L; Peasah, Samuel; Stevens, Gregg A

2017-01-01

Provide a systematic review of the primary literature on efforts to reduce Clostridium difficile infection (CDI) occurrence and improve outcomes in older adults. PubMed and CINAHL databases were searched for research studies using search terms CDI, CDI prevention, reduction, control, management, geriatric, elderly, adults 65 years of age and older. The MeSH categories Aged and Aged, 80 and older, were used. A second search of PubMed, CINAHL, National Guideline Clearinghouse, and TRIP databases was conducted for primary, secondary, and tertiary literature for CDI epidemiology, burden, and management in adults of all ages, and prevention and management guidelines. Of the 2,263 articles located, 105 were selected for full review: 55 primary and 50 secondary, tertiary. Primary literature selected for full review included studies of interventions to prevent, reduce occurrence, control, manage, or improve outcomes in adults 65 years of age and older. Patient settings included the community, assisted living, nursing facility, subacute care, or hospital. The main outcome measures for research studies were whether the studied intervention prevented, reduced occurrence, controlled, managed, or improved outcomes. Studies were conducted in acute or long-term hospitals, with a few in nursing facilities. Interventions that prevented or reduced CDI included antibiotic policy changes, education, procedure changes, infection control, and multi-intervention approaches. There were few management studies for adults 65 years of age and older or for all adults with results stratified by age. Treatments studied included efficacy of fidaxomicin, metronidazole, vancomycin, and fecal microbiota transplant. Though clinical outcomes were slightly less robust in those 65 years of age and older, age was not an independent predictor of success or failure. The current prevention and management guidelines for adults of all ages, as well as special considerations in skilled nursing facilities, extracted from the secondary/tertiary literature selected, are summarized. There are a limited number of studies designed for older adults. Our findings suggest that guideline recommendations for adults are adequate and appropriate for older adults. Exposure to antibiotics and Clostridium difficile remain the two major risk factors for CDI, reinforcing the importance of antibiotic stewardship and infection control.

Changes in ground layer vegetation following timber harvests on the Missouri Ozark Forest Ecosystem Project

Treesearch

Jennifer K. Grabner; Eric K. Zenner

2002-01-01

The Missouri Ozark Forest Ecosystem Project (MOFEP) is a landscape-scale experiment to test for effects of the following three common forest management practices on upland forests: 1) even-aged management (EAM), 2) uneven-aged management (UAM), and 3) no-harvest management (NHM). The first round of harvesting treatments was applied on the nine MOFEP sites in 1996. One...

The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial Ischaemia National Audit Project (MINAP).

PubMed

Zaman, M Justin; Stirling, Susan; Shepstone, Lee; Ryding, Alisdair; Flather, Marcus; Bachmann, Max; Myint, Phyo Kyaw

2014-06-14

Older people increasingly constitute a large proportion of the acute coronary syndrome (ACS) population. We examined the relationship of age with receipt of more intensive management and secondary prevention medicine. Then, the comparative association of intensive management (reperfusion/angiography) over a conservative strategy on time to death was investigated by age. Using data from 155 818 patients in the national registry for ACS in England and Wales [the Myocardial Ischaemia National Audit Project (MINAP)], we found that older patients were incrementally less likely to receive secondary prevention medicines and intensive management for both ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In STEMI patients ≥85 years, 55% received reperfusion compared with 84% in those aged 18 to <65 [odds ratio 0.22 (95% CI 0.21, 0.24)]. Not receiving intensive management was associated with worse survival [mean follow-up 2.29 years (SD 1.42)] in all age groups (adjusted for sex, cardiovascular risk factors, co-morbidities, healthcare factors, and case severity), but there was an incremental reduction in survival benefit from intensive management with increasing age. In STEMI patients aged 18-64, 65-74, 75-84, and ≥85, adjusted hazard ratios (HRs) for all-cause mortality comparing conservative treatment to intensive management were 1.98 (1.78, 2.19), 1.65 (1.51, 1.80), 1.62 (1.52, 1.72), and 1.36 (1.27, 1.47), respectively. In NSTEMI patients, the respective HRs were 4.37 (4.00, 4.78), 3.76 (3.54, 3.99), 2.79 (2.67, 2.91), and 1.90 (1.77, 2.04). We found an incremental reduction in the use of evidence-based therapies with increasing age using a national ACS registry cohort. While survival benefit from more intensive management reduced with older age, better survival was associated with intensive management at all ages highlighting the requirement to improve standard of care in older patients with ACS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Dry Eye Disease: Prevalence, Assessment, and Management.

PubMed

Rouen, Patricia A; White, Mary L

Dry eye disease is a chronic condition of the corneal surface marked by persistent symptoms of irritation or burning that can cause inflammatory damage to the cornea and conjunctiva if untreated. Common risk factors for this syndrome include advancing age, female sex, low humidity environments, systemic medications, and autoimmune disorders. Treatments to relieve symptoms include tear replacement, humidification, improved nutrition, and anti-inflammatory ocular agents. Home healthcare nurses can identify signs and symptoms of dry eye syndrome and initiate strategies that range from warm compresses to physician referrals for more aggressive treatment. Consistent management of this condition improves quality of life and minimizes damage to the ocular surface.

"I'll do anything to maintain my health": How women aged 65-94 perceive, experience, and cope with their aging bodies.

PubMed

Bennett, Erica V; Hurd Clarke, Laura; Kowalski, Kent C; Crocker, Peter R E

2017-06-01

We explored how physically active women perceived, experienced, and coped with their aging bodies, and examined their perceptions of the utility of self-compassion to manage aging body-related changes. Findings from a thematic analysis of interviews with 21 women aged 65-94 revealed that they were appreciative of how their bodies worked and accepting of their physical limitations, yet concurrently critical of their body's functionality and appearance. Participants engaged in physical activity and healthy eating to maintain their health and body functionality, yet also used diet, hair styling, anti-aging creams, makeup, physical activity, and clothing to manage their appearances. To assess their bodies (in)adequacies, they engaged in upward or downward social comparisons with others their age. Participants perceived self-compassion for the aging body to be idealistic and contextual. Findings highlight the importance of health and body functionality in influencing the cognitive, emotional, and behavioral management of the aging body. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical characteristics and treatment of severe encephalitis associated with neurogenic pulmonary edema caused by enterovirus 71 in China

PubMed Central

Zhang, Yu-cai; Li, Xing-wang; Zhu, Xiao-dong; Qian, Su-yun; Shang, Yun-xiao; Li, Bi-ru; Liu, Xiao-lin

2010-01-01

BACKGROUND: Hand-foot-mouth disease has become a major public health issue in children in China. In the present prospective study we investigated the clinical characteristics and emergency management of children with severe encephalitis associated with NPE caused by enterovirus 71. METHODS: The study was conducted in 2 pediatric intensive care units (PICUs) over a 2-month period. Clinical records were reviewed of critically ill children with severe encephalitis associated with NPE caused by EV71 who were admitted to PICUs during the period of May to June 2008 in Fuyang. RESULTS: We reviewed the complete records of 36 children, of whom 23 (63.9%) were male and 13 (36.1%) female. Their age ranged from 4 to 48 months, with an average of 15.8 months. All children except one were under 3 years of age. The overall mortality in these children was 19.4%. The average duration of critical life threatening signs and symptoms was 2.1 days (12 hours-5 days). Nervous system diseases included brainstem encephalitis in 27 children (75%), brainstem encephalitis associated with myelitis in 6 children (16.7%), and general encephalitis in 3 chidren (8.3%), respectively. In 12 patients of NPE (33.3%) pink or bloody bubble sputum and asymmetric pulmonary edema or hemorrhage was the primary manifestation but no typical exanthema was observed. Five children died of acute onset of NPE and / or pulmonary hemorrhage with rapid progression of cardiopulmonary failure within hours after admission. Therapeutic management consisted of mechanical ventilation and administration of mannitol, methylprednisolone, intravenous immunoglobulin (IVIG) and vasoactive drugs, associated with the need of fluid volume resuscitation in 9 (25%) of the 36 children. CONCLUSIONS: In children less than 3 years of age found to be affected by severe EV71 encephalitis associated with NPE, one fifth may die. The major organ systems infected by severe EV71 include the central nervous system, the respiratory system, and the cardiovascular system. Early diagnosis and evaluation, respiratory support, treatment of intracranial hypertension, and mainttenance of function of the cardiovascular system are the most important therapeutic measures. PMID:25214951

Impact of Information Technology on the Therapy of Type-1 Diabetes: A Case Study of Children and Adolescents in Germany

PubMed Central

Berndt, Rolf-Dietrich; Takenga, Claude; Preik, Petra; Kuehn, Sebastian; Berndt, Luise; Mayer, Herbert; Kaps, Alexander; Schiel, Ralf

2014-01-01

Being able to manage and adjust insulin doses is a key part of managing type-1 diabetes. Children and adolescents with type-1 diabetes mellitus often have serious difficulties with this dosage adjustment. Therefore, this paper aims to investigate the impact of using novel mobile, web and communication technologies in assisting their therapy and treatment. A trial was conducted in the north-eastern part of Germany to evaluate the impact of the “Mobil Diab”, a mobile diabetes management system, on the clinical outcome. 68 subjects aged between 8 and 18 years, divided randomly into control and intervention groups, were included into the study. Metrics such as changes in the quality of metabolic control, changes in psychological parameters, usability and acceptance of the technology were used for evaluation purpose. Metabolic control was mainly assessed by the mean HbAlc. Analysis showed a good acceptance of the proposed system. An overall improvement in mean levels of HbA1c was observed, however further studies will be conducted to prove evidence of the weight and BMI improvements. Moreover, initial indications of positive impact on the improvement in psychological parameters were presumed based on the result of the conducted study. The system appeared to be an efficient and time saving tool in diabetes management. PMID:25563223

A proactive approach for managing indoor air quality

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

Greene, R.E.; Casey, J.M.; Williams, P.L.

1997-11-01

Ventilation and maintenance, followed by psychosocial issues, are the factors most often implicated in indoor air quality (IAQ) investigations. The absence of accepted exposure standards and the presence of a wide variety of building designs, ages, ventilation systems, and usages often make IAQ complaint investigations ineffective. Thus, the best approach to achieving IAQ is to prevent problems from occurring. This paper presents the framework for a proactive approach to managing the causes most often implicated in IAQ investigations. It is the aim of this proactive protocol to provide a cost-effective guide for preventing IAQ problems in nonindustrial settings and inmore » buildings for which there are no current IAQ complaints. The proposed protocol focuses on heating, ventilation, and air-conditioning (HVAC) system maintenance and operation; psychosocial factors; and the handling and investigation of complaints. An IAQ manager is designated to implement and manage the protocol. The HVAC system portion of the protocol focuses on proper maintenance of the components often identified as sources of problems in IAQ studies, documentation of the maintenance procedures, and training of individuals responsible for building maintenance. The protocol addresses the psychosocial factors with an environmental survey that rates the occupants` perceptions of the indoor air to identify potential IAQ problems. The psychosocial portion of the protocol also incorporates occupant education and awareness. Finally, a three-step initial investigation procedure for addressing IAQ problems is presented.« less

Taking it one day at a time: African American women aging with HIV and co-morbidities.

PubMed

Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi

2014-07-01

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52-65. Topics included HIV and co-morbidity self-management, social support needs, medication adherence, and future plans for old age. A constant comparison approach was applied during data analysis. Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV. This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness. Social responsibilities, including caring for family, positively impacted participants' ability to self-manage HIV by serving as motivation to stay healthy in order to continue to help family members. In contrast, inflexible work schedules negatively impacted women's ability to sustain medication adherence. Overall, this study demonstrates that HIV and co-morbidity self-management are inextricably linked. We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations. Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies.

Preparing for an Aging Work Force: A Practical Guide for Employers.

ERIC Educational Resources Information Center

AARP, Washington, DC.

This booklet, which is intended for human resource managers, provides practical guidance regarding preparing for an aging work force. Chapter 1 concerns the relationship between business practices and age neutrality and offers checklists that human resource managers can use to assess their company's general policy development, training,…

10 CFR 54.21 - Contents of application-technical information.

Code of Federal Regulations, 2013 CFR

2013-01-01

... delineated in § 54.4, identify and list those structures and components subject to an aging management review. Structures and components subject to an aging management review shall encompass those structures and... component identified in paragraph (a)(1) of this section, demonstrate that the effects of aging will be...

10 CFR 54.21 - Contents of application-technical information.

Code of Federal Regulations, 2012 CFR

2012-01-01

... delineated in § 54.4, identify and list those structures and components subject to an aging management review. Structures and components subject to an aging management review shall encompass those structures and... component identified in paragraph (a)(1) of this section, demonstrate that the effects of aging will be...

10 CFR 54.21 - Contents of application-technical information.

Code of Federal Regulations, 2014 CFR

2014-01-01

... delineated in § 54.4, identify and list those structures and components subject to an aging management review. Structures and components subject to an aging management review shall encompass those structures and... component identified in paragraph (a)(1) of this section, demonstrate that the effects of aging will be...

How applicable is even-aged silviculture in the northeast?

Treesearch

Ralph H. Griffin

1977-01-01

The applicability of even-aged silviculture in the management of forest stands in the Northeast is examined through consideration of the forest stand, stand development, intermediate cuttings, and regeneration methods. It is concluded that even-aged silviculture is quite applicable in the management of forest stands in the Northeast.

The Grocery Store Food Environment in Northern Greenland and Its Implications for the Health of Reproductive Age Women.

PubMed

Watson, Zoe A; Shanks, Carmen Byker; Miles, Mary P; Rink, Elizabeth

2018-02-01

The population of Greenland is diminishing and environmental and social shifts implicate food availability and the health of reproductive age women. There is little knowledge of the grocery store food environment in Greenland. To address this gap and provide baseline information the present study measured food availability in five grocery stores in northern Greenland. As well, 15 interviews were conducted with reproductive age women, three grocery store managers were interviewed and one interview was conducted with a food distribution manager. Results show few fresh fruits and vegetables are available in grocery stores and in some stores no fresh foods are available. In Kullorsuaq, the primary location for this study, the Nutrition Environment Measures Survey in Stores score in spring 2016 was (3/30) and the Freedman Grocery Store Survey Score was (11/49). Interview results highlight a need to increase communication within the food system and to tailor food distribution policies to the Arctic context with longer term planning protocols for food distribution. These findings can be used to inform future food store environment research in Greenland and for informing policies that improve healthful food availability in grocery stores in northern Greenland.

[Pregnancy in systemic autoimmune diseases: Myths, certainties and doubts].

PubMed

Danza, Álvaro; Ruiz-Irastorza, Guillermo; Khamashta, Munther

2016-10-07

Systemic autoimmune diseases especially affect young women during childbearing age. The aim of this review is to update systemic lupus erythematosus, antiphospholipid syndrome and systemic sclerosis management during pregnancy. These diseases present variable maternal and fetal risks. Studies show that an appropriate disease control and a reasonable remission period prior to pregnancy are associated with satisfactory obstetric outcomes. Antiphospholipid autoantibodies profile, anti-Ro/anti-La antibodies, pulmonary pressure and activity evaluation are crucial to assess the pregnancy risk. Monitoring requires a multidisciplinary team, serial analytic controls and Doppler ultrasound of maternal and fetal circulation. Evaluation of the activity of the disease is essential. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Immediate, landscape-scale impacts of even-aged and uneven-aged forest management on herpetofaunal communities of the Missouri Ozark Forest Ecosystem Project

Treesearch

Rochelle B. Renken; Debby K. Frantz

2002-01-01

We examined the immediate, landscape-scale impacts of even-aged and uneven-aged forest management on the species composition, species richness, and relative abundance of herpetofaunal communities and selected focal groups of species during the second and third years following initial tree harvest on Missouri Ozark Forest Ecosystem Project (MOFEP) sites in southern...

Implementation of the integrated management of childhood illness with parasitological diagnosis of malaria in rural Ghana: health worker perceptions.

PubMed

Febir, Lawrence G; Baiden, Frank E; Agula, Justina; Delimini, Rupert K; Akpalu, Bright; Tivura, Mathilda; Amanfo, Nelson; Chandramohan, Daniel; Owusu-Agyei, Seth; Webster, Jayne

2015-04-23

Timely and appropriate management of febrile illness among children under five years of age will contribute to achieving Millennium Development Goal-4. The revised World Health Organization-Global Malaria Programme's policy on test-based management of malaria must integrate effectively into the Integrated Management of Childhood Illness (IMCI). This study reports on perceptions of health workers on the health system factors influencing effective delivery of test-based diagnosis of malaria with IMCI. A qualitative study was conducted among a range of health workers at different levels of the health system in the Brong Ahafo Region of Ghana. Interview transcripts were transferred into Nvivo 8 software for data management and analysis. A frame-work approach at two levels was used in the analysis, which included the processes required for implementation of test-based management of malaria and the health systems context. Forty-nine in-depth interviews were conducted. The National Health Insurance Scheme (NHIS) was perceived to have led to an increase in health facility attendance, thereby increasing the workload of health workers. Workload was reported as the main reason that health workers were not able to complete all of the examinations included in the IMCI algorithm. The NHIS financing guidelines were seen to be determining diagnosis and treatment practices by health-care givers. Concern was expressed about the erratic supply of malaria rapid diagnostic test kits (RDTs), the quality of RDTs related to potential false negative results when clinical symptoms were consistent with malaria. IMCI was seen as important but practically impossible to fully implement due to workload. Implementation of the WHO-revised IMCI guideline is confronted with a myriad of health systems challenges. The perceptions of front-line health workers on the accuracy and need for RDTs together with the capacity of health systems to support implementation plays a crucial role. The NHIS financing guidelines of diagnostics and treatments are influencing clinical decision-making in this setting. Further study is needed to understand the impact of the NHIS on the feasibility of integrating test-based management for malaria into the IMCI guidelines.

Ponseti method in the management of clubfoot under 2 years of age: A systematic review

PubMed Central

Luximon, Ameersing; Al-Jumaily, Adel; Balasankar, Suchita Kothe; Naik, Ganesh R.

2017-01-01

Background Congenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: hindfoot equinus, hindfoot varus, midfoot cavus, and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are not uncommon. Several previous literatures discussed about the technical details of Ponseti method, adherence of Ponseti protocol among walking age or older children. However there is a necessity to investigate the relapse pattern, compliance of bracing, number of casts used in treatment and the percentages of surgical referral under two years of age for clear understanding and better practice to achieve successful outcome without or reduce relapse. Therefore this study aims to review the current evidence of Ponseti method (manipulation, casting, percutaneous Achilles tenotomy, and bracing) in the management of clubfoot under two years of age. Materials and methods Articles were searched from 2000 to 2015, in the following databases to identify the effectiveness of Ponseti method treatment for clubfoot: Medline, Cumulative Index to Nursing and Allied Health Literature (CINHAL), PubMed, and Scopus. The database searches were limited to articles published in English, and articles were focused on the effectiveness of Ponseti method on children with less than 2 years of age. Results Of the outcome of 1095 articles from four electronic databases, twelve articles were included in the review. Pirani scoring system, Dimeglio scoring system, measuring the range of motion and rate of relapses were used as outcome measures. Conclusions In conclusion, all reviewed, 12 articles reported that Ponseti method is a very effective method to correct the clubfoot deformities. However, we noticed that relapses occur in nine studies, which is due to the non-adherence of bracing regime and other factors such as low income and social economic status. PMID:28632733

Prevalence and management of dementia in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network.

PubMed

Drummond, Neil; Birtwhistle, Richard; Williamson, Tyler; Khan, Shahriar; Garies, Stephanie; Molnar, Frank

2016-01-01

The proportion of Canadians living with Alzheimer disease and related dementias is projected to rise, with an increased burden on the primary health care system in particular. Our objective was to describe the prevalence and management of dementia in a community-dwelling sample using electronic medical record (EMR) data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), which consists of validated, national, point-of-care data from primary care practices. We used CPCSSN data as of Dec. 31, 2012, for patients 65 years and older with at least 1 clinical encounter in the previous 2 years. A validated case definition for dementia was used to calculate the national and provincial prevalence rates, to examine variations in prevalence according to age, sex, body mass index, rural or urban residence, and select comorbid conditions, and to describe patterns in the pharmacologic management of dementia over time at the provincial level. The age-standardized prevalence of dementia among community-dwelling patients 65 years and older was 7.3%. Prevalence estimates increased with age; they also varied between provinces, and upward trends were observed. Dementia was found to be associated with comorbid diabetes, depression, epilepsy and parkinsonism. Most of the patients with dementia did not have a prescription for a dementia-related medication recorded in their EMR between 2008 and 2012 inclusive. Those who had a prescription were most often prescribed donepezil by their primary care provider. Overall prevalence estimates for dementia based on EMR data in this sample managed in primary care were generally in line with previous estimates based on administrative data, survey results or clinical sources.

Approving for a community aged care package: experiences and perceptions of six metropolitan aged care assessment service teams.

PubMed

Stephens, Delwyne; Wells, Yvonne; Gardner, Ian

2011-06-01

To establish whether the experiences and perceptions of different metropolitan Aged Care Assessment Service (ACAS) teams when approving people for Community Aged Care Packages (CACPs) were similar. Six semi-structured 30-minute group interviews were completed. ACAS team approval processes for CACPs were similar. The primary criterion for approval was need for case management. Many factors, however, impinged on the approval process. Barriers to making approvals included long waiting times, a lack of confidence in the priority rating system, and consideration of whether a person was better off with Home and Community Care services because of the impact of the Australian Government's Cost Recovery policy. ACAS teams have competing considerations when approving a person for a CACP. In particular, structural barriers, such as cost recovery policies, can have a significant negative impact on approval decisions. © 2010 The Authors. Journal compilation © 2010 ACOTA.

Advanced Engineering Environment FY09/10 pilot project.

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

Lamph, Jane Ann; Kiba, Grant W.; Pomplun, Alan R.

2010-06-01

The Advanced Engineering Environment (AEE) project identifies emerging engineering environment tools and assesses their value to Sandia National Laboratories and our partners in the Nuclear Security Enterprise (NSE) by testing them in our design environment. This project accomplished several pilot activities, including: the preliminary definition of an engineering bill of materials (BOM) based product structure in the Windchill PDMLink 9.0 application; an evaluation of Mentor Graphics Data Management System (DMS) application for electrical computer-aided design (ECAD) library administration; and implementation and documentation of a Windchill 9.1 application upgrade. The project also supported the migration of legacy data from existing corporatemore » product lifecycle management systems into new classified and unclassified Windchill PDMLink 9.0 systems. The project included two infrastructure modernization efforts: the replacement of two aging AEE development servers for reliable platforms for ongoing AEE project work; and the replacement of four critical application and license servers that support design and engineering work at the Sandia National Laboratories/California site.« less

Adolescent and Caregiver use of a Tethered Personal Health Record System

PubMed Central

Hong, Matthew K.; Wilcox, Lauren; Feustel, Clayton; Wasileski-Masker, Karen; Olson, Thomas A.; Simoneaux, Stephen F.

2016-01-01

Supporting adolescent patient engagement in care is an important yet underexplored topic in consumer health informatics. Personal Health Records (PHRs) show potential, but designing PHR systems to accommodate both emerging adults and their parents is challenging. We conducted a mixed-methods study with teenage adolescent patients (ages 13-17) with cancer and blood disorders, and their parents, to investigate their experiences with My-Chart, a tethered PHR system. Through analyses of usage logs and independently-conducted surveys and interviews, we found that patients and parents both valued MyChart, but had different views about the role of the PHR for care communication and management, and different attitudes about its impact on the patient’s ability to manage care. Specific motivations for using MyChart included patient–parent coordination of care activities, communication around hospital encounters, and support for transitioning to adult care. Finally, some parents had concerns about certain diagnostic test results being made available to their children. PMID:28269859

On Robust Methodologies for Managing Public Health Care Systems

PubMed Central

Nimmagadda, Shastri L.; Dreher, Heinz V.

2014-01-01

Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems. PMID:24445953

McMaster Optimal Aging Portal: an evidence-based database for geriatrics-focused health professionals.

PubMed

Barbara, Angela M; Dobbins, Maureen; Brian Haynes, R; Iorio, Alfonso; Lavis, John N; Raina, Parminder; Levinson, Anthony J

2017-07-11

The objective of this work was to provide easy access to reliable health information based on good quality research that will help health care professionals to learn what works best for seniors to stay as healthy as possible, manage health conditions and build supportive health systems. This will help meet the demands of our aging population that clinicians provide high quality care for older adults, that public health professionals deliver disease prevention and health promotion strategies across the life span, and that policymakers address the economic and social need to create a robust health system and a healthy society for all ages. The McMaster Optimal Aging Portal's (Portal) professional bibliographic database contains high quality scientific evidence about optimal aging specifically targeted to clinicians, public health professionals and policymakers. The database content comes from three information services: McMaster Premium LiteratUre Service (MacPLUS™), Health Evidence™ and Health Systems Evidence. The Portal is continually updated, freely accessible online, easily searchable, and provides email-based alerts when new records are added. The database is being continually assessed for value, usability and use. A number of improvements are planned, including French language translation of content, increased linkages between related records within the Portal database, and inclusion of additional types of content. While this article focuses on the professional database, the Portal also houses resources for patients, caregivers and the general public, which may also be of interest to geriatric practitioners and researchers.

Individual medication management system (IMMS) as a proposition of obeying the doctor's recommendation with pharmacist cooperation.

PubMed

Waszyk-Nowaczyk, Magdalena; Simon, Marek; Matwij, Karolina

2012-01-01

The pharmacist is an expert with the knowledge of drugs, who has a possibility to follow the patient's individual pharmacotherapy, which is the basis of the pharmaceutical care programme. The implementation of the Individual Medication Management System (IMMS) may be one of the proposals which will enable an analysis of the course of pharmacotherapy and elimination of drug problems, which are the chief goals of pharmaceutical care. In order to determine community pharmacy patients' degree of interest in the IMMS and to evaluate the degree of patients' discipline concerning the application of doctors' recommendations they were given an anonymous questionnaire. The research was done from August 2009 to May 2010 on a sample of 179 people selected at random. They were patients of community pharmacies in Poznań, where 70% were women and 30% were men, all of them aged between 20 and 85 years. The individual age groups were: 20-40 years--27.0%, 41-50 years--10.8%, 51-64 years--43.6%, 65 years or more--18.6%. The patients' education was as follows: primary--4.7%, vocational--8.0%, secondary--31.0%, incomplete university--12.0% and university--44.3%. The chi2 and Fisher-Freeman-Halton tests were used for statistical analysis of the results. Each time the level of statistical significance was assumed at p < 0.05. The collected results confirmed the fact that there is a higher number of specialists involved in patients' treatment with their age (p = 0.001), which indirectly leads to a higher number of prescribed drugs (p = 0.00000002). It was proved that more than 90% of the patients aged over 50 years take the prescribed drugs for more than a year (p = 0.00000002). The analysis confirmed the fact that there are mostly men which do not abide the indications concerning the dosage regimen (p = 0.049). The answers to the questions evaluating the patients' attitude to the IMMS revealed that 47.2% of the respondents indicate the advantages of the system. However, it was mostly women and respondents with university education that were the most interested in it. More than 50% of the patients aged 20-40 years and those aged over 65 years indicate the purposefulness of the systems. It is mainly the group aged 20-40 years that confirms facilitation in following the doctor's recommendations (p = 0.02). The respondents indicated their interest and confirmed the purposefulness of the IMMS mainly due to the fact that it helps to avoid drug-related problems resulting from omitting doses and helps to keep the dosage time and frequency in a long-term therapy. The research confirms the fact that individualized therapy will contribute to its higher efficacy, economy and safety.

Army Transformation in the Age of Globalization - Implementing Directed Change with Strategic Management Design (SMD): An Analysis Based on the Army Staff in the German Ministry of Defense

DTIC Science & Technology

2008-05-01

researched and tested in the U.S. Army during the Unified Quest exercise series, design of military campaigns occurs in the complex globalized environment...Army Transformation in the Age of Globalization – Implementing Directed Change with Strategic Management Design (SMD) An Analysis based on the...the Age of globalization – Implementing Direction Change with Strategic Management Design (SMD). 5c. PROGRAM ELEMENT NUMBER 5d. PROJECT NUMBER

Carboplatin-Associated Ototoxicity in Children With Retinoblastoma

PubMed Central

Qaddoumi, Ibrahim; Bass, Johnnie K.; Wu, Jianrong; Billups, Catherine A.; Wozniak, Amy W.; Merchant, Thomas E.; Haik, Barrett G.; Wilson, Matthew W.; Rodriguez-Galindo, Carlos

2012-01-01

Purpose Carboplatin-induced ototoxicity remains poorly defined but is of potential great consequence in children with retinoblastoma. We retrospectively assessed the incidence of ototoxicity and its risk factors in children with retinoblastoma who were treated with carboplatin. Patients and Methods We reviewed the audiologic test results of 60 patients with retinoblastoma who received front-line treatment with systemic carboplatin and vincristine according to the St Jude RET-3 protocol (n = 23) or best clinical management (n = 37). Ototoxicity was evaluated by three different grading systems. Results Twelve patients (20%) developed ototoxicity at some time after treatment initiation; however, ototoxicity resolved in two patients, and thus,10 patients (17%) had sustained hearing loss as documented at their most recent audiologic evaluation. Nine of these 10 patients had grade 3 or 4 ototoxicity, and nine patients were less than 6 months of age at the start of chemotherapy. Age at the start of chemotherapy was the only risk factor identified as a significant predictor of sustained hearing loss. Younger age was associated with an increased incidence of hearing loss. The different ototoxicity grading systems showed good overall agreement in the identification of patients with ototoxicity. Agreement was greatest between the Brock and Children's Cancer Group systems. Conclusion We found that young patients with retinoblastoma who were treated with systemic carboplatin had a higher incidence of ototoxicity than previously reported. Younger patients (< 6 months of age at the start of treatment) were more likely to have ototoxicity than were older patients. Children treated with carboplatin should routinely undergo thorough, long-term audiologic monitoring. PMID:22370329

Sexuality in the Older Adult.

PubMed

Morton, Laura

2017-09-01

Sexuality is an important part of a person's life continuing into older age. Physiologic changes that occur with aging can affect sexual function and may be exacerbated by comorbid disease. To diagnose sexual dysfunction, providers must obtain a thorough history and physical examination, including psychosocial factors. The causes of sexual dysfunction along with patient preferences within the patient's social system serve as the foundation for developing person-centered strategies to address these concerns. To improve care of older adults with sexual concerns, providers should initiate discussions with, listen to, and work with patients to create a comprehensive management plan. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictors of willingness to use a smartphone for research in underserved persons living with HIV.

PubMed

Schnall, Rebecca; Cho, Hwayoung; Webel, Allison

2017-03-01

The burden of HIV/AIDS is borne disproportionally by a growing number of racial and ethnic minorities and socioeconomically disadvantaged individuals. Developing mHealth interventions for the everyday self-management needs of persons living with HIV (PLWH) can be challenging given the current constraints of the U.S. healthcare system, especially for those from underserved communities. In order to develop effective, evidence-based mHealth self-management interventions, we need a better understanding of the factors associated with mHealth research. The purpose of this study was to assess factors associated with PLWH's for participation in research using smartphones. We conducted a prospective cohort study (parent study) to examine the relationships among HIV self-management, age, gender and mental wellness. Relevant to this study, we analyzed the relationship between self-reported use of smartphones, willingness to use a smartphone for research, and other predictor variables including: HIV stigma, social isolation, social integration functions, and depression. We selected these variables because previous work indicated they may influence smartphone or mHealth use and because they also tend to be elevated in PLWH. We found increased age, HIV stigma and social isolation were negatively associated with smartphone use, which supports the use of smartphones for conducting research with PLWH but also suggests that age, stigma, social integration functions and social isolation need to be considered in research involving PLWH. Findings here support smartphone use in research involving PLWH. However, future mHealth interventions targeting PLWH should take into account the inverse relationship between smartphone use and age, HIV stigma, and social isolation, and other predictor variables. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.